Martin Daniel, von der Grün Jens, Rödel Claus, Fokas Emmanouil
Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.
Frankfurt Cancer Institute, Frankfurt, Germany.
Front Oncol. 2020 Aug 12;10:1576. doi: 10.3389/fonc.2020.01576. eCollection 2020.
Sarcopenia, defined as a loss of muscle mass and quality, has been associated with impaired oncological outcome and treatment toxicities in several malignancies. However, its role in anal squamous cell carcinoma (ASCC) remains less well explored.
METHODS/MATERIALS: Planning CT scans were used to measure cross-sectional skeletal muscle area (SMA) to calculate the skeletal muscle index (SMI). The association of sarcopenia with clinical and treatment-related parameters, and toxicity was assessed in 114 patients with ASCC that underwent standard 5-Fluorouracil/Mitomycin C chemoradiotherapy (CRT). The prognostic impact of sarcopenia on local relapse-free survival (LRFS), disease-free survival (DFS), and overall survival was examined using a Cox regression analysis.
29 (25.4%) patients had sarcopenia. Patients with sarcopenia had lower baseline hemoglobin levels ( = 0.002), worse Karnofsky Performance Status ( = 0.001) lower BMI ( < 0.001), and a significantly lower body surface area ( = 0.03), and lower incidence of involved lymph nodes ( = 0.03). Regarding acute toxicity, sarcopenia was associated with a significantly higher incidence of ≥grade 3leukopenia (OR: 3.5; 95% CI: 1.6-7.5, = 0.007) and ≥grade 3 thrombopenia (OR: 5.1; 95% CI: 1.3-21, = 0.018) after CRT. Despite higher hematologic toxicity in sarcopenic patients, total treatment time was similar between patients with and without sarcopenia (median 44 vs 45 days, = 0.95). There was no significant prognostic impact of sarcopenia on either LRFS, DFS, or OS.
This is the largest study to assess the impact of sarcopenia on toxicity and oncological outcome in patients with ASCC. Increased clinician awareness of higher hematological toxicity risk is needed for sarcopenic patients with ASCC undergoing CRT to facilitate closer monitoring of side effects and earlier introduction of supportive measures. Further prospective studies are needed to elucidate the prognostic role and impact of sarcopenia on CRT-related toxicity in ASCC.
肌肉减少症定义为肌肉质量和质量的丧失，已与多种恶性肿瘤的肿瘤学预后受损和治疗毒性相关。然而，其在肛门鳞状细胞癌（ASCC）中的作用仍未得到充分探索。
方法/材料：使用计划CT扫描测量横断面骨骼肌面积（SMA）以计算骨骼肌指数（SMI）。在114例接受标准5-氟尿嘧啶/丝裂霉素C放化疗（CRT）的ASCC患者中，评估肌肉减少症与临床及治疗相关参数和毒性的关联。使用Cox回归分析检查肌肉减少症对局部无复发生存期（LRFS）、无病生存期（DFS）和总生存期的预后影响。
29例（25.4%）患者存在肌肉减少症。肌肉减少症患者的基线血红蛋白水平较低（P = 0.002），卡氏功能状态较差（P = 0.001），体重指数较低（P < 0.001），体表面积显著较低（P = 0.03），受累淋巴结发生率较低（P = 0.03）。关于急性毒性，肌肉减少症与CRT后≥3级白细胞减少症的发生率显著较高相关（OR：3.5；95%CI：1.6 - 7.5，P = 0.007）和≥3级血小板减少症（OR：5.1；95%CI：1.3 - 21，P = 0.018）。尽管肌肉减少症患者的血液学毒性较高，但有和没有肌肉减少症的患者之间的总治疗时间相似（中位数44天对45天，P = 0.95）。肌肉减少症对LRFS、DFS或OS均无显著的预后影响。
这是评估肌肉减少症对ASCC患者毒性和肿瘤学预后影响的最大规模研究。对于接受CRT的ASCC肌肉减少症患者，临床医生需要提高对更高血液学毒性风险的认识，以便更密切地监测副作用并更早地引入支持措施。需要进一步的前瞻性研究来阐明肌肉减少症在ASCC中对CRT相关毒性的预后作用和影响。
