Yip Connie, Goh Vicky, Davies Andrew, Gossage James, Mitchell-Hay Rosalind, Hynes Orla, Maisey Nick, Ross Paul, Gaya Andrew, Landau David B, Cook Gary J, Griffin Nyree, Mason Robert
Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK,
Eur Radiol. 2014 May;24(5):998-1005. doi: 10.1007/s00330-014-3110-4. Epub 2014 Feb 18.
Sarcopenia and changes in body composition following neoadjuvant chemotherapy (NAC) may affect clinical outcome. We assessed the associations between CT body composition changes following NAC and outcomes in oesophageal cancer.
A total of 35 patients who received NAC followed by oesophagectomy, and underwent CT assessment pre- and post-NAC were included. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (FMR) and visceral to subcutaneous adipose tissue ratio (VA/SA) were derived from CT. Changes in FM, FFM, FMR, VA/SA and sarcopenia were correlated to chemotherapy dose reductions, postoperative complications, length of hospital stay (LOS), circumferential resection margin (CRM), pathological chemotherapy response, disease-free survival (DFS) and overall survival (OS).
Nine (26 %) patients were sarcopenic before NAC and this increased to 15 (43 %) after NAC. Average weight loss was 3.7 % ± 6.4 (SD) in comparison to FM index (-1.2 ± 4.2), FFM index (-4.6 ± 6.8), FMR (-1.2 ± 24.3) and VA/SA (-62.3 ± 12.7). Changes in FM index (p = 0.022), FMR (p = 0.028), VA/SA (p = 0.024) and weight (p = 0.007) were significant univariable factors for CRM status. There was no significant association between changes in body composition and survival.
Loss of FM, differential loss of VA/SA and skeletal muscle were associated with risk of CRM positivity.
• Changes in CT body composition occur after neoadjuvant chemotherapy in oesophageal cancer. • Sarcopenia was more prevalent after neoadjuvant chemotherapy. • Fat mass, fat-free mass and weight decreased after neoadjuvant chemotherapy. • Changes in body composition were associated with CRM positivity. • Changes in body composition did not affect perioperative complications and survival.
新辅助化疗（NAC）后肌肉减少症和身体成分变化可能影响临床结局。我们评估了NAC后CT身体成分变化与食管癌结局之间的关联。
纳入35例接受NAC后行食管切除术且在NAC前后均接受CT评估的患者。通过CT得出脂肪量（FM）、去脂体重（FFM）、皮下脂肪与肌肉比率（FMR）以及内脏与皮下脂肪组织比率（VA/SA）。FM、FFM、FMR、VA/SA的变化以及肌肉减少症与化疗剂量减少、术后并发症、住院时间（LOS）、环切缘（CRM）、病理化疗反应、无病生存期（DFS）和总生存期（OS）相关。
9例（26%）患者在NAC前存在肌肉减少症，NAC后增至15例（43%）。与FM指数（-1.2±4.2）、FFM指数（-4.6±6.8）、FMR（-1.2±24.3）和VA/SA（-62.3±12.7）相比，平均体重减轻3.7%±6.4（标准差）。FM指数（p = 0.022）、FMR（p = 0.028）、VA/SA（p = 0.024）和体重（p = 0.007）的变化是CRM状态的显著单因素。身体成分变化与生存期之间无显著关联。
FM减少、VA/SA差异减少和骨骼肌减少与CRM阳性风险相关。
• 食管癌新辅助化疗后CT身体成分会发生变化。• 新辅助化疗后肌肉减少症更为普遍。• 新辅助化疗后脂肪量、去脂体重和体重下降。• 身体成分变化与CRM阳性相关。• 身体成分变化不影响围手术期并发症和生存期。
