Department of Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
Thorac Cancer. 2018 Jan;9(1):99-104. doi: 10.1111/1759-7714.12545. Epub 2017 Oct 25.
Recent studies have revealed a reduction in the skeletal muscle area in patients with advanced non-small cell lung cancer (NSCLC) after chemotherapy. EGFR and ALK tyrosine kinase inhibitor (TKI)-based therapies are less cytotoxic than chemotherapy, but differences in skeletal muscle mass between patients receiving EGFR and ALK TKI therapies and patients receiving cytotoxic chemotherapy have not yet been reported.
Data of pathologically proven NSCLC patients were reviewed, and chest computed tomography and/or positron emission tomography-computed tomography images obtained from January 2012 to December 2014 were selected. Patients were divided into two groups: cytotoxic chemotherapy (CG) and molecular targeted (MG). Muscle mass was measured with a single cross-sectional area of the muscle at the third lumber vertebra (L3MA). To estimate skeletal muscle changes during chemotherapy, we defined the following L3 skeletal muscle index (L3SMI) ratio: post L3SMI/pre L3SMI. Differences in the SMI ratio between the groups were evaluated using the Wilcoxon signed-rank test.
Sixty-five patients were included in this study: 44 patients received cytotoxic chemotherapy and 21 received molecular targeted therapy (EGFR and ALK TKI). The loss of L3MA in the CG was higher than in the MG (P = 0.03). In the CG, the L3SMI ratio defined to evaluate skeletal muscle mass changes was significantly lower than in the MG (P = 0.0188).
Our results suggest that skeletal muscle loss during first-line therapy was significantly different between patients receiving cytotoxic chemotherapy and those receiving TKIs. Specifically, skeletal muscle loss was lower in patients receiving TKIs than in patients receiving cytotoxic chemotherapy.
最近的研究表明，化疗后晚期非小细胞肺癌（NSCLC）患者的骨骼肌面积减少。与化疗相比，表皮生长因子受体（EGFR）和间变性淋巴瘤激酶（ALK）酪氨酸激酶抑制剂（TKI）的治疗方法细胞毒性更小，但接受 EGFR 和 ALK TKI 治疗的患者与接受细胞毒性化疗的患者之间的骨骼肌质量差异尚未报道。
回顾经病理证实的 NSCLC 患者的数据，并选择 2012 年 1 月至 2014 年 12 月获得的胸部计算机断层扫描和/或正电子发射断层扫描-计算机断层扫描图像。患者分为两组：细胞毒性化疗（CG）和分子靶向治疗（MG）。肌肉质量用第三腰椎（L3）的肌肉横截面积（L3MA）来测量。为了估计化疗过程中骨骼肌的变化，我们定义了以下 L3 骨骼肌指数（L3SMI）比值：后 L3SMI/前 L3SMI。使用 Wilcoxon 符号秩检验评估组间 SMI 比值的差异。
本研究共纳入 65 例患者：44 例接受细胞毒性化疗，21 例接受分子靶向治疗（EGFR 和 ALK TKI）。CG 中 L3MA 的丢失高于 MG（P=0.03）。在 CG 中，用于评估骨骼肌质量变化的 L3SMI 比值明显低于 MG（P=0.0188）。
我们的结果表明，接受细胞毒性化疗的患者与接受 TKI 治疗的患者之间，一线治疗期间骨骼肌丢失有显著差异。具体而言，接受 TKI 治疗的患者骨骼肌丢失低于接受细胞毒性化疗的患者。
