Calixto-Lima Larissa, Wiegert Emanuelly Varea Maria, Oliveira Livia Costa de, Chaves Gabriela Villaça, Bezerra Flavia Fioruci, Avesani Carla Maria
National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil.
Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
JPEN J Parenter Enteral Nutr. 2023 Feb;47(2):265-275. doi: 10.1002/jpen.2460. Epub 2022 Nov 29.
Factors associated with the concomitant occurrence of low muscle mass and low muscle radiodensity are unclear. This study investigated whether different skeletal muscle phenotypes are associated with functional impairment, serum inflammatory markers, and survival in patients with incurable cancer.
Three hundred and twenty-six patients (median age, 60 years; 67.5% female) who had abdominal or pelvic computed tomography (CT) scans up to 30 days before the initial assessment were enrolled in the study. CT images were used for the assessment of skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD). Optimal stratification analysis was used to derive cohort-specific cutoff points to define SMI and SMD groups with a higher risk for mortality (SMI, males <45.0 cm /m and females <44.0 cm /m ; SMD, males <34 Hounsfield units [HU] and females <30 HU). Based on these cutoffs, participants were classified into four phenotypes: low-risk SMI + low-risk SMD, high-risk SMI + low-risk SMD, low-risk SMI + high-risk SMD, and high-risk SMI + high-risk SMD.
Phenotypes with high-risk SMI or high-risk SMD, especially when combined, were associated with low handgrip strength, poor performance status, higher C-reactive protein, and lower serum albumin levels. The phenotypes with high-risk SMD, regardless of low-risk SMI (hazard ratio [HR], 1.74; 95% CI, 1.05-2.88) or high-risk SMI (HR, 1.99; 95% CI, 1.29-3.05) were associated with higher 90 days' mortality risk.
In patients with incurable cancer, phenotype groups with high-risk SMI and high-risk SMD, particularly when combined, were associated with worse functional impairment and inflammation. Moreover, high-risk SMD was associated with increased mortality risk.
低肌肉量与低肌肉放射密度同时出现的相关因素尚不清楚。本研究调查了不同的骨骼肌表型是否与无法治愈的癌症患者的功能障碍、血清炎症标志物及生存率相关。
对在初次评估前30天内进行过腹部或盆腔计算机断层扫描（CT）的326例患者（中位年龄60岁；67.5%为女性）进行研究。CT图像用于评估骨骼肌指数（SMI）和骨骼肌放射密度（SMD）。采用最佳分层分析得出特定队列的截断点，以定义死亡风险较高的SMI和SMD组（SMI，男性<45.0 cm²/m²且女性<44.0 cm²/m²；SMD，男性<34亨氏单位[HU]且女性<30 HU）。基于这些截断点，参与者被分为四种表型：低风险SMI + 低风险SMD、高风险SMI + 低风险SMD、低风险SMI + 高风险SMD和高风险SMI + 高风险SMD。
高风险SMI或高风险SMD的表型，尤其是两者同时存在时，与握力低、体能状态差、C反应蛋白水平较高及血清白蛋白水平较低相关。无论低风险SMI（风险比[HR]，1.74；95%置信区间[CI]，1.05 - 2.88）还是高风险SMI（HR，1.99；95% CI，1.29 - 3.05），高风险SMD的表型均与90天死亡风险较高相关。
在无法治愈癌症的患者中，高风险SMI和高风险SMD的表型组，尤其是两者同时存在时，与更严重的功能障碍和炎症相关。此外，高风险SMD与死亡风险增加相关。
