Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
J Surg Oncol. 2023 Jul;128(1):75-84. doi: 10.1002/jso.27251. Epub 2023 Mar 27.
The association between sarcopenia and response to neoadjuvant treatment remains unclear. This study investigates sarcopenia as a predictor of overall complete response (oCR) after Total Neoadjuvant Therapy (TNT) for advanced rectal cancer.
A prospective observational study was performed of patients with rectal cancer undergoing TNT at three South Australian hospitals between 2019 and 2022. Sarcopenia was diagnosed by pretreatment computed tomography measurement of psoas muscle cross-sectional area at the third lumbar vertebra level, normalised for patient height. The primary endpoint was oCR rate defined as the proportion of patients who achieved either clinical complete response (cCR) or pathological complete response.
This study included 118 rectal cancer patients with an average age of 59.5 years, 83 (70.3%) of whom formed the non-sarcopenic group (NSG) and 35 (29.7%) the sarcopenic group (SG). The oCR rate was significantly higher in NSG compared with the SG (p < 0.001). cCR rate was significantly greater in NSG compared with the SG (p = 0.001). Multivariate analysis revealed sarcopenia (p = 0.029) and hypoalbuminemia (p = 0.040) were risk factors for cCR and sarcopenia was an independent risk factor for oCR (p = 0.020).
Sarcopenia and hypoalbuminemia were negatively associated with tumour response following TNT in advanced rectal cancer patients.
肌少症与新辅助治疗反应之间的关系尚不清楚。本研究探讨了肌少症作为接受全新辅助治疗（TNT）的晚期直肠癌患者总体完全缓解（oCR）的预测指标。
对 2019 年至 2022 年间在南澳大利亚的三家医院接受 TNT 的直肠癌患者进行了前瞻性观察研究。通过第三腰椎水平的竖脊肌横截面积的预处理 CT 测量来诊断肌少症，并对患者的身高进行归一化。主要终点是 oCR 率，定义为达到临床完全缓解（cCR）或病理完全缓解的患者比例。
本研究纳入了 118 例平均年龄为 59.5 岁的直肠癌患者，其中 83 例（70.3%）为非肌少症组（NSG），35 例（29.7%）为肌少症组（SG）。与 SG 相比，NSG 的 oCR 率显著更高（p<0.001）。NSG 的 cCR 率显著高于 SG（p=0.001）。多变量分析显示，肌少症（p=0.029）和低白蛋白血症（p=0.040）是 cCR 的危险因素，肌少症是 oCR 的独立危险因素（p=0.020）。
肌少症和低白蛋白血症与晚期直肠癌患者接受 TNT 后的肿瘤反应呈负相关。
