Ge Yi-Zhong, Ruan Guo-Tian, Zhang Qi, Dong Wen-Jun, Zhang Xi, Song Meng-Meng, Zhang Xiao-Wei, Li Xiang-Rui, Zhang Kang-Ping, Tang Meng, Li Wei, Shen Xian, Shi Han-Ping
Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Nutr Metab (Lond). 2022 May 7;19(1):34. doi: 10.1186/s12986-022-00667-3.
Body water measured by bioelectrical impedance analysis (BIA) predicts the outcomes of many diseases. This study aimed to evaluate the relationship between body water and the prognosis of cancer patients with sarcopenia.
This study employed 287 cancer patients with sarcopenia underwent BIA from a prospective multicenter study of patients with cancer in China from 2013 to 2020. The primary outcome of interest was all-cause mortality presented as the longest time to follow-up available. Eight indicators of body water [total body water, extracellular water, intracellular water, free fat mass, active cell mass, extracellular water/intracellular water, extracellular water/total body water (ECW/TBW), and intracellular water/total body water] were included in the research. Neutrophil-lymphocyte ratio (NLR) = neutrophil (× 10)/lymphocyte (× 10). The discriminatory ability and prediction accuracy of each factor were assessed using the C-index. The hazard ratios (HR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazard model.
The median age was 65 years old, and 138 (48%) patients were men. During a mean follow-up of 46 months, 140 deaths were recorded, resulting in a rate of 204.6 events per 1000 patient-years. ECW/TBW showed the best predictive accuracy (C-index = 0.619) compared to the other indicators [p = 0.004, adjusted HR (95% CI) 1.70 (1.18,2.44)]. In the middle tertile (0.385-0.405), ECW/TBW had a strong independent negative association with patient survival [adjusted HR (95% CI) 2.88 (1.39-5.97), p = 0.004]. Patients who had a high ECW/TBW (ECW/TBW ≥ 0.395) combined with a high NLR had 3.84-fold risk of mortality (p < 0.001, 95% CI 1.99,7.38).
ECW/TBW was better than other indicators in predicting survival of cancer patients with sarcopenia. High ECW/TBW combined with high NLR would further increase the risk of mortality.
The Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) (Chinese Clinical Trial Registry: ChiCTR1800020329, URL of registration: http://www.chictr.org.cn/showprojen.aspx?proj=31813 ).
通过生物电阻抗分析（BIA）测量的身体水分可预测多种疾病的预后。本研究旨在评估身体水分与癌症合并肌少症患者预后之间的关系。
本研究纳入了287例癌症合并肌少症患者，这些患者来自2013年至2020年在中国进行的一项关于癌症患者的前瞻性多中心研究，并接受了BIA检查。主要关注的结局是全因死亡率，以可获得的最长随访时间表示。研究纳入了八项身体水分指标[总体水、细胞外水、细胞内水、游离脂肪量、活性细胞量、细胞外水/细胞内水、细胞外水/总体水（ECW/TBW）和细胞内水/总体水]。中性粒细胞与淋巴细胞比值（NLR）=中性粒细胞（×10）/淋巴细胞（×10）。使用C指数评估每个因素的鉴别能力和预测准确性。使用Cox比例风险模型计算风险比（HR）和95%置信区间（CI）。
中位年龄为65岁，138例（48%）患者为男性。在平均46个月的随访期间，记录了140例死亡，死亡率为每1000患者年204.6例事件。与其他指标相比，ECW/TBW显示出最佳的预测准确性（C指数=0.619）[p=0.004，调整后HR（95%CI）1.70（1.18，2.44）]。在中间三分位数（0.385 - 0.405）中，ECW/TBW与患者生存具有强烈的独立负相关[调整后HR（95%CI）2.88（1.39 - 5.97），p=0.004]。ECW/TBW高（ECW/TBW≥0.395）且NLR高的患者死亡风险是3.84倍（p<0.001，95%CI 1.99，7.38）。
在预测癌症合并肌少症患者的生存方面，ECW/TBW优于其他指标。高ECW/TBW与高NLR相结合会进一步增加死亡风险。
常见癌症营养状况与临床结局调查（INSCOC）（中国临床试验注册中心：ChiCTR1800020329，注册网址：http://www.chictr.org.cn/showprojen.aspx?proj=31813 ）
