Department of Surgery, Division of Gastrointestinal and Pediatric Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
Department of Surgery, Japanese Red Cross Tottori Hospital, 117 Shotoku-cho, Tottori, 680-8517, Japan.
BMC Cancer. 2021 Nov 13;21(1):1219. doi: 10.1186/s12885-021-08953-8.
The mortality rate of patients with unresectable gastric cancer (UGC) has decreased with the development of chemotherapies and surgical techniques. However, the survival rate remains low. We retrospectively examined the prognostic significance of the pretreatment skeletal muscle mass index (SMI) and nutritional and inflammatory factors in patients with UGC.
This study included 83 patients diagnosed with UGC at Tottori University Hospital who received palliative chemotherapy based on 5-fluorouracil. Pretreatment computed tomography (CT) measured overall skeletal muscle mass (SMM) and cross-sectional SMM at the third lumbar vertebra (L3). We focused on the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), prognostic nutritional index (PNI), and platelet-to-lymphocyte ratio (PLR) as nutritional and inflammatory factors.
Receiver operating characteristic curve analysis was performed for median survival time (MST) after palliative chemotherapy. SMIs for males and females (43.9 cm/m and 34.7 cm/m, respectively) were the cutoff values, and patients were divided into high (SMI; n = 41) and low SMI groups (SMI; n = 42). Body mass index (BMI) was significantly higher in patients in the SMI group than in the SMI group (p < 0.001). The number of patients who received third-line chemotherapy was significantly higher in the SMI group than in the SMI group (p = 0.037). The MST was significantly higher in the SMI group than in the SMI group (17.3 vs. 13.8 months; p = 0.008). The incidence of grade 3 or 4 side effects was significantly higher in patients with SMI UGC (p = 0.028). NLR was significantly higher in patients with SMI than it was in those with SMI. (p = 0.047). In the univariate analysis, performance status, SMI, histological type, lines of chemotherapy, and NLR were prognostic indicators. The multivariate analysis identified SMI (p = 0.037), NLR (p = 0.002), and lines of chemotherapy (p < 0.001) as independent prognostic factors.
The SMI group had significantly more grade 3 or 4 side effects, were related to high NLR, and had a significantly worse prognosis than the SMI group.
Retrospectively registerd.
随着化疗和手术技术的发展，不可切除胃癌（UGC）患者的死亡率有所下降。然而，生存率仍然较低。我们回顾性研究了 UGC 患者治疗前骨骼肌质量指数（SMI）和营养及炎症因素的预后意义。
本研究纳入了在鸟取大学医院接受基于 5-氟尿嘧啶姑息化疗的 83 例 UGC 患者。治疗前 CT 测量了总骨骼肌质量（SMM）和第三腰椎（L3）的横截面积 SMM。我们主要关注中性粒细胞与淋巴细胞比值（NLR）、C 反应蛋白与白蛋白比值（CAR）、预后营养指数（PNI）和血小板与淋巴细胞比值（PLR）等营养和炎症因素。
对姑息化疗后中位生存时间（MST）进行了受试者工作特征曲线分析。男性和女性的 SMI（分别为 43.9cm/m 和 34.7cm/m）为截断值，将患者分为高 SMI 组（n=41）和低 SMI 组（n=42）。高 SMI 组的 BMI 显著高于低 SMI 组（p<0.001）。高 SMI 组接受三线化疗的患者数量显著多于低 SMI 组（p=0.037）。高 SMI 组的 MST 显著长于低 SMI 组（17.3 与 13.8 个月；p=0.008）。SMI UGC 患者的 3 级或 4 级不良反应发生率显著高于低 SMI 组（p=0.028）。SMI 患者的 NLR 显著高于低 SMI 组（p=0.047）。单因素分析显示，体力状态、SMI、组织学类型、化疗线数和 NLR 是预后指标。多因素分析确定 SMI（p=0.037）、NLR（p=0.002）和化疗线数（p<0.001）为独立的预后因素。
高 SMI 组 3 级或 4 级不良反应发生率显著较高，与高 NLR 相关，预后显著差于低 SMI 组。
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