Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Int J Clin Oncol. 2022 Jan;27(1):141-153. doi: 10.1007/s10147-021-02062-z. Epub 2021 Nov 6.
This study aimed to investigate the effect of sarcopenia on the prognosis of advanced lower rectal cancer patients receiving neoadjuvant chemoradiotherapy (CRT). Sarcopenia has been recognized as an adverse factor for surgical outcomes in several malignancies. However, the impact of preoperative sarcopenia on rectal cancer patients receiving CRT is still unknown.
This retrospective study included cT3-T4 anyN M0 lower rectal cancer patients who underwent CRT followed by R0 resection at our institution between October 2003 and December 2016. CRT consisted of 5-fluorouracil-based oral chemotherapy and long course radiation (50.4 Gy/28 fr). The psoas muscle area at the third lumbar vertebra level was evaluated by computed tomography before and after CRT, and was adjusted by the square of the height to obtain the psoas muscle mass index (PMI). Sarcopenia was defined as the sex-specific lowest quartile of the PMI. We assessed the association between pre- and post-CRT sarcopenia and postoperative prognosis.
Among 234 patients, 55 and 179 patients were categorized as sarcopenia and non-sarcopenia patients, respectively. Although post-CRT sarcopenia correlated with residual tumor size, it had no association with other pathological features. The median follow-up period was 72.9 months, and the 5-year DFS and OS were 67.0% and 85.8%, respectively. Multivariate analysis showed that post-CRT sarcopenia was independently associated with poor DFS (HR: 1.76; P = 0.036), OS (HR: 2.01; P = 0.049), and recurrence in the liver (HR: 3.01; P = 0.025).
Sarcopenia is a poor prognostic indicator in lower advanced rectal cancer patients treated with CRT.
本研究旨在探讨肌少症对接受新辅助放化疗（CRT）的晚期低位直肠癌患者预后的影响。肌少症已被认为是多种恶性肿瘤手术结局的不利因素。然而，术前肌少症对接受 CRT 的直肠癌患者的影响尚不清楚。
本回顾性研究纳入了 2003 年 10 月至 2016 年 12 月期间在我院接受 CRT 后行 RO 切除的 cT3-T4 任何 N M0 低位直肠癌患者。CRT 包括基于氟尿嘧啶的口服化疗和长程放疗（50.4Gy/28 次）。在 CRT 前后通过 CT 评估第三腰椎水平的竖脊肌面积，并通过身高的平方进行调整以获得竖脊肌质量指数（PMI）。肌少症定义为 PMI 的性别特异性最低四分位数。我们评估了 CRT 前后肌少症与术后预后的关系。
在 234 例患者中，55 例和 179 例患者分别被归类为肌少症和非肌少症患者。虽然 CRT 后肌少症与残留肿瘤大小相关，但与其他病理特征无关。中位随访时间为 72.9 个月，5 年无病生存率（DFS）和总生存率（OS）分别为 67.0%和 85.8%。多因素分析显示，CRT 后肌少症与较差的 DFS（HR：1.76；P=0.036）、OS（HR：2.01；P=0.049）和肝脏复发（HR：3.01；P=0.025）独立相关。
肌少症是接受 CRT 治疗的低位晚期直肠癌患者的不良预后指标。
