CT 评估的骨骼肌减少症对小细胞肺癌患者的预后意义。

Prognostic Significance of CT-Determined Sarcopenia in Patients with Small-Cell Lung Cancer.

机构信息

*Department of Radiology, and †Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea.

出版信息

J Thorac Oncol. 2015 Dec;10(12):1795-9. doi: 10.1097/JTO.0000000000000690.

DOI:10.1097/JTO.0000000000000690

PMID:26484630

Abstract

INTRODUCTION

The primary objective of this study was to determine the prognostic significance of computed tomography (CT)-determined sarcopenia in small-cell lung cancer (SCLC) patients.

METHODS

This retrospective study consisted of a total of 149 consecutive SCLC patients. The cross-sectional area of muscle at the level of the third lumbar vertebra (L3) was measured using baseline CT images. Sarcopenia was defined as a L3 muscle index of less than 55 cm/m for men and of less than 39 cm/m for women as proposed by international consensus of cancer cachexia. In addition, Korean-specific cutoffs for sarcopenia was also applied (49 cm/m for men and 31 cm/m for women). Overall survival (OS) and clinical characteristics of patients with or without sarcopenia were compared.

RESULTS

Mean patient age was 68.6 ± 9.5 years. Most were male (85.3%) and 67.8% had extensive disease at time of diagnosis. Sarcopenia was present in 118 patients (79.2%) and was significantly related to an advanced age (p = 0.028), male sex (p < 0.001), lower body mass index (p < 0.001), and poor performance status (p = 0.049). Sarcopenic patients had shorter OS than nonsarcopenic patients (median: 8.6 months versus 16.8 months; p = 0.031). Multivariable analysis revealed that sarcopenia was an independent prognostic factor of poor survival (hazards ratio: 1.68; 95% confidence interval: 1.04-2.72; p = 0.034), along with extensive stage (p < 0.001), supportive care only (p < 0.001), and an elevated lactate dehydrogenase level (p = 0.020). Using Korean sarcopenia cutoffs, sarcopenic patients were also found to have poorer OS than nonsarcopenic patients, however, the survival difference was not statistically significant (median: 8.4 months versus 12.7 months; p = 0.144 by the log-rank test).

CONCLUSIONS

Sarcopenia as determined by CT could be used to predict prognosis in patients with SCLC. Optimum reference values to predict cancer-specific outcomes should be tailored by further studies.

摘要

简介

本研究的主要目的是确定计算机断层扫描（CT）确定的小细胞肺癌（SCLC）患者肌肉减少症的预后意义。

方法

这项回顾性研究共纳入了 149 例连续的 SCLC 患者。使用基线 CT 图像测量第三腰椎（L3）水平的肌肉横截面积。肌肉减少症的定义为男性 L3 肌肉指数<55cm/m，女性<39cm/m，这是癌症恶病质国际共识提出的标准。此外，还应用了韩国特有的肌肉减少症截断值（男性 49cm/m，女性 31cm/m）。比较了有或没有肌肉减少症的患者的总生存期（OS）和临床特征。

结果

患者的平均年龄为 68.6±9.5 岁。大多数为男性（85.3%），67.8%在诊断时患有广泛期疾病。118 例（79.2%）患者存在肌肉减少症，且与高龄（p=0.028）、男性（p<0.001）、较低的体重指数（p<0.001）和较差的体能状态（p=0.049）显著相关。有肌肉减少症的患者 OS 短于无肌肉减少症的患者（中位：8.6 个月比 16.8 个月；p=0.031）。多变量分析显示，肌肉减少症是预后不良的独立预测因素（风险比：1.68；95%置信区间：1.04-2.72；p=0.034），此外还包括广泛期疾病（p<0.001）、仅接受支持治疗（p<0.001）和乳酸脱氢酶水平升高（p=0.020）。使用韩国肌肉减少症截断值，有肌肉减少症的患者 OS 也短于无肌肉减少症的患者，但生存差异无统计学意义（中位：8.4 个月比 12.7 个月；log-rank 检验，p=0.144）。