Jördens Markus S, Wittig Linda, Heinrichs Lisa, Keitel Verena, Schulze-Hagen Maximilian, Antoch Gerald, Knoefel Wolfram T, Fluegen Georg, Luedde Tom, Loberg Christina, Roderburg Christoph, Loosen Sven H
Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany.
Department for Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany.
J Clin Med. 2021 Sep 23;10(19):4340. doi: 10.3390/jcm10194340.
Cholangiocarcinoma (CCA) represents the second most common primary liver cancer and is characterized by a very poor outcome, but reliable prognostic markers are largely missing. Sarcopenia, the progressive loss of muscle mass and strength, as well as myosteatosis have been associated with an unfavorable outcome in several clinical conditions, including cancer. Here, we evaluated the prognostic relevance of sarcopenia and myosteatosis using routine abdominal CT (computed tomography) scans in advanced stage CCA patients undergoing palliative treatment.
Routine abdominal CT scans were used to assess the skeletal muscle and the psoas muscle index (L3SMI/L3PMI) at the level of the third lumbar vertebra as radiological indices for sarcopenia as well as the mean skeletal muscle attenuation (MMA) as a surrogate for myosteatosis. Results were correlated with clinical data and outcomes.
Using a calculated optimal cut-off value of 71.95 mm/cm, CCA patients with an L3SMI value below this cut-off showed a significantly reduced median overall survival (OS) of only 250 days compared to 450 days in patients with a higher L3SMI. Moreover, the median OS of CCA patients with an L3PMI above 6345 mm/cm was 552 days compared to 252 days in patients with a lower L3PMI. Finally, CCA patients with an MMA above 30.51 Hounsfield Units survived significantly longer (median OS: 430 days) compared to patients with an MMA value below this ideal cut-off (median OS: 215 days). The prognostic relevance of L3SMI, L3PMI, and MMA was confirmed in uni- and multivariate Cox regression analyses.
Routine abdominal CT scans represent a unique opportunity to evaluate sarcopenia as well as myosteatosis in advanced CCA patients. We identified the L3SMI/L3PMI as well as the MMA as negative prognostic factors in CCA patients undergoing palliative therapy, arguing that the "opportunistic" evaluation of these parameters might yield important clinical information in daily routine.
胆管癌（CCA）是第二常见的原发性肝癌，预后很差，但目前仍缺乏可靠的预后标志物。肌肉减少症，即肌肉质量和力量的逐渐丧失，以及肌少脂性在包括癌症在内的多种临床病症中都与不良预后相关。在此，我们利用常规腹部CT（计算机断层扫描）扫描评估了接受姑息治疗的晚期CCA患者中肌肉减少症和肌少脂性的预后相关性。
使用常规腹部CT扫描评估第三腰椎水平的骨骼肌和腰大肌指数（L3SMI/L3PMI），作为肌肉减少症的影像学指标，并将平均骨骼肌衰减（MMA）作为肌少脂性的替代指标。结果与临床数据和预后相关。
使用计算得出的最佳截断值71.95 mm/cm，L3SMI值低于该截断值的CCA患者中位总生存期（OS）显著缩短，仅为250天，而L3SMI值较高的患者为450天。此外，L3PMI高于6345 mm/cm的CCA患者中位OS为552天，而L3PMI较低的患者为252天。最后，MMA高于30.51亨氏单位的CCA患者生存期显著更长（中位OS：430天），而MMA值低于该理想截断值的患者（中位OS：215天）。单因素和多因素Cox回归分析证实了L3SMI、L3PMI和MMA的预后相关性。
常规腹部CT扫描为评估晚期CCA患者的肌肉减少症和肌少脂性提供了独特的机会。我们确定L3SMI/L3PMI以及MMA是接受姑息治疗的CCA患者的负面预后因素，表明对这些参数的“机会性”评估可能在日常临床中产生重要的临床信息。
