Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
Department of Minimally Invasive Interventional Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
Nutrition. 2021 Feb;82:111032. doi: 10.1016/j.nut.2020.111032. Epub 2020 Oct 12.
Sarcopenia is a well-known risk factor for inferior cancer outcomes, but the identification of patients at risk remains challenging. A new sarcopenia index (SI), defined as serum creatinine (Cr) × cystatin C (CysC)-based glomerular filtration rate (eGFR), has been reported to be an objective surrogate marker for sarcopenia. The aim of this study was to assess whether the SI is associated with sarcopenia and cancer-related fatigue (CRF) in patients with advanced cancer.
This cross-sectional study included 182 patients with different types of cancer (cancer stages III/IV; mean age 55.1 ± 11.1 y). Sarcopenia was defined as the presence of both low muscle mass and low muscle strength. The cross-sectional area of skeletal muscle mass (SMA) at the third lumbar spine was estimated by computed tomography (CT). Low muscle mass was defined as a skeletal muscle index (SMA/height) <34.9 cm/m for women and 40.8 cm/m for men. Low muscle strength was determined by handgrip strength (HGS) according to the cutoffs of the Asian Working Group for Sarcopenia (<18 kg for women and <26 kg for men). CRF was measured by the Brief Fatigue Inventory (BFI). The associations between SI with both sarcopenia and CRF were investigated.
The prevalence of sarcopenia was 27.5%. The SI was significantly lower in both the sarcopenia and severe fatigue groups. The associations between SI and SMA (r = 0.365; P < 0.001), skeletal muscle index (SMI) (r = 0.340; P < 0.001), and HGS (r = 0.414; P <0 .001) were stronger than the associations between the serum creatinine/cystatin C (Cr/CysC) ratio and SMA (r = 0.299; P < 0.001), SMI (r = 0.269; P <0 .001), and HGS (r = 0.364; P <0 .001). Additionally, a decrease in the SI was associated with a higher likelihood of sarcopenia (odds ratio per 10-unit, 1.09; 95% confidence interval, 1.02-1.16) after adjusting for potential confounding factors. However, there was only a weak correlation between the SI and BFI score (r = -0.161, P = 0.045).
The SI might be a useful objective tool for assessing sarcopenia in patients with advanced cancer. Further studies are warranted to extend the present findings.
肌少症是癌症预后不良的一个众所周知的危险因素，但识别高危患者仍然具有挑战性。一种新的肌少症指数（SI），定义为血清肌酐（Cr）与半胱氨酸蛋白酶抑制剂 C（CysC）的肾小球滤过率（eGFR）乘积，已被报道为肌少症的客观替代标志物。本研究旨在评估 SI 是否与晚期癌症患者的肌少症和癌症相关疲劳（CRF）相关。
本横断面研究纳入了 182 名患有不同类型癌症（癌症分期 III/IV；平均年龄 55.1 ± 11.1 岁）的患者。肌少症的定义为存在低肌肉量和低肌肉力量。通过计算机断层扫描（CT）估计第三腰椎的骨骼肌质量（SMA）的横截面积。低肌肉量定义为女性骨骼肌指数（SMA/身高）<34.9 cm/m，男性<40.8 cm/m。低肌肉力量通过握力（HGS）根据亚洲肌少症工作组的截断值（女性<18 kg，男性<26 kg）来确定。CRF 通过简短疲劳量表（BFI）进行测量。研究了 SI 与肌少症和 CRF 之间的相关性。
肌少症的患病率为 27.5%。在肌少症和严重疲劳组中，SI 均显著降低。SI 与 SMA（r=0.365；P<0.001）、骨骼肌指数（SMI）（r=0.340；P<0.001）和 HGS（r=0.414；P<0.001）的相关性均强于血清肌酐/半胱氨酸蛋白酶抑制剂 C（Cr/CysC）比值与 SMA（r=0.299；P<0.001）、SMI（r=0.269；P<0.001）和 HGS（r=0.364；P<0.001）的相关性。此外，在校正潜在混杂因素后，SI 每降低 10 个单位，肌少症的可能性增加 1.09 倍（优势比，1.09；95%置信区间，1.02-1.16）。然而，SI 与 BFI 评分之间仅存在弱相关性（r=-0.161，P=0.045）。
SI 可能是评估晚期癌症患者肌少症的有用的客观工具。需要进一步的研究来扩展本研究结果。
