Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, E21-19, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Division of Systems Biology, Nagoya University Graduate School of Medicine, 65 (710), Turumaichyo, Shouwa ku, Nagoya, Aichi, 466-8550, Japan.
Int J Clin Oncol. 2021 Feb;26(2):409-416. doi: 10.1007/s10147-020-01805-8. Epub 2020 Oct 26.
Regorafenib is a key agent for patients with advanced or recurrent colorectal cancer. Sarcopenia represented by skeletal muscle depletion is closely related to frailty and predicts oncological prognoses. We hypothesized that sarcopenia negatively affects the time to treatment failure (TTF) or overall survival (OS) of patients treated with regorafenib.
We retrospectively reviewed the medical records of all patients treated with regorafenib between May 2013 and April 2019 at our institution. The cross-sectional area of the psoas muscle at the level of the third lumbar vertebra on baseline computed tomography (CT) was assessed to calculate the psoas muscle index (PMI). Sarcopenia was defined based on PMI cut-off values for Asian adults (6.36 cm/m for males and 3.92 cm/m for females).
Thirty-four patients were analyzed. The prevalence of sarcopenia was 44.1%. Sarcopenia was significantly associated with poorer OS (median 3.2 vs. 5.3 months, p = 0.031). Less 75% 1-Month Relative Dose Intensity patients experienced significantly shorter TTF and OS than the rest, as did patients receiving total regorafenib dose of < 3360 mg (median 3.1 and 9.4 months, p < 0.001). Multivariate analysis showed that sarcopenia was a significant predictor of prognosis.
Sarcopenia was a predictive marker of negative outcome for patients with advanced or recurrent colorectal cancer treated with regorafenib. Screening for sarcopenia can be used to identify patients more likely to benefit from regorafenib in routine clinical practice.
瑞戈非尼是治疗晚期或复发性结直肠癌患者的关键药物。以骨骼肌消耗为特征的肌肉减少症与虚弱密切相关，并预测肿瘤学预后。我们假设肌肉减少症会对接受瑞戈非尼治疗的患者的治疗失败时间（TTF）或总生存期（OS）产生负面影响。
我们回顾性分析了 2013 年 5 月至 2019 年 4 月期间在我院接受瑞戈非尼治疗的所有患者的病历。在基线 CT 上评估第三腰椎水平的腰大肌横截面积以计算腰大肌指数（PMI）。根据亚洲成年人的 PMI 截断值（男性 6.36 cm/m，女性 3.92 cm/m）定义肌肉减少症。
共分析了 34 例患者。肌肉减少症的患病率为 44.1%。肌肉减少症与较差的 OS 显著相关（中位数 3.2 与 5.3 个月，p=0.031）。与其他患者相比，75%的 1 个月相对剂量强度小于 1 的患者的 TTF 和 OS 更短，接受的总瑞戈非尼剂量小于 3360mg 的患者也是如此（中位数 3.1 和 9.4 个月，p<0.001）。多变量分析表明，肌肉减少症是预测预后的显著指标。
肌肉减少症是接受瑞戈非尼治疗的晚期或复发性结直肠癌患者不良结局的预测标志物。在常规临床实践中，筛查肌肉减少症可以用于识别更有可能从瑞戈非尼中获益的患者。
