Taylor James M, Song Andrew, David Allison R, Chen Victor E, Lu Bo, Werner-Wasik Maria
Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA.
Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, USA.
Cureus. 2020 Sep 29;12(9):e10712. doi: 10.7759/cureus.10712.
Background Sarcopenia has been associated with poor survival among cancer patients. Normalized total psoas area (NTPA) has been used as a surrogate for defining sarcopenia. Few data exist characterizing the impact of sarcopenia and other metrics of fitness on clinical outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated non-invasively with stereotactic body radiotherapy (SBRT). Methods To assess the association between sarcopenia and clinical outcomes, we conducted a retrospective analysis of consecutive patients treated with SBRT from 2013 to 2019 . Overall survival (OS), local failure free survival (LFS), distant failure free survival (DFS), NTPA, body mass index (BMI), and Charlson comorbidity index (CCI) were included for analysis. NTPA was calculated by measuring the psoas volume at the L3 vertebra and normalizing for patient height and gender. Survival functions were evaluated using the Kaplan-Meier method. Log-rank test and Cox-proportional hazards were performed for categorical and continuous variables, respectively. Significance was set as p < 0.05. Results A total of 91 patients met the criteria. The median age was seven years and Karnofsky Performance Status score (KPS) was 80 (range: 60-100). Approximately 79% of patients had T1 tumors. Median radiation dose and number of fractions were 60 Gy (range: 45-60) and 5 fractions (range: 3-5). Median NTPA was 531.16 mm/m (range: 90.4-1356.2). After normalization (sarcopenia: <385 mm/m, female; <585 mm/mmale), 39 patients (42.8%) had sarcopenia. NTPA had no association with OS (p = 0.7), LFS (p = 0.9), or DFS (p = 0.5). Increasing BMI was associated with improved OS (HR 0.90, 95% CI 0.83-0.98). With a median follow-up of 23.4 months, median OS was 60, 60, and 45.9 months (p = 0.37) in all patients, non-sarcopenic patients, and sarcopenic patients, respectively. Conclusion Sarcopenia was not associated with OS, LFS, or DFS. Increasing BMI is associated with improved OS. Future, prospective work is needed to define the impact of sarcopenia and other fitness metrics on clinical outcomes among NSCLC patients treated non-invasively with SBRT.
肌肉减少症与癌症患者的不良生存相关。标准化总腰大肌面积（NTPA）已被用作定义肌肉减少症的替代指标。关于肌肉减少症和其他身体状况指标对接受立体定向体部放疗（SBRT）非侵入性治疗的早期非小细胞肺癌（NSCLC）患者临床结局影响的特征性数据很少。方法：为评估肌肉减少症与临床结局之间的关联，我们对2013年至2019年接受SBRT治疗的连续患者进行了回顾性分析。纳入总生存期（OS）、局部无失败生存期（LFS）、远处无失败生存期（DFS）、NTPA、体重指数（BMI）和Charlson合并症指数（CCI）进行分析。通过测量L3椎体水平的腰大肌体积并根据患者身高和性别进行标准化来计算NTPA。使用Kaplan-Meier方法评估生存函数。分别对分类变量和连续变量进行对数秩检验和Cox比例风险分析。显著性设定为p<0.05。结果：共有91例患者符合标准。中位年龄为7岁，卡氏功能状态评分（KPS）为80（范围：60-100）。约79%的患者患有T1期肿瘤。中位放射剂量和分次次数分别为60 Gy（范围：45-60）和5次（范围：3-5）。中位NTPA为531.16 mm/m（范围：90.4-1356.2）。标准化后（肌肉减少症：女性<385 mm/m，男性<585 mm/m），39例患者（42.8%）存在肌肉减少症。NTPA与OS（p = 0.7）、LFS（p = 0.9）或DFS（p = 0.5）均无关联。BMI增加与OS改善相关（HR 0.90，95%CI 0.83-0.98）。中位随访23.4个月，所有患者、非肌肉减少症患者和肌肉减少症患者的中位OS分别为60、60和45.9个月（p = 0.37）。结论：肌肉减少症与OS、LFS或DFS均无关联。BMI增加与OS改善相关。未来需要开展前瞻性研究来确定肌肉减少症和其他身体状况指标对接受SBRT非侵入性治疗的NSCLC患者临床结局的影响。
