Liang Huanwei, Peng Huajian, Chen Long
Department of Radiotherapy, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
Cancer Manag Res. 2021 Jan 11;13:181-192. doi: 10.2147/CMAR.S288522. eCollection 2021.
To determine the independent and combined prognostic value of sarcopenia and systemic inflammatory markers in esophageal cancer patients undergoing definitive radiotherapy.
Sarcopenia was diagnosed on the basis of the skeletal muscle index (SMI) as determined by the skeletal muscle area at the third lumbar (L3) region and body height. The optimal cutoff value of systemic inflammatory markers was determined by the receiver-operating curve (ROC). Logistic regression was used to analyze the correlation among different variables. Cox proportional hazards model was used to identify the factors significantly correlated to overall survival (OS). Based on the results of multivariate survival analysis, a nomogram was established to predict the survival rate. The accuracy of the nomogram was evaluated by the coordination index and the calibration curve.
A total of 100 esophageal cancer patients were included, of which 77 exhibited sarcopenia. The lymphocyte-monocyte ratio (LMR) was significantly correlated to the risk of sarcopenia (OR = 0.637, 95% CI, 0.452-0.898, P = 0.010). In addition, sarcopenia (P = 0.002, HR = 3.991, 95% CI: 1.653-9.638) and LMR < 2.67 (P < 0.001, HR = 2.665, 95% CI: 1.563-4.543) were independent predictors of OS. Two nomograms with good predictive accuracy were established.
Sarcopenia and LMR can independently predict the survival of patients with esophageal cancer receiving definitive radiotherapy and have good combined prognostic value.
确定肌肉减少症和全身炎症标志物对接受根治性放疗的食管癌患者的独立及联合预后价值。
根据第三腰椎（L3）区域的骨骼肌面积和身高确定的骨骼肌指数（SMI）来诊断肌肉减少症。通过受试者操作特征曲线（ROC）确定全身炎症标志物的最佳临界值。采用逻辑回归分析不同变量之间的相关性。使用Cox比例风险模型确定与总生存期（OS）显著相关的因素。基于多变量生存分析结果，建立列线图以预测生存率。通过一致性指数和校准曲线评估列线图的准确性。
共纳入100例食管癌患者，其中77例存在肌肉减少症。淋巴细胞与单核细胞比值（LMR）与肌肉减少症风险显著相关（OR = 0.637，95%CI：0.452 - 0.898，P = 0.010）。此外，肌肉减少症（P = 0.002，HR = 3.991，95%CI：1.653 - 9.638）和LMR < 2.67（P < 0.001，HR = 2.665，95%CI：1.563 - 4.543）是OS的独立预测因素。建立了两个预测准确性良好的列线图。
肌肉减少症和LMR可独立预测接受根治性放疗的食管癌患者的生存情况，并具有良好的联合预后价值。
