新辅助化疗后行食管癌切除术患者骨骼肌量测量对临床结局的影响。

Impact of measurement of skeletal muscle mass on clinical outcomes in patients with esophageal cancer undergoing esophagectomy after neoadjuvant chemotherapy.

机构信息

Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Japan.

出版信息

Surgery. 2019 Dec;166(6):1041-1047. doi: 10.1016/j.surg.2019.07.033. Epub 2019 Oct 11.

DOI:10.1016/j.surg.2019.07.033

PMID:31607486

Abstract

BACKGROUND

Some studies have reported that sarcopenia is linked to clinical outcomes in multiple types of malignancies, but this association has not been established in esophageal cancer. We assessed how sarcopenia affects clinical outcomes of multidisciplinary treatments for esophageal cancer.

METHODS

We included 165 esophageal cancer patients who had undergone neoadjuvant chemotherapy followed by esophagectomy. Computed tomography was used for cross-sectional measurement of the psoas muscle at the third lumbar vertebra; we then calculated the height-adjusted psoas muscle index. Pre- and postneoadjuvant chemotherapy psoas muscle indices were evaluated for associations with neoadjuvant chemotherapy response and neoadjuvant chemotherapy -related adverse events and postoperative complications, in addition to survival. Psoas muscle index cutoffs were 6.36 cm/m for men and 3.92 cm/m for women.

RESULTS

Psoas muscle index decreased after neoadjuvant chemotherapy (from 7.17 to 6.96 cm/m; P = .0008), and specifically in men (from 7.45 to 7.23 cm/m; P = .0001) but not in women (from 5.21 to 5.17 cm/m; P = .810). Preneoadjuvant chemotherapy psoas muscle index (low versus high) was associated with neoadjuvant chemotherapy response (response rate: 65.1% vs 80.3%; P = .0494) and neoadjuvant chemotherapy-related adverse events (neutropenia: 93.0% vs 78.7%; P = .0337; febrile neutropenia: 53.5% vs 34.3%; P = .0278; hyponatremia: 51.2% vs 31.2%; P = .0190). Post-neoadjuvant chemotherapy psoas muscle index correlated with postoperative rate of complications (56.9% vs 33.3%; P = .0046), especially pneumonia (31.4% vs 9.7% P = .0008). Psoas muscle index was not associated with survival.

CONCLUSION

Cross sectional measures of sarcopenia before and after neoadjuvant chemotherapy could predict tumor response, neoadjuvant chemotherapy -related adverse events, and postoperative complications in multidisciplinary treatments for esophageal cancer.

摘要

背景

一些研究表明，骨骼肌减少症与多种恶性肿瘤的临床结局有关，但这一关联在食管癌中尚未得到证实。我们评估了骨骼肌减少症如何影响食管癌多学科治疗的临床结局。

方法

我们纳入了 165 名接受新辅助化疗后行食管切除术的食管癌患者。使用计算机断层扫描（CT）对第 3 腰椎的竖脊肌进行横截面积测量；然后计算出身高校正后的竖脊肌指数。评估新辅助化疗前后的竖脊肌指数与新辅助化疗反应以及新辅助化疗相关不良反应和术后并发症的相关性，以及与生存的相关性。男性的竖脊肌指数截断值为 6.36cm/m，女性为 3.92cm/m。

结果

新辅助化疗后竖脊肌指数下降（从 7.17cm/m 降至 6.96cm/m；P=0.0008），特别是男性（从 7.45cm/m 降至 7.23cm/m；P=0.0001），而女性则没有变化（从 5.21cm/m 降至 5.17cm/m；P=0.810）。新辅助化疗前的竖脊肌指数（低与高）与新辅助化疗反应（反应率：65.1%比 80.3%；P=0.0494）和新辅助化疗相关不良反应（中性粒细胞减少症：93.0%比 78.7%；P=0.0337；发热性中性粒细胞减少症：53.5%比 34.3%；P=0.0278；低钠血症：51.2%比 31.2%；P=0.0190）相关。新辅助化疗后的竖脊肌指数与术后并发症发生率（56.9%比 33.3%；P=0.0046）相关，尤其是肺炎（31.4%比 9.7%；P=0.0008）。竖脊肌指数与生存无关。