Uemura Shinya, Iwashita Takuji, Ichikawa Hironao, Iwasa Yuhei, Mita Naoki, Shiraki Makoto, Shimizu Masahito
First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
Br J Nutr. 2021 May 28;125(10):1140-1147. doi: 10.1017/S0007114520003463. Epub 2020 Sep 4.
Sarcopenia, defined as decrease in skeletal muscle mass (SMM) and strength, might be associated with reduced survival. We investigated the impact of sarcopenia and decrease in SMM in patients with advanced pancreatic cancer during FOLFIRINOX (FX) therapy. Consecutive sixty-nine patients who received FX were evaluated. Skeletal muscle index (SMI) (cm2/m2) was used to evaluate SMM. The cut-off value of sarcopenia was defined as SMI <42 for males and <38 for females, based on the Asian Working Group for sarcopenia criteria. Sarcopenia was diagnosed in thirty-three (48 %) subjects. Comparison of baseline characteristics of the two groups (sarcopenia group: non-sarcopenia group) showed a significant difference in sex, tumour size and BMI. There was no significant difference in the incidence of adverse events with grades 3-5 and progression-free survival (PFS) during FX between the two groups (PFS 8·1 and 8·8 months; P = 0·88). On the multivariate analysis, progressive disease at the first follow-up computed tomography (hazard ratio (HR) 3·87, 95 % CI 1·53, 9·67), decreased SMI ≥ 7·9 % in 2 months (HR 4·02, 95 % CI 1·87, 8·97) and carcinoembryonic antigen ≥ 4·6 (HR 2·52, 95 % CI 1·10, 6·11) were significant risk factors associated with poor overall survival (OS), but sarcopenia at diagnosis was not. OS in patients with decreased SMI of ≥7·9 % and <7·9 % were 10·9 and 21·0 months (P < 0·01), respectively. In conclusion, decrease in SMM within 2 months after the initiation of chemotherapy had significantly shorter OS, although sarcopenia at diagnosis did not affect OS. Therefore, it might be important to maintain SMM during chemotherapy for a better prognosis.
肌肉减少症定义为骨骼肌质量（SMM）和力量下降，可能与生存率降低有关。我们调查了晚期胰腺癌患者在接受FOLFIRINOX（FX）治疗期间肌肉减少症和SMM下降的影响。对连续接受FX治疗的69例患者进行了评估。使用骨骼肌指数（SMI）（cm²/m²）评估SMM。根据亚洲肌肉减少症工作组标准，肌肉减少症的临界值定义为男性SMI<42，女性<38。33例（48%）受试者被诊断为肌肉减少症。两组（肌肉减少症组：非肌肉减少症组）基线特征比较显示，在性别、肿瘤大小和BMI方面存在显著差异。两组在FX治疗期间3-5级不良事件发生率和无进展生存期（PFS）方面无显著差异（PFS分别为8.1个月和8.8个月；P=0.88）。多因素分析显示，首次随访计算机断层扫描时疾病进展（风险比[HR]3.87，95%CI 1.53，9.67）、2个月内SMI下降≥7.9%（HR 4.02，95%CI 1.87，8.97）和癌胚抗原≥4.6（HR 2.52，95%CI 1.10，6.11）是与总生存期（OS）较差相关的显著危险因素，但诊断时的肌肉减少症不是。SMI下降≥7.9%和<7.9%的患者OS分别为10.9个月和21.0个月（P<0.01）。总之，化疗开始后2个月内SMM下降的患者OS明显缩短，尽管诊断时的肌肉减少症不影响OS。因此，化疗期间维持SMM可能对改善预后很重要。
