Youn Susie, Eurich Dean T, McCall Michael, Walker John, Smylie Michael, Sawyer Michael B
Department of Surgery, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
University of Alberta School of Public Health, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
Clin Nutr. 2022 May;41(5):1066-1072. doi: 10.1016/j.clnu.2022.03.001. Epub 2022 Mar 5.
Sarcopenia (low skeletal muscle index, SMI) and myosteatosis (low skeletal muscle radiodensity, SMD) have been associated with worse survival in cancer. This study evaluated associations of body composition with survival in patients with resected stage III melanoma.
A retrospective review was performed of resected stage III melanoma patients in Alberta, Canada from 2007 to 2017. Preoperative CT scans were analyzed to determine SMI and SMD. Cohort-specific SMI and SMD cut-offs that optimally predicted overall survival (OS) were identified through stratification, in addition to testing cut-offs previously established in the literature. Overall (OS), melanoma-specific (MSS), and recurrence-free survival (RFS) were determined from date of surgery and analysed using multivariable Cox regressions with age, sex, BMI, stage subgroup, ECOG PS, and tumor location as covariates.
We included 330 patients in the final analysis. Mean age was 56 years and 62.4% of patients were male. At time of censoring 150 patients (45.6%) had died. Sarcopenia based on literature cut-offs was associated with decreased OS (HR 1.55, 95% CI 1.00-2.21, p = 0.016). Using cohort-specific cut-offs, sarcopenic patients also had significantly decreased OS (HR 1.87, 95% CI 1.27-2.76, p = 0.002). Myosteatosis defined using cohort-specific cut-offs predicted worse OS (HR 2.15, 95% CI 1.42-3.25, p < 0.001), MSS (HR 2.29, 95% CI 1.40-3.75, p = 0.001) and RFS (HR 1.52, 95% CI 1.02-2.27, p = 0.041). Increased BMI ( ≥ 25) and visceral fat index were not significantly associated with survival.
Sarcopenia and myosteatosis, defined using two sets of cut-offs, are associated with decreased OS and MSS in resected stage III melanoma.
肌肉减少症（低骨骼肌指数，SMI）和肌少脂性（低骨骼肌放射密度，SMD）与癌症患者较差的生存率相关。本研究评估了身体成分与III期黑色素瘤切除患者生存率的相关性。
对2007年至2017年加拿大艾伯塔省III期黑色素瘤切除患者进行回顾性研究。分析术前CT扫描以确定SMI和SMD。通过分层确定了最佳预测总生存期（OS）的队列特异性SMI和SMD临界值，此外还测试了文献中先前确定的临界值。从手术日期确定总生存期（OS）、黑色素瘤特异性生存期（MSS）和无复发生存期（RFS），并使用多变量Cox回归分析，将年龄、性别、BMI、分期亚组、ECOG体能状态和肿瘤位置作为协变量。
最终分析纳入330例患者。平均年龄为56岁，62.4%的患者为男性。在随访时，150例患者（45.6%）死亡。根据文献临界值定义的肌肉减少症与OS降低相关（HR 1.55，95%CI 1.00 - 2.21，p = 0.016）。使用队列特异性临界值，肌肉减少症患者的OS也显著降低（HR 1.87，95%CI 1.27 - 2.76，p = 0.002）。使用队列特异性临界值定义的肌少脂性预测较差的OS（HR 2.15，95%CI 1.42 - 3.25，p < 0.001）、MSS（HR 2.29，95%CI 1.40 - 3.75，p = 0.001）和RFS（HR 1.52，95%CI 1.02 - 2.27，p = 0.041）。BMI增加（≥25）和内脏脂肪指数与生存率无显著相关性。
使用两组临界值定义的肌肉减少症和肌少脂性与III期黑色素瘤切除患者的OS和MSS降低相关。
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