Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA; University of Florida Health Cancer Center, Gainesville, Florida, USA.
Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA.
Nutrition. 2023 Mar;107:111934. doi: 10.1016/j.nut.2022.111934. Epub 2022 Dec 10.
Individuals with prior cancer diagnosis are more likely to have low muscle mass (LMM) than their cancer-free counterparts. Understanding the effects of LMM on the prognosis of cancer survivors can be clinically important. The aim of this study was to investigate whether risks for all-cause and cardiovascular disease (CVD)-specific mortality differ by status of LMM in cancer survivors and a matched cohort without cancer history.
We used cohort data from the 1999-2006 and 2011-2014 National Health and Nutrition Examination Survey. Participants included 946 adults surviving for ≥1 since cancer diagnosis and a matched cohort (by age, sex, and race) without cancer history (N = 1857). LMM was defined by appendicular lean mass and body height (men <7.26 kg/m, women <5.45 kg/m). Death was ascertained via the National Death Index and cause of death was assessed via International Classification of Diseases, Tenth Revision. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratio (aHR) and 95% confidence interval (CI) of LMM.
The mean age of cancer survivors and matched cohort was 60.6 y (SD 15) and 60.2 y (SD 14.9), respectively. The median follow-up was 10.5 y for survivors and 10.9 y for matched cohort. Overall, 22.2% of cancer survivors and 19.7% of the matched cohort had LMM, respectively. In all, 321 survivors (33.9%) and 495 participants (26.7%) in the matched cohort died during follow-up. CVD-specific deaths were identified in 58 survivors (6.1%) and 122 participants in the matched cohort (6.6%). The multivariable Cox model suggested that LMM was positively associated with all-cause (aHR, 1.73; 95% CI, 1.31-2.29) and CVD-specific (aHR, 2.13; 95% CI, 1.14-4.00) mortality in cancer survivors. The associations between LMM and risk for all-cause (aHR, 1.24; 95% CI, 0.98-1.56) and CVD-specific (aHR, 1.21; 95% CI, 0.75-1.93) mortality were not statistically significant in the matched cohort.
Cancer survivors with LMM have an increased risk for all-cause and CVD-specific mortality. This increase appears to be larger than that in counterparts without cancer history.
患有癌症的个体比没有癌症的个体更容易出现肌肉减少症（低肌肉质量）。了解低肌肉质量对癌症幸存者预后的影响在临床上可能很重要。本研究的目的是调查在癌症幸存者和无癌症病史的匹配队列中，低肌肉质量状态是否会影响全因和心血管疾病（CVD）特异性死亡率。
我们使用了 1999-2006 年和 2011-2014 年全国健康和营养调查的队列数据。参与者包括 946 名癌症存活时间≥1 年的成年人和一个无癌症病史的匹配队列（按年龄、性别和种族）（n=1857）。低肌肉质量通过四肢瘦体重和身高（男性<7.26kg/m，女性<5.45kg/m）定义。死亡通过国家死亡指数确定，死因通过国际疾病分类，第十次修订版评估。多变量 Cox 比例风险模型用于估计低肌肉质量的调整后危险比（aHR）和 95%置信区间（CI）。
癌症幸存者和匹配队列的平均年龄分别为 60.6 岁（SD 15）和 60.2 岁（SD 14.9）。幸存者的中位随访时间为 10.5 年，匹配队列为 10.9 年。总的来说，分别有 22.2%的癌症幸存者和 19.7%的匹配队列有低肌肉质量。在随访期间，共有 321 名幸存者（33.9%）和 495 名匹配队列成员（26.7%）死亡。在幸存者中，有 58 人（6.1%）和匹配队列中的 122 人（6.6%）死于心血管疾病特定死亡。多变量 Cox 模型表明，低肌肉质量与癌症幸存者的全因死亡率（aHR，1.73；95%CI，1.31-2.29）和心血管疾病特异性死亡率（aHR，2.13；95%CI，1.14-4.00）呈正相关。在匹配队列中，低肌肉质量与全因死亡率（aHR，1.24；95%CI，0.98-1.56）和心血管疾病特异性死亡率（aHR，1.21；95%CI，0.75-1.93）之间的关联没有统计学意义。
患有低肌肉质量的癌症幸存者全因死亡率和心血管疾病特异性死亡率增加。这种增加似乎大于无癌症病史的对照者。
