Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou China.
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
Curr Probl Cancer. 2020 Apr;44(2):100513. doi: 10.1016/j.currproblcancer.2019.100513. Epub 2019 Nov 1.
Given the growing evidence that sarcopenia and inflammation influence the survival of patients with cancer, we evaluated the prognostic significance of the skeletal muscle index (SMI) combined with an inflammation marker in patients with breast cancer who underwent postoperative adjuvant radiotherapy.
We conducted a retrospective analysis of 301 patients with breast cancer who received postoperative adjuvant radiotherapy between 2010 and 2012. The SMI was measured using preradiotherapy computed tomography (CT) simulation images at the level of the fourth thoracic vertebra (T4). Receiver operating characteristic curve analyses were used to determine the optimal cutoff values for the SMI and inflammatory marker. Patients were divided into 2 groups (high SMI and low SMI), based on the SMI cutoff of 10.57 cm/m.
Patients in the high-SMI group had a median overall survival (OS) of 62.4 months, which was significantly shorter than those in the low-SMI group, with a median OS of 68.5 months (P = 0.025). Patients in the high-SMI group had a median recurrence-free survival (RFS) of 62.3 months, which was shorter but not significantly than the median RFS of 65.2 months of the low-SMI group (P = 0.159). Univariate and multivariate survival analyses revealed SMI was an independent predictor of OS (P = 0.044). The SMI-MLR combination was found to be an independent predictor of OS (P = 0.006) and RFS (P = 0.009).
The current findings support the SMI as a promising indicator for predicting clinical outcomes in patients with breast cancer receiving postoperative adjuvant radiotherapy. A high SMI accompanied by systemic inflammation was significantly associated with reduced OS and RFS.
鉴于越来越多的证据表明肌少症和炎症会影响癌症患者的生存，我们评估了骨骼肌指数（SMI）结合炎症标志物在接受术后辅助放疗的乳腺癌患者中的预后意义。
我们对 2010 年至 2012 年间接受术后辅助放疗的 301 例乳腺癌患者进行了回顾性分析。SMI 使用术前放疗计算机断层扫描（CT）模拟图像在第四胸椎（T4）水平进行测量。使用受试者工作特征曲线分析确定 SMI 和炎症标志物的最佳截断值。根据 SMI 截断值 10.57cm/m 将患者分为 2 组（高 SMI 组和低 SMI 组）。
高 SMI 组患者的中位总生存期（OS）为 62.4 个月，明显短于低 SMI 组的 68.5 个月（P=0.025）。高 SMI 组患者的中位无复发生存期（RFS）为 62.3 个月，虽然短于但无统计学意义低于低 SMI 组的 65.2 个月（P=0.159）。单因素和多因素生存分析表明，SMI 是 OS 的独立预测因子（P=0.044）。SMI-MLR 联合是 OS（P=0.006）和 RFS（P=0.009）的独立预测因子。
目前的研究结果支持 SMI 作为预测接受术后辅助放疗的乳腺癌患者临床结局的有前途的指标。高 SMI 伴全身炎症与 OS 和 RFS 降低显著相关。
