Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France.
Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France.
Radiat Oncol. 2020 May 22;15(1):116. doi: 10.1186/s13014-020-01545-z.
Sarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radiotherapy is the standard treatment for locally-advanced tumour, not accessible to surgical resection. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy.
The clinical, nutritional, anthropometric, and functional-imaging (FDG-PET/CT) data were collected in 97 patients treated between 2006 and 2012 in our institution. The skeletal muscle area was automatically delineated on cross-sectional CT images acquired at the 3rd. lumbar vertebra level and divided by the patient's squared height (SML3/h) to obtain the Skeletal Muscle Index (SMI). The primary endpoint was overall survival probability.
Seventy-six deaths were reported. The median survival time was 27 [95% Confidence Interval 23-40] months for the whole population. Univariate analyses (Cox Proportional Hazard Model) showed decreased survival probabilities in patients with reduced SMI, WHO > 0, Body Mass Index ≤21, and Nutritional Risk Index ≤97.5. Multivariate analyses showed that sarcopenia was the only significant prognostic factor (HR 2.32 [1.24-4.34], p = 0.008). Using Receiver Operating Characteristics curves, the Area Under the Curve (AUC) was 0.73 in males (p = 0.0002], the optimal threshold being 51.5 cm/m. In women, the AUC was 0.65 (p = 0.19).
Sarcopenia is a powerful independent prognostic factor, associated with a rise of the overall mortality in patients treated exclusively by radiochemotherapy for a locally advanced oesophageal cancer. L3 CT images are easily gathered from FDG-PET/CT acquisitions.
肌少症是指骨骼肌量减少伴或不伴脂肪量减少。肌少症与癌症患者的治疗耐受性降低和预后较差有关，包括接受局限性食管癌手术的患者。同步放化疗是局部晚期肿瘤的标准治疗方法，无法进行手术切除。我们使用骨骼肌的自动勾画来研究在接受根治性同步放化疗的局部晚期食管癌（LAOC）患者中肌少症的预后价值。
我们收集了 97 例于 2006 年至 2012 年在我院接受治疗的患者的临床、营养、人体测量和功能成像（FDG-PET/CT）数据。在第 3 腰椎水平的横断面上自动勾画骨骼肌面积，并将其除以患者的平方身高（SML3/h），以获得骨骼肌指数（SMI）。主要终点是总生存概率。
报告了 76 例死亡。全人群的中位生存时间为 27 [95%置信区间 23-40] 个月。单因素分析（Cox 比例风险模型）显示，SMI 降低、WHO > 0、BMI ≤ 21 和营养风险指数 ≤ 97.5 的患者的生存概率降低。多因素分析显示，肌少症是唯一具有显著预后意义的因素（HR 2.32 [1.24-4.34]，p=0.008）。使用接收者操作特征曲线，男性的曲线下面积（AUC）为 0.73（p=0.0002]，最佳阈值为 51.5cm/m。女性的 AUC 为 0.65（p=0.19）。
肌少症是一个强大的独立预后因素，与接受局部晚期食管癌单纯放化疗治疗的患者的总死亡率升高相关。L3 CT 图像可以从 FDG-PET/CT 采集轻松获得。
