Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Sydney, NSW, Australia.
Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Br J Nutr. 2022 Mar 14;127(5):722-735. doi: 10.1017/S0007114521001446. Epub 2021 Apr 29.
Body composition measurement using diagnostic computed tomography (CT) scans has emerged as a method to assess sarcopenia (low muscle mass) in oncology patients. Assessment of skeletal muscle mass (SMM) using the cross-sectional area of a single vertebral slice (at lumbar L3) in a CT scan is correlated with whole-body skeletal muscle volume. This method is used to assess CT-defined sarcopenia in patients with cancer, with low SMM effecting outcomes. However, as diagnostic scans are based on tumour location, not all include L3. We evaluated the evidence for the use of alternate vertebral CT slices for SMM evaluation when L3 is not available. Five electronic databases were searched from January 1996 to April 2020 for studies using CT scan vertebral slices above L3 for SM measurement in adults with cancer (solid tumours). Validation with whole-body SMM, rationale for the chosen slice and sarcopenia cut-off values were investigated. Thirty-two studies were included, all retrospective and cross-sectional in design. Cervical, thoracic and lumbar slices were used (from C3 to L1), with no validation of whole-body SMM using CT scans. Alternate slices were used in lung, and head and neck cancer patients. Sarcopenia cut-off values were reported in 75 % of studies, with differing methods, with or without sex-specific values, and a lack of consensus. Current evidence is inadequate to provide definitive recommendations for alternate vertebral slice use for SMM evaluation in cancer patients. Variation in sarcopenia cut-offs warrants more robust investigation, in order for risk stratification to be applied to all patients with cancer.
使用诊断计算机断层扫描（CT）扫描进行身体成分测量已成为评估肿瘤患者肌肉减少症（低肌肉量）的一种方法。在 CT 扫描中，使用单个椎骨切片（第 L3 腰椎）的横截面积评估骨骼肌量（SMM）与全身骨骼肌体积相关。该方法用于评估癌症患者的 CT 定义的肌肉减少症，低 SMM 会影响结果。但是，由于诊断性扫描基于肿瘤位置，并非所有扫描都包括 L3。当无法获得 L3 时，我们评估了使用其他椎骨 CT 切片评估 SMM 的证据。从 1996 年 1 月到 2020 年 4 月，我们在五个电子数据库中搜索了使用 CT 扫描椎骨切片测量成人癌症（实体瘤）患者 SMM 的研究。研究了与全身 SMM 的验证，所选切片的原理和肌肉减少症截止值。共纳入 32 项研究，均为回顾性和横断面设计。使用了颈椎、胸椎和腰椎切片（从 C3 到 L1），但未使用 CT 扫描对全身 SMM 进行验证。在肺癌和头颈部癌症患者中使用了替代切片。75%的研究报告了肌肉减少症截止值，但方法不同，有无性别特异性值，且缺乏共识。目前的证据不足以提供明确的建议，无法确定在癌症患者中使用替代椎骨切片评估 SMM。肌肉减少症截止值的差异需要更深入的研究，以便对所有癌症患者进行风险分层。
