肌肉减少症对异基因造血细胞移植后不良结局的影响。
Impact of Sarcopenia on Adverse Outcomes After Allogeneic Hematopoietic Cell Transplantation.
机构信息
See the Notes section for the full list of authors' affiliations.
出版信息
J Natl Cancer Inst. 2019 Aug 1;111(8):837-844. doi: 10.1093/jnci/djy231.
BACKGROUND
High intensity treatments such as hematopoietic cell transplantation (HCT) can be curative for patients with hematologic malignancies, but this needs to be balanced by the high risk of nonrelapse mortality (NRM) during the first 2 years after HCT. Sarcopenia (low muscle mass) is associated with physical disability and premature mortality in individuals with nonmalignant diseases and may be a predictor of NRM and poor overall survival in patients undergoing HCT.
METHODS
This was a retrospective cohort study of 859 patients with acute leukemia or myelodysplastic syndrome who underwent a first HCT as adults (≥18 years) between 2007 and 2014. Sarcopenia was assessed from pre-HCT abdominal computed tomography scans. Two-year cumulative incidence of NRM was calculated, with relapse/progression considered as a competing risk event. Fine-Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained and adjusted for relevant covariates. Kaplan-Meier method was used to examine overall survival. All statistical tests were two-sided.
RESULTS
Median age at HCT was 51 years (range = 18-74 years); 52.5% had a high [≥3] HCT-comorbidity index; 33.7% had sarcopenia pre-HCT. Sarcopenia was an independent predictor of higher NRM risk (hazard ratio = 1.58, 95% CI = 1.16 to 2.16) compared with patients who were not. The 2-year incidence of NRM approached 30% in patients with sarcopenia and high (≥3) HCT-comorbidity index. Patients with sarcopenia had on average a longer hospitalization (37.2 days vs 31.5 days, P < .001) and inferior overall survival at 2 years (55.2%, 95% CI = 49.5% to 61.0% vs 66.9%, 95% CI = 63.0% to 70.8%, P < .001).
CONCLUSIONS
Sarcopenia is an important and independent predictor of survival after HCT, with potential additional downstream impacts on health-economic outcomes. This information can be used to facilitate treatment decisions prior to HCT and guide interventions to decrease the risk of treatment-related complications after HCT.
背景
高强度治疗，如造血细胞移植（HCT），可以治愈血液系统恶性肿瘤患者，但需要平衡 HCT 后 2 年内非复发死亡率（NRM）的高风险。肌肉减少症（肌肉量低）与非恶性疾病患者的身体残疾和过早死亡有关，并且可能是预测 HCT 患者 NRM 和总体生存不良的指标。
方法
这是一项回顾性队列研究，纳入了 859 名在 2007 年至 2014 年间接受首次 HCT 的成人（≥18 岁）急性白血病或骨髓增生异常综合征患者。HCT 前的腹部计算机断层扫描评估肌肉减少症。计算 2 年累积 NRM 发生率，将复发/进展视为竞争风险事件。采用 Fine-Gray 亚分布风险比估计值和 95%置信区间（CI），并调整了相关协变量。采用 Kaplan-Meier 方法检查总生存情况。所有统计检验均为双侧。
结果
HCT 时的中位年龄为 51 岁（范围为 18-74 岁）；52.5%患者的 HCT 合并症指数高[≥3]；33.7%患者 HCT 前存在肌肉减少症。与无肌肉减少症的患者相比，肌肉减少症是 NRM 风险较高的独立预测因素（风险比=1.58，95%CI=1.16 至 2.16）。肌肉减少症和高（≥3）HCT 合并症指数患者的 2 年 NRM 发生率接近 30%。肌肉减少症患者的平均住院时间较长（37.2 天比 31.5 天，P<.001），2 年总体生存率较低（55.2%，95%CI=49.5%至 61.0%比 66.9%，95%CI=63.0%至 70.8%，P<.001）。
结论
肌肉减少症是 HCT 后生存的一个重要且独立的预测因素，对健康经济学结果可能有潜在的后续影响。这些信息可用于在 HCT 前辅助治疗决策，并指导干预措施，以降低 HCT 后治疗相关并发症的风险。
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