Lascala Fabiana, da Silva Moraes Bruna Karoline, Mendes Maria Carolina Santos, de Carvalho Mariluce Barbosa, Branbilla Sandra Regina, da Cunha Júnior Ademar Dantas, Lopes Luiz Roberto, Andreollo Nelson Adami, Macedo Lígia Traldi, Prado Carla M, Carvalheira José Barreto Campello
Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, PR, Brazil.
Eur J Clin Nutr. 2023 Jan;77(1):116-126. doi: 10.1038/s41430-022-01201-7. Epub 2022 Sep 8.
BACKGROUND/OBJECTIVES: The association between systemic inflammation and myosteatosis upon diagnosis of gastric cancer (GC) and whether these factors could predict survival outcomes is not clear. Our aim was to explore the association between systemic inflammation and myosteatosis upon diagnosis of GC, specially whether the co-occurrence of these factors could predict survival outcomes.
SUBJECTS/METHODS: Computed tomography (CT) was performed at the level of the third lumbar vertebra for body composition analysis in 280 patients with GC. Myoesteatosis was defined as the lowest tertile of the muscle radiodensity distribution or based on clinical significance using optimal stratification analysis. Inflammatory indexes were measured, including the neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte and lymphocyte-to-monocyte ratios.
Patients with low skeletal muscle (SM) radiodensity were more likely to be older than 65 years, have a higher body mass index and have diabetes. They also had higher intermuscular visceral and subcutaneous adipose tissue areas and indexes. The highest tertile of SM radiodensity was associated with better disease-free survival (DFS) (HR = 0.51, 95% CI [0.31, 0.84], p = 0.020) and overall survival (OS) (HR = 0.49, 95% CI [0.29, 0.82], p = 0.022). Patients with NLR > 2.3 and myosteatosis had the worst DFS and OS (HR = 2.77, 95% CI [1.54, 5.00], p = 0.001; HR = 3.31, 95% CI [1.79, 6.15], p < 0.001, respectively).
Co-occurrence of myosteatosis and inflammation increased disease progression and death risk by almost three times. These regularly obtained biomarkers might improve prognostic risk prediction in resectable GC.
背景/目的：胃癌（GC）诊断时全身炎症与肌少脂性之间的关联以及这些因素是否能够预测生存结局尚不清楚。我们的目的是探讨GC诊断时全身炎症与肌少脂性之间的关联，特别是这些因素的共同出现是否能够预测生存结局。
受试者/方法：对280例GC患者在第三腰椎水平进行计算机断层扫描（CT）以分析身体成分。肌少脂性定义为肌肉放射密度分布的最低三分位数或基于临床意义采用最佳分层分析来定义。测量炎症指标，包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值以及淋巴细胞与单核细胞比值。
骨骼肌（SM）放射密度低的患者更可能年龄大于65岁、体重指数较高且患有糖尿病。他们的肌间内脏和皮下脂肪组织面积及指数也更高。SM放射密度的最高三分位数与更好的无病生存期（DFS）（风险比[HR]=0.51，95%置信区间[CI][0.31,0.84]，p=0.020）和总生存期（OS）（HR=0.49，95%CI[0.29,0.82]，p=0.022）相关。NLR>2.3且存在肌少脂性的患者DFS和OS最差（HR分别为2.77，95%CI[1.54,5.00]，p=0.001；HR=3.31，95%CI[1.79,6.15]，p<0.001）。
肌少脂性与炎症的共同出现使疾病进展和死亡风险增加近三倍。这些常规获取的生物标志物可能会改善可切除GC的预后风险预测。
