Cho Yeona, Kim Jun Won, Keum Ki Chang, Lee Chang Geol, Jeung Hei Cheul, Lee Ik Jae
Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
Front Oncol. 2018 Oct 22;8:457. doi: 10.3389/fonc.2018.00457. eCollection 2018.
With growing evidence that inflammation and low muscularity play a role in the survival of cancer patients, we evaluated the prognostic implications of sarcopenia with systemic inflammation in patients who underwent definitive chemoradiotherapy (CCRT) for locally advanced head and neck cancer. We analyzed 221 patients with head and neck cancer who received definitive CCRT between 2006 and 2015. The skeletal muscle area was measured using a single computed tomography image slice at the level of the third lumbar vertebra (L3). Sarcopenia was defined as an L3 muscle index of <49 cm/m for men and <31 cm/m for women. Patients with sarcopenia ( = 106) exhibited higher neutrophil/lymphocyte ratios (NLRs) than those without ( = 115); the former also had an inferior 3-year overall survival (OS) rate (62%) than the latter (76%, = 0.037). Among patients with sarcopenia, those who also had high NLRs ( = 51) showed significantly poorer OS and progression-free survival (PFS). In the multivariate analysis, sarcopenia plus a high NLR remained the most significant predictor of poor OS and PFS. Patients with sarcopenia required more frequent interruption of RT; patients whose RT was interrupted for ≥5 days showed inferior disease control and OS. Sarcopenia accompanied by systemic inflammation at initial diagnosis is associated with significantly inferior OS and PFS. Additionally, patients with sarcopenia required RT interruption more frequently. Intensive nutritional support and additional treatment methods are required for these patients while undergoing RT.
随着越来越多的证据表明炎症和低肌肉量在癌症患者的生存中起作用，我们评估了在接受局部晚期头颈癌根治性放化疗（CCRT）的患者中，肌肉减少症合并全身炎症的预后意义。我们分析了2006年至2015年间接受根治性CCRT的221例头颈癌患者。使用第三腰椎（L3）水平的单个计算机断层扫描图像切片测量骨骼肌面积。肌肉减少症的定义为男性L3肌肉指数<49 cm/m，女性<31 cm/m。肌肉减少症患者（n = 106）的中性粒细胞/淋巴细胞比值（NLRs）高于无肌肉减少症的患者（n = 115）；前者的3年总生存率（OS）（62%）也低于后者（76%，P = 0.037）。在肌肉减少症患者中，NLRs也高的患者（n = 51）的OS和无进展生存期（PFS）明显更差。在多变量分析中，肌肉减少症加NLRs高仍然是OS和PFS差的最显著预测因素。肌肉减少症患者需要更频繁地中断放疗；放疗中断≥5天的患者疾病控制和OS较差。初始诊断时伴有全身炎症的肌肉减少症与明显较差的OS和PFS相关。此外，肌肉减少症患者更频繁地需要中断放疗。这些患者在接受放疗时需要强化营养支持和额外的治疗方法。
