VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
Oral Oncol. 2020 Sep;108:104771. doi: 10.1016/j.oraloncology.2020.104771. Epub 2020 May 30.
It is unknown whether or not the body composition is correlated with the prognosis and inflammatory response in patients with nasopharyngeal cancer (NPC).
This cohort included 1767 patients with NPC. Visceral, subcutaneous and intra muscular adipose tissues (VAT, SAT and IMAT), and skeletal muscle index were quantified with computed tomography. We used the optimal stratification to select cut points for VAT, SAT and IMAT. We defined sarcopenia according to a widely used cut-point. The primary endpoint was overall survival (OS). The association between body composition and inflammatory response was also examined.
Low VAT, SAT, IMAT and sarcopenia were observed in 260 (14.7%), 451 (25.5%), 773 (43.7%) and 683 (38.7%) patients, respectively. Low VAT (P < 0.001, hazard ratio [HR], 1.884; 95% confidence interval [CI], 1.436-2.473,) and SAT (P = 0.022, HR, 1.334, 95%CI, 1.043-1.706) were both associated worse survival. IMAT and sarcopenia were not with prognostic value. In multivariate analysis, we found the prognostic value of the VAT (HR: 1.544, 95% CI: 1.128-2.114; P = 0.007) was independent of T stage, N stage, disease stage, lactic dehydrogenase, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), the systemic immune-inflammation index (SII), EBV-DNA and body mass index. We observed higher NLR (P = 0.028) and PLR (P < 0.001) in patients with low SAT. Both low VAT (P = 0.009) and SAT (P = 0.005) were associated with decreased stromal lymphocyte infiltrating intensity.
Among body composition parameters, VAT was an independent prognostic factor, especially in patients with locally advanced NPC.
目前尚不清楚体成分与鼻咽癌（NPC）患者的预后和炎症反应是否相关。
本队列纳入了 1767 例 NPC 患者。采用 CT 定量检测内脏脂肪组织（VAT）、皮下脂肪组织（SAT）和肌内脂肪组织（IMAT）以及骨骼肌指数。我们采用最佳分层法选择 VAT、SAT 和 IMAT 的切点。根据广泛使用的切点定义肌肉减少症。主要终点为总生存期（OS）。还研究了体成分与炎症反应的关系。
260（14.7%）、451（25.5%）、773（43.7%）和 683（38.7%）例患者分别存在低 VAT、SAT、IMAT 和肌肉减少症。低 VAT（P<0.001，风险比 [HR]，1.884；95%置信区间 [CI]，1.436-2.473）和 SAT（P=0.022，HR，1.334，95%CI，1.043-1.706）均与较差的生存相关。IMAT 和肌肉减少症与预后无关。多因素分析发现，VAT 的预后价值（HR：1.544，95%CI：1.128-2.114；P=0.007）独立于 T 分期、N 分期、疾病分期、乳酸脱氢酶、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）、EBV-DNA 和体重指数。我们观察到低 SAT 患者的 NLR（P=0.028）和 PLR（P<0.001）较高。低 VAT（P=0.009）和 SAT（P=0.005）均与基质淋巴细胞浸润强度降低相关。
在体成分参数中，VAT 是一个独立的预后因素，尤其是在局部晚期 NPC 患者中。
