在新辅助治疗期间发生肌肉减少症与食管腺癌患者的生存预后更差相关。

Developing sarcopenia during neoadjuvant therapy is associated with worse survival in esophageal adenocarcinoma patients.

机构信息

University of Louisville School of Medicine, Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY.

出版信息

Surgery. 2024 Mar;175(3):718-725. doi: 10.1016/j.surg.2023.09.017. Epub 2023 Oct 20.

DOI:10.1016/j.surg.2023.09.017

PMID:37867097

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10872798/

Abstract

BACKGROUND

Sarcopenia in cancer patients has been associated with mixed postoperative outcomes. The aim of this study was to evaluate whether the development of sarcopenia during the neoadjuvant period is predictive of postoperative mortality in esophageal adenocarcinoma patients.

METHODS

We queried a prospective database to retrieve the sarcopenic status of patients with esophageal adenocarcinoma who underwent cross-sectional imaging of the third lumbar vertebra at diagnosis and within 2 months of undergoing an esophagogastrectomy between 2014 and 2022.

RESULTS

Of the 71 patients included in the study, 36 (50.7%) presented with sarcopenia at diagnosis. Of the 35 non-sarcopenic patients, 14 (40%) developed sarcopenia during the neo-adjuvant period. Patients who were not sarcopenic at diagnosis but developed sarcopenia preoperatively had significantly worse overall survival than patients sarcopenic at diagnosis and not sarcopenic preoperatively and patients experiencing no change in sarcopenic status (median 18 vs 47 vs 31 months; P = .02). Diagnostic and preoperative sarcopenic status alone were not significantly associated with overall survival (P = .48 and P = .56, respectively). Although 37 (52.1%) patients died, the cause of death was often not cancer-related (54.1%) and included acute respiratory failure, pneumonia, and cardiac arrest. No significant survival difference was observed when stratified by >10% weight loss (P = .9) or large loss in body mass index (P = .8).

CONCLUSION

Developing sarcopenia during the neo-adjuvant period may be associated with worse overall survival in patients requiring esophagogastrectomy.

摘要

背景

癌症患者的肌肉减少症与混合术后结局有关。本研究旨在评估新辅助期间发生的肌肉减少症是否可预测食管腺癌患者的术后死亡率。

方法

我们查询了一个前瞻性数据库，以检索在 2014 年至 2022 年间接受第三腰椎横断面成像诊断和接受食管胃切除术 2 个月内的食管腺癌患者的肌肉减少症状态。

结果

在纳入研究的 71 例患者中，36 例（50.7%）在诊断时出现肌肉减少症。在 35 例非肌肉减少症患者中，14 例（40%）在新辅助期间出现肌肉减少症。在诊断时无肌肉减少症但术前出现肌肉减少症的患者的总生存率明显低于诊断时和术前均有肌肉减少症的患者以及肌肉减少症状态无变化的患者（中位数 18 个月 vs 47 个月 vs 31 个月；P =.02）。诊断时和术前的肌肉减少症状态单独与总生存率均无显著相关性（P =.48 和 P =.56）。尽管有 37 例（52.1%）患者死亡，但死亡的原因往往不是癌症相关的（54.1%），包括急性呼吸衰竭、肺炎和心脏骤停。当按体重减轻>10%（P =.9）或体重指数大量减轻（P =.8）分层时，未观察到生存率有显著差异。