在诊断为骨转移肺癌的患者中，外周肌肉量而非轴周肌肉量与早期死亡率相关。

Peripheral but not axial muscle mass is associated with early mortality in bone metastatic lung cancer patients at diagnosis.

机构信息

Département de Radiologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Département de Radiologie, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France; Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; CREATIS, CNRS UMR 5220, Inserm 1206 Unit, Université Lyon 1, INSA Lyon, 69100 Villeurbanne, France.

Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Inserm UMR1033, LYOS, Université de Lyon, 69003 Lyon, France.

出版信息

Joint Bone Spine. 2023 Sep;90(5):105613. doi: 10.1016/j.jbspin.2023.105613. Epub 2023 Jul 11.

DOI:10.1016/j.jbspin.2023.105613

PMID:37442335

Abstract

OBJECTIVES

Identification of sarcopenia is a key issue in oncology. Several methods may be used to evaluate muscle mass in patients. Routine cancer follow-up computed tomography (CT) provides axial muscle mass whereas whole-body densitometry (DEXA) measures appendicular lean mass (ALM). Up to now, no studies have assessed, in cancer patients, the correlation between CT and DEXA muscle mass indicators and compared their prognostic value.

METHODS

We included patients with synchronous bone metastases from lung adenocarcinoma at diagnosis. Diagnosis was confirmed by bone biopsy. Skeletal muscle area was determined semi-automatically on initial CT scan at the T7, T12, and L3 vertebral level using Osirix® software. The skeletal muscle index (SMI) was calculated as the ratio of muscle area to height squared. Standardised ALM/height squared data were obtained by DEXA assessment within a 30-day window of CT.

RESULTS

A total of 65 patients were included; 47 (72%) were male. Mean±SD age was 65±11.4years. DEXA was available for 46 patients. The performance status was good (<1) for 39 patients. SMI indicators were significantly correlated with each other (rho from 0.3 to 0.7) but moderately correlated with ALM (rho from 0.1 to 0.7). ALM had a good discriminatory ability on 6-month survival (AUC 0.87 [0.76; 0.97]). ALM was associated with early mortality (<6months) (HR=0.29, 95% CI [0.15; 0.57]; P<0.001) but not with later mortality (>6months). In contrast, no significant effect was found for SMI.

CONCLUSIONS

Peripheral muscle mass (standardized ALM by DEXA) but not axial muscle mass (SMI assessed by CT) was associated with early mortality (<6months) suggesting that cancer-induced muscle loss would affect differently appendicular muscles and axial muscles.

摘要

目的

在肿瘤学中，识别肌肉减少症是一个关键问题。有几种方法可用于评估患者的肌肉量。常规癌症随访计算机断层扫描（CT）提供了轴向肌肉量，而全身密度测定法（DEXA）则测量四肢瘦体重（ALM）。到目前为止，尚无研究评估癌症患者 CT 和 DEXA 肌肉量指标之间的相关性，并比较其预后价值。

方法

我们纳入了初诊时同时伴有肺腺癌骨转移的患者。通过骨活检确认诊断。使用 Osirix®软件在初始 CT 扫描的 T7、T12 和 L3 椎体水平半自动确定骨骼肌面积。通过 DEXA 评估在 CT 后 30 天的窗口内获得标准化的 ALM/身高平方数据。

结果

共纳入 65 例患者，其中 47 例（72%）为男性。平均年龄±标准差为 65±11.4 岁。有 46 例患者可进行 DEXA 检查。状态良好（<1）的患者有 39 例。SMI 指标彼此之间呈显著相关（相关系数为 0.3 至 0.7），但与 ALM 中度相关（相关系数为 0.1 至 0.7）。ALM 在 6 个月生存率上具有良好的区分能力（AUC 0.87 [0.76；0.97]）。ALM 与早期死亡率（<6 个月）相关（HR=0.29，95%CI [0.15；0.57]；P<0.001），但与晚期死亡率（>6 个月）无关。相比之下，SMI 没有显著影响。