Medical Oncology, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Thorac Cancer. 2018 Dec;9(12):1623-1630. doi: 10.1111/1759-7714.12870. Epub 2018 Sep 27.
Sarcopenia and muscle tissue degradation are hallmarks of the majority of chronic diseases, including non-small cell lung cancer (NSCLC). A computed tomography scan could be an easy modality to estimate the skeletal muscle mass through cross-sectional image analysis at the level of the third lumbar vertebra.
Baseline skeletal muscle mass (SMM) was evaluated through the skeletal muscle index (SMI), together with skeletal muscle radiodensity (SMD), in NSCLC patients undergoing first-line chemotherapy to evaluate correlations with safety and clinical outcomes. When SMIs at different time points were available, further comparison was made between patients with worse and improved SMIs.
Among 81 stage IV NSCLC patients, 28 had low SMM and 23 had low SMD. There were no significant differences in univariate analysis of progression-free survival (PFS) between patients with baseline low and non-low SMM (P = 0.06388) or between patients with low and non-low SMD (P = 0.9126). Baseline low SMM, however, proved a significant predictor of shorter PFS in multivariate analysis (hazard ratio 0.54, 95% confidence interval 0.31-0.93; P = 0.0278), but not low SMD. There were no differences in overall survival (OS) between patients with baseline low and non-low SMM or low and non-low SMD. No differences in PFS and OS between evaluable patients with worse or improved SMI were found. A significant difference in hematological toxicities between patients with baseline low and non-low SMM (P = 0.0358) was observed.
Low SMM is predictive of shorter PFS, while consecutive changes in muscular mass do not seem to be a predictor of PFS or OS. The role of muscle radiodensity remains a matter of debate.
肌肉减少症和肌肉组织退化是大多数慢性疾病的特征，包括非小细胞肺癌（NSCLC）。通过横断面图像分析在第三腰椎水平估计骨骼肌质量，计算机断层扫描（CT）可能是一种简单的方式。
对接受一线化疗的 NSCLC 患者进行基线骨骼肌质量（SMM）评估，通过骨骼肌指数（SMI）和骨骼肌放射密度（SMD）评估骨骼肌质量，评估其与安全性和临床结局的相关性。当获得不同时间点的 SMIs 时，对 SMI 恶化和改善的患者进行进一步比较。
在 81 例 IV 期 NSCLC 患者中，28 例患者存在低 SMM，23 例患者存在低 SMD。在无进展生存期（PFS）的单因素分析中，基线时低 SMM 和非低 SMM 患者之间（P = 0.06388）或低 SMD 和非低 SMD 患者之间（P = 0.9126）均无显著差异。然而，多因素分析显示基线低 SMM 是 PFS 较短的显著预测因素（风险比 0.54，95%置信区间 0.31-0.93；P = 0.0278），但低 SMD 不是。低 SMM 和非低 SMM 患者的总生存期（OS）无差异，低 SMD 和非低 SMD 患者的 OS 无差异。SMI 恶化和改善的可评估患者之间的 PFS 和 OS 无差异。基线时低 SMM 和非低 SMM 患者的血液学毒性存在显著差异（P = 0.0358）。
低 SMM 是 PFS 较短的预测因素，而肌肉质量的连续变化似乎不是 PFS 或 OS 的预测因素。肌肉放射密度的作用仍存在争议。
