低骨骼肌量预测肿瘤治疗反应：一项荟萃分析。
Low skeletal muscle mass predicts treatment response in oncology: a meta-analysis.
机构信息
Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany.
Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
出版信息
Eur Radiol. 2023 Sep;33(9):6426-6437. doi: 10.1007/s00330-023-09524-0. Epub 2023 Mar 16.
OBJECTIVES
Low skeletal muscle mass (LSMM) predicts relevant clinical outcomes in oncologic patients. The purpose of this study was to perform a meta-analysis of data regarding associations between LSMM and treatment response (TR) in oncology.
METHODS
MEDLINE, Cochrane, and SCOPUS databases were screened for relationships between LSMM and TR in oncologic patients up to November 2022. Overall, 35 studies met the inclusion criteria. The meta-analysis was performed using RevMan 5.4 software.
RESULTS
The collected 35 studies comprised 3858 patients. In 1682 patients (43.6%), LSMM was diagnosed. In the overall sample, LSMM predicted a negatively objective response rate (ORR), OR = 0.70, 95% CI = (0.54-0.91), p = 0.007, and disease control rate (DCR), OR = 0.69, 95% CI = (0.50-0.95), p = 0.02. In the curative setting, LSMM predicted a negatively ORR, OR = 0.24, 95% CI = (0.12-0.50), p = 0.0001, but not DCR, OR = 0.60, 95% CI = (0.31-1.18), p = 0.14. In palliative treatment with conventional chemotherapies, LSMM did not predict ORR: OR = 0.94, 95% CI (0.57-1.55), p = 0.81, and DCR: OR = 1.13, 95% CI (0.38-3.40), p = 0.82. In palliative treatment with tyrosine kinase inhibitors (TKI), LSMM did not predict TR: ORR, OR = 0.74, 95% CI (0.44-1.26), p = 0.27, and DCR, OR = 1.04, 95% CI (0.53-2.05), p = 0.90. In palliative immunotherapy, LSMM tended to predict ORR, OR = 0.74, 95% CI = (0.54-1.01), p = 0.06, and predicted DCR, OR = 0.53, 95% CI = (0.37-0.76), p = 0.0006.
CONCLUSION
LSMM is a risk factor for poor TR in curative chemotherapy in the adjuvant and/or neoadjuvant setting. LSMM is a risk factor for treatment failure in treatment with immunotherapy. Finally, LSMM does not influence TR in palliative treatment with conventional chemotherapy and/or TKIs.
KEY POINTS
• Low skeletal muscle mass (LSMM) predicts treatment response (TR) to chemotherapy in the adjuvant and/or neoadjuvant setting. • LSMM predicts TR in immunotherapy. • LSMM does not influence TR in palliative chemotherapy.
目的
低骨骼肌量（LSMM）可预测肿瘤患者的相关临床结局。本研究旨在对有关 LSMM 与肿瘤患者治疗反应（TR）之间关系的数据进行荟萃分析。
方法
截至 2022 年 11 月，通过 MEDLINE、Cochrane 和 SCOPUS 数据库筛选 LSMM 与肿瘤患者 TR 之间关系的研究。共纳入 35 项研究。采用 RevMan 5.4 软件进行荟萃分析。
结果
共纳入 35 项研究，包含 3858 例患者。在 1682 例患者（43.6%）中诊断出 LSMM。在总体样本中，LSMM 预测客观缓解率（ORR）和疾病控制率（DCR）的可能性降低，OR 值分别为 0.70（95%CI：0.54-0.91）和 0.69（95%CI：0.50-0.95），p 值分别为 0.007 和 0.02。在根治性治疗中，LSMM 预测 ORR 的可能性降低，OR 值为 0.24（95%CI：0.12-0.50），p 值为 0.0001，但对 DCR 无影响，OR 值为 0.60（95%CI：0.31-1.18），p 值为 0.14。在接受常规化疗的姑息性治疗中，LSMM 对 ORR 和 DCR 无预测作用，OR 值分别为 0.94（95%CI：0.57-1.55）和 1.13（95%CI：0.38-3.40），p 值分别为 0.81 和 0.82。在接受酪氨酸激酶抑制剂（TKI）姑息性治疗的患者中，LSMM 对 TR 无预测作用，OR 值分别为 0.74（95%CI：0.44-1.26）和 1.04（95%CI：0.53-2.05），p 值分别为 0.27 和 0.90。在姑息性免疫治疗中，LSMM 倾向于预测 ORR（OR 值为 0.74，95%CI：0.54-1.01），p 值为 0.06，同时预测 DCR（OR 值为 0.53，95%CI：0.37-0.76），p 值为 0.0006。
结论
在辅助和/或新辅助化疗的根治性治疗中，LSMM 是治疗反应（TR）不良的危险因素。LSMM 是免疫治疗中治疗失败的危险因素。最后，LSMM 不影响常规化疗和/或 TKI 姑息性治疗的 TR。
关键点
• LSMM 可预测辅助和/或新辅助化疗中肿瘤患者的治疗反应（TR）。• LSMM 可预测免疫治疗的 TR。• LSMM 不影响姑息性化疗的 TR。
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