Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia.
Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Support Care Cancer. 2019 Jul;27(7):2657-2664. doi: 10.1007/s00520-018-4563-9. Epub 2018 Nov 26.
Sarcopenia is associated with reduced survival in cancer. Currently, data on sarcopenia at presentation and muscle loss throughout treatment are unknown in patients receiving chemoradiation therapy (CRT) for non-small cell lung cancer (NSCLC). This study evaluated skeletal muscle changes in NSCLC patients receiving CRT and relationship with survival.
Secondary analysis of 41 patients with NSCLC treated with CRT assessed for skeletal muscle area and muscle density by computed tomography pre-treatment and 3 months post-treatment. Images at week 4 of treatment were available for 32 (78%) patients. Linear mixed models were applied to determine changes in skeletal muscle over time and related to overall survival using Kaplan-Meier plots.
Muscle area and muscle density decreased significantly by week 4 of CRT (- 6.6 cm, 95% CI - 9.7 to - 3.1, p < 0.001; - 1.3 HU, 95% CI - 1.9 to - 0.64, p < 0.001, respectively), with minimal change between week 4 of CRT and 3 months post-CRT follow-up (- 0.2 cm, 95% CI - 3.6-3.1, p = 0.91; - 0.27, 95% CI - 0.91-0.36, p = 0.36, respectively). Sarcopenia was present in 25 (61%) and sarcopenic obesity in 6 (14%) of patients prior to CRT, but not associated with poorer survival. Median survival was shorter in patients with low muscle density prior to treatment although not statistically significant (25 months + 8.3 vs 53 months + 13.0, log-rank p = 0.17).
Significant loss of muscle area and muscle density occurs in NSCLC patients early during CRT. A high proportion of patients are sarcopenic prior to CRT; however, this was not significantly associated with poorer survival.
肌肉减少症与癌症患者的存活率降低有关。目前，在接受放化疗的非小细胞肺癌（NSCLC）患者中，尚不清楚治疗前的肌肉减少症和整个治疗过程中的肌肉丢失数据。本研究评估了接受放化疗的 NSCLC 患者的骨骼肌变化及其与生存的关系。
对 41 例接受放化疗的 NSCLC 患者进行了二次分析，通过 CT 评估治疗前和治疗后 3 个月的骨骼肌面积和肌肉密度。32 例（78%）患者的治疗第 4 周有图像。应用线性混合模型来确定随时间推移的骨骼肌变化，并通过 Kaplan-Meier 图与总体生存率相关。
CRT 治疗第 4 周时，肌肉面积和肌肉密度明显下降（-6.6cm，95%CI-9.7 至-3.1，p<0.001；-1.3HU，95%CI-1.9 至-0.64，p<0.001），而在 CRT 治疗第 4 周和 CRT 后 3 个月的随访中，变化最小（-0.2cm，95%CI-3.6-3.1，p=0.91；-0.27，95%CI-0.91-0.36，p=0.36）。在 CRT 之前，25 例（61%）患者存在肌肉减少症，6 例（14%）患者存在肌肉减少性肥胖症，但与较差的生存率无关。治疗前肌肉密度较低的患者中位生存期较短，但无统计学意义（25 个月+8.3 与 53 个月+13.0，对数秩检验 p=0.17）。
在 NSCLC 患者接受放化疗早期，骨骼肌面积和密度明显下降。在 CRT 之前，相当比例的患者存在肌肉减少症；然而，这与较差的生存率并无显著相关性。
