总腰大肌肌肉面积指数低是转移性胰腺癌的一个强有力的预后因素。
A Low Total Psoas Muscle Area Index Is a Strong Prognostic Factor in Metastatic Pancreatic Cancer.
机构信息
From the Department of Hepatogastroenterology, University Hospital of Saint-Etienne, Saint-Etienne.
Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez.
出版信息
Pancreas. 2021 Apr 1;50(4):579-586. doi: 10.1097/MPA.0000000000001796.
OBJECTIVES
The total psoas area index (TPI) is an emerging alternative to the total skeletal muscle area index as a prognostic factor but has never been evaluated in metastatic pancreatic cancer (mPC).
METHODS
Areas were manually recorded, as previously described. Sex-specific cutoffs were identified by optimum stratification of TPI using log-rank χ2 statistic associated with mortality to define sarcopenic psoas. Progression-free survival (PFS) and overall survival (OS) were the primary objectives. Two period groups were used as internal validation.
RESULTS
During the period study, 79 patients were treated for mPC. The TPI was correlated with PFS (hazards ratio, 0.81; P = 0.02) and OS (hazards ratio, 0.7; P < 0.001). Optimum thresholds defining sarcopenic psoas were less than 5.73 cm2/m2 in men and less than 4.37 cm2/m2 in women. Patients with sarcopenic psoas (62.0%) had shorter median PFS (2.9 months) compared with the others (6.6 months, adjusted P log-rank = 0.01), independently to the intensity of chemotherapy, weight loss, and performance status greater than 1. Similarly, OS was independently shorter in patients with sarcopenic psoas (7.6 months) versus the others (22.2 months, adjusted P < 0.001). These results were confirmed in the 2 period groups.
CONCLUSIONS
A low TPI is a stronger independent prognostic factor in mPC.
目的
总腰大肌面积指数（TPI）是一种新兴的替代总骨骼肌面积指数的预后因素，但尚未在转移性胰腺癌（mPC）中进行评估。
方法
如前所述，手动记录面积。通过使用与死亡率相关的对数秩 χ2 统计量对 TPI 进行最佳分层，确定男性和女性特有的截断值，以定义肌肉减少性腰大肌。无进展生存期（PFS）和总生存期（OS）是主要目标。使用两个时期组进行内部验证。
结果
在研究期间，79 名患者接受了 mPC 治疗。TPI 与 PFS（风险比，0.81；P = 0.02）和 OS（风险比，0.7；P < 0.001）相关。定义肌肉减少性腰大肌的最佳截断值为男性小于 5.73 cm2/m2，女性小于 4.37 cm2/m2。患有肌肉减少性腰大肌的患者（62.0%）的中位 PFS（2.9 个月）较其他患者（6.6 个月，调整 P log-rank = 0.01）更短，与化疗强度、体重减轻和体力状态大于 1 独立相关。同样，患有肌肉减少性腰大肌的患者 OS 更短（7.6 个月），而其他患者（22.2 个月，调整 P < 0.001）。这些结果在两个时期组中得到了证实。
结论
TPI 较低是 mPC 中更强的独立预后因素。
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