Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea.
Thorac Cancer. 2021 Jun;12(11):1662-1667. doi: 10.1111/1759-7714.13958. Epub 2021 Apr 7.
Skeletal muscle depletion (sarcopenia) is associated with poor prognosis in patients with lung cancer. We analyzed changes in skeletal muscle area using serial computed tomography (CT) until the death of patients with advanced squamous cell lung cancer (SQCLC).
This retrospective study comprised 70 consecutive patients who underwent palliative chemotherapy for SQCLC. The cross-sectional area of the skeletal muscle at the level of the first lumbar vertebra (L1) was measured using chest CT. An artificial intelligence algorithm was developed and used for the serial assessment of the muscle area. Sarcopenia was defined as an L1 skeletal muscle index <46 cm /m in men and < 29 cm /m in women.
The median age was 69 years; 62 patients (89%) had metastatic disease at the time of initial diagnosis. Sarcopenia was present in 58 patients (82.9%) at baseline; all patients experienced net muscle loss over the disease trajectory. The median overall survival was 8.7 (95% confidence interval 5.9-11.5) months. The mean percentage loss of skeletal muscle between the first and last CT was 16.5 ± 11.0%. Skeletal muscle loss accelerated over time and was the highest in the last 3 months of life (p < 0.001). Patients losing skeletal muscle rapidly (upper tertile, >3.24 cm /month) had shorter overall survival than patients losing skeletal muscle slowly (median, 5.7 vs. 12.0 months, p < 0.001).
Patients with advanced SQCLC lose a significant amount of skeletal muscle until death. The rate of muscle area reduction is faster at the end of life.
骨骼肌减少（肌少症）与肺癌患者的预后不良相关。我们分析了 70 例接受姑息性化疗的晚期鳞状细胞肺癌（SQCLC）患者连续 CT 检查的骨骼肌面积变化。
这项回顾性研究纳入了 70 例连续接受姑息性化疗的 SQCLC 患者。采用胸部 CT 测量第 1 腰椎（L1）水平的骨骼肌横截面积。开发了一种人工智能算法，用于肌肉面积的连续评估。男性 L1 骨骼肌指数<46cm/m 和女性<29cm/m 定义为肌少症。
中位年龄为 69 岁；62 例（89%）患者在初诊时已有转移性疾病。基线时 58 例（82.9%）患者存在肌少症；所有患者在疾病过程中均经历了肌肉净减少。中位总生存期为 8.7（95%置信区间 5.9-11.5）个月。第 1 次和最后 1 次 CT 之间骨骼肌丢失的平均百分比为 16.5±11.0%。骨骼肌丢失随时间加速，在生命的最后 3 个月最快（p<0.001）。快速丢失骨骼肌的患者（上 3 分位数，>3.24cm/月）总生存期比缓慢丢失骨骼肌的患者更短（中位值，5.7 个月比 12.0 个月，p<0.001）。
晚期 SQCLC 患者在死亡前会丢失大量骨骼肌。生命末期肌肉面积减少的速度更快。
