Department of Urology, Yale University School of Medicine, New Haven, Connecticut.
Department of Urology, University of Washington School of Medicine, Seattle, Washington.
Cancer. 2022 Jun 1;128(11):2073-2084. doi: 10.1002/cncr.34174. Epub 2022 Mar 14.
This study was aimed at assessing the associations of sarcopenia, muscle density, adiposity, and inflammation with overall survival (OS) after cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma.
In all, 158 patients undergoing CN from 2001 to 2014 had digitized preoperative imaging for tissue segmentation via Slice-O-Matic software (version 5.0) at the mid-L3 level. The skeletal muscle index was calculated with the skeletal muscle area (cm ) normalized for height (m ), and the skeletal muscle density (SMD) was calculated with average Hounsfield units. Adiposity was measured with the cross-sectional area (cm ) of visceral, subcutaneous, and intramuscular adiposity compartments and was similarly normalized for height. The average fat density was obtained in Hounsfield units. OS was estimated with the Kaplan-Meier method. Associations between body composition, inflammation metrics, and relevant clinicopathology and OS were assessed with univariable and multivariate Cox analyses.
Seventy-six of the 158 patients (48%) were sarcopenic. Sarcopenia was associated with elevated neutrophil to lymphocyte ratios (NLRs; P = .02), increased age (P = .001), lower body mass indices (P = .009), greater modified Motzer scores (P = .019), and lower SMD (P = .006). The median OS was 15.0 and 29.4 months for sarcopenic and nonsarcopenic patients, respectively (P = .04). Elevated inflammation (NLR or C-reactive protein), in addition to sarcopenia, was independently associated with OS, with an elevated NLR ≥ 3.5 and sarcopenia associated with the poorest OS at 10.2 months. No associations were observed between measurements of muscle density or adiposity and OS.
Sarcopenia and measures of high systemic inflammation are additively associated with inferior OS after CN and may be of use in preoperative risk stratification.
Body composition and sarcopenia (a deficiency in skeletal musculature) have been shown to affect outcomes in cancer. We found that sarcopenic patients had poor survival in comparison with nonsarcopenic patients in the setting of metastatic renal cell carcinoma (mRCC). Patients with both elevated inflammation and sarcopenia had the poorest survival. Sarcopenia is an objective measure of nutrition that can assist in therapeutic counseling and decision-making for individualized treatment in mRCC.
本研究旨在评估肌肉减少症、肌肉密度、肥胖和炎症与接受细胞减灭性肾切除术（CN）治疗转移性肾细胞癌（mRCC）后的总生存期（OS）之间的相关性。
2001 年至 2014 年间共 158 例接受 CN 的患者，通过 Slice-O-Matic 软件（版本 5.0）对术前数字成像进行组织分割。通过将骨骼肌面积（cm ）标准化为身高（m ）来计算骨骼肌指数，通过平均亨氏单位来计算骨骼肌密度（SMD）。通过内脏、皮下和肌内脂肪体积的横截面积（cm ）来测量肥胖程度，并按身高进行类似的标准化。平均脂肪密度以亨氏单位表示。采用 Kaplan-Meier 法估计 OS。通过单变量和多变量 Cox 分析评估体成分、炎症指标与相关临床病理学因素和 OS 之间的关系。
158 例患者中有 76 例（48%）患有肌肉减少症。肌肉减少症与高中性粒细胞与淋巴细胞比值（NLR；P =.02）、年龄较大（P =.001）、体重指数较低（P =.009）、改良的 Motzer 评分较高（P =.019）和 SMD 较低（P =.006）相关。肌肉减少症患者的中位 OS 为 15.0 个月，非肌肉减少症患者为 29.4 个月（P =.04）。除肌肉减少症外，升高的炎症（NLR 或 C 反应蛋白）与 OS 独立相关，NLR≥3.5 和肌肉减少症与最差的 OS 相关，为 10.2 个月。肌肉密度或肥胖的测量值与 OS 之间没有观察到相关性。
肌肉减少症和全身性炎症的升高与 CN 后较差的 OS 相关，可用于术前风险分层。
身体成分和肌肉减少症（骨骼肌缺乏）已被证明会影响癌症患者的预后。我们发现，与非肌肉减少症患者相比，肌肉减少症患者的转移性肾细胞癌（mRCC）患者的生存率较低。同时存在炎症升高和肌肉减少症的患者的生存率最差。肌肉减少症是一种营养的客观衡量标准，可用于协助咨询和决策治疗，并为 mRCC 患者提供个体化治疗。
