Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Tottori, 683-8504, Japan.
Int J Clin Oncol. 2020 Jan;25(1):158-164. doi: 10.1007/s10147-019-01544-5. Epub 2019 Sep 13.
To evaluate the relationship between sarcopenia and myelosuppression or between sarcopenia and survival outcomes in patients with urothelial carcinoma (UC) undergoing chemotherapy with gemcitabine plus cisplatin (GC) or carboplatin (GCa).
We evaluated 80 patients with UC who underwent chemotherapy between 2013 and 2017 at our institution. In total, 53 patients had metastatic UC and were ultimately included in the study. Predictive factors for myelosuppression (neutropenia, thrombocytopenia, and anemia) in all patients and overall survival (OS) in metastatic UC patients were analyzed. Sarcopenia was assessed on computed tomography before chemotherapy. Each patient's total psoas area was measured at the lumbar vertebrae (L3) and sarcopenia was defined as median values or lower. Predictive factors for myelosuppression were assessed using logistic regression analysis and survival was evaluated using Cox regression analysis.
The patients' mean age was 71.6 years (range 44.4-89.2 years). Of the initial 80 patients, 39 were diagnosed with sarcopenia and 26 of 53 patients with metastatic UC were diagnosed with sarcopenia. Sarcopenia was an independent predictive factor (P = 0.030; odds ratio, 3.526; 95% confidence interval [CI] 1.128-11.01) for neutropenia on multivariate analysis. Patients without sarcopenia had a significantly longer OS compared to those with sarcopenia (P = 0.013). Sarcopenia and albumin (P = 0.045, 0.023; hazard ratio (HR), 2.309, 2.652; 95% CI 1.021-5.225, 1.141-6.165, respectively) were independent predictors of OS in multivariate analysis.
Sarcopenia was predictive for neutropenia associated with GC or GCa in UC patients and OS in metastatic UC.
评估肌少症与接受吉西他滨联合顺铂（GC）或卡铂（GCa）化疗的尿路上皮癌（UC）患者骨髓抑制之间的关系，以及肌少症与生存结局之间的关系。
我们评估了 2013 年至 2017 年在我院接受化疗的 80 例 UC 患者。共有 53 例转移性 UC 患者，最终纳入研究。分析所有患者骨髓抑制（中性粒细胞减少症、血小板减少症和贫血）和转移性 UC 患者总生存期（OS）的预测因素。化疗前在 CT 上评估肌少症。在腰椎（L3）测量每位患者的总腰大肌面积，以中位数或更低值定义为肌少症。使用逻辑回归分析评估骨髓抑制的预测因素，使用 Cox 回归分析评估生存情况。
患者的平均年龄为 71.6 岁（范围为 44.4-89.2 岁）。在最初的 80 名患者中，有 39 名患者被诊断为肌少症，53 名转移性 UC 患者中有 26 名被诊断为肌少症。多变量分析显示，肌少症是中性粒细胞减少的独立预测因素（P=0.030；优势比，3.526；95%置信区间[CI]，1.128-11.01）。无肌少症患者的 OS 明显长于有肌少症患者（P=0.013）。肌少症和白蛋白（P=0.045，0.023；风险比（HR），2.309，2.652；95%CI，1.021-5.225，1.141-6.165）是多变量分析中 OS 的独立预测因素。
肌少症与 UC 患者接受 GC 或 GCa 化疗相关的中性粒细胞减少症和转移性 UC 的 OS 相关。
