Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer. 2022 Mar 15;128(6):1302-1311. doi: 10.1002/cncr.34043. Epub 2021 Nov 30.
Body composition is associated with chemotherapy toxicity (chemotoxicity) in adults with cancer; this association remains unexplored in children with cancer.
Using baseline computed tomography scans of 107 children with Hodgkin lymphoma (n = 45), non-Hodgkin lymphoma (n = 42), or rhabdomyosarcoma (n = 20), this study examined body composition (skeletal muscle index [SMI], skeletal muscle density [SMD], and height-adjusted total adipose tissue [hTAT]) to determine its association with chemotoxicity. Clinical characteristics and chemotoxicities were abstracted from medical records. Primary outcomes included grade 4 or higher hematologic toxicities and grade 3 or higher nonhematologic toxicities within 6 months of the diagnosis. Logistic regression models accounting for repeated measures were constructed to examine the association between body composition indices and chemotoxicities; adjustments were made for age at diagnosis, sex, race/ethnicity, cancer type, risk group, body mass index (measured as a percentile), or body surface area.
The median SMI was 41.0 cm /m (range, 25.8-68.6 cm /m ), the median SMD was 54.1 HU (range, 35-69.4 HU), and the median hTAT was 19.5 cm /m (range, 0-226.7 cm /m ). Grade 4 or higher hematologic toxicities and grade 3 or higher nonhematologic toxicities were observed in 74.7% and 66.3% of the chemotherapy cycles, respectively. A higher SMD at diagnosis was associated with lower odds of grade 4 or higher hematologic toxicity (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.85-0.97; P = .004). SMI (OR, 0.99; 95% CI, 0.95-1.04; P = .7) and hTAT (OR, 1.00; 95% CI, 0.99-1.01; P = .9) were not associated with hematologic toxicities. Nonhematologic toxicities did not show any association with body composition.
The association between low SMD and hematologic toxicities in children with lymphoma or rhabdomyosarcoma could be due to body composition-based biodistribution of chemotherapeutic agents and needs further investigation.
Body composition at cancer diagnosis in children with lymphoma and rhabdomyosarcoma may provide information that could identify those at risk for serious side effects from chemotherapy. Routinely used measures such as body mass index and body surface area show poor correlations with body composition assessed via computed tomography scans.
人体成分与癌症成人的化疗毒性（化毒性）有关；这一关联在癌症儿童中尚未得到探索。
本研究使用 107 例霍奇金淋巴瘤（n=45）、非霍奇金淋巴瘤（n=42）或横纹肌肉瘤（n=20）患儿的基线计算机断层扫描（CT），检查身体成分（骨骼肌指数[SMI]、骨骼肌密度[SMD]和身高调整的总脂肪组织[hTAT]），以确定其与化毒性的关系。临床特征和化毒性从病历中提取。主要结局包括诊断后 6 个月内发生的 4 级或以上血液学毒性和 3 级或以上非血液学毒性。构建了考虑重复测量的逻辑回归模型，以检查身体成分指标与化毒性之间的关联；调整了诊断时的年龄、性别、种族/民族、癌症类型、风险组、体重指数（以百分位数表示）或体表面积。
中位数 SMI 为 41.0 cm /m（范围，25.8-68.6 cm /m），中位数 SMD 为 54.1 HU（范围，35-69.4 HU），中位数 hTAT 为 19.5 cm /m（范围，0-226.7 cm /m）。74.7%的化疗周期出现 4 级或以上血液学毒性，66.3%的化疗周期出现 3 级或以上非血液学毒性。诊断时较高的 SMD 与较低的 4 级或以上血液学毒性发生率相关（比值比[OR]，0.90；95%置信区间[CI]，0.85-0.97；P=.004）。SMI（OR，0.99；95% CI，0.95-1.04；P=.7）和 hTAT（OR，1.00；95% CI，0.99-1.01；P=.9）与血液学毒性无关。非血液学毒性与身体成分无任何关联。
淋巴瘤或横纹肌肉瘤患儿 SMD 低与血液学毒性之间的关联可能是由于化疗药物基于身体成分的分布不同所致，需要进一步研究。
淋巴瘤和横纹肌肉瘤患儿癌症诊断时的身体成分可能提供可识别化疗严重副作用风险的信息。体重指数和体表面积等常用指标与 CT 扫描评估的身体成分相关性较差。
