Laufer Menachem, Perelman Maxim, Segal Gad, Sarfaty Michal, Itelman Edward
Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel.
Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 6139001, Israel.
Cancers (Basel). 2023 Dec 29;16(1):174. doi: 10.3390/cancers16010174.
Sarcopenia is characterized by the loss of muscle mass and function and is associated with frailty, a syndrome linked to an increased likelihood of falls, fractures, and physical disability. Both frailty and sarcopenia are recognized as markers for shortened survival in a number of medical conditions and in cancer patient populations. Low alanine aminotransferase (ALT) values, representing low muscle mass (sarcopenia), may be associated with increased frailty and subsequently shortened survival in cancer patients. In the current study, we aimed to assess the potential relationship between low ALT and shorter survival in bladder cancer patients and survivors.
This was a retrospective analysis of bladder cancer patients and survivors, both in and outpatients. We defined patients with sarcopenia as those presenting with ALT < 17 IU/L.
A total of 5769 bladder cancer patients' records were identified. After the exclusion of patients with no available ALT values or ALT levels above the upper normal limit, the final study cohort included 3075 patients (mean age 73.2 ± 12 years), of whom 80% were men and 1362 (53% had ALT ≤ 17 IU/L. The mean ALT value of patients within the low ALT group was 11.44 IU/L, while the mean value in the higher ALT level group was 24.32 IU/L ( < 0.001). Patients in the lower ALT group were older (74.7 vs. 71.4 years; < 0.001), had lower BMI (25.8 vs. 27; < 0.001), and their hemoglobin values were lower (11.7 vs. 12.6 g/dL; < 0.001). In a univariate analysis, low ALT levels were associated with a 45% increase in mortality (95% CI 1.31-1.60, < 0.001). In a multivariate model controlling for age, kidney function, and hemoglobin, low ALT levels were still associated with 22% increased mortality.
Low ALT values, indicative of sarcopenia and frailty, are associated with decreased survival of bladder cancer patients and survivors and could potentially be applied for optimizing individual treatment decisions.
肌肉减少症的特征是肌肉质量和功能丧失，与衰弱相关，衰弱是一种与跌倒、骨折和身体残疾可能性增加相关的综合征。衰弱和肌肉减少症在许多医疗状况和癌症患者群体中均被视为生存缩短的标志物。低丙氨酸氨基转移酶（ALT）值代表低肌肉量（肌肉减少症），可能与癌症患者衰弱增加及随后生存缩短有关。在本研究中，我们旨在评估膀胱癌患者及幸存者中低ALT与较短生存之间的潜在关系。
这是一项对膀胱癌患者及幸存者（包括门诊和住院患者）的回顾性分析。我们将肌肉减少症患者定义为ALT<17 IU/L的患者。
共识别出5769例膀胱癌患者的记录。在排除无可用ALT值或ALT水平高于正常上限的患者后，最终研究队列包括3075例患者（平均年龄73.2±12岁），其中80%为男性，1362例（53%）ALT≤17 IU/L。低ALT组患者的平均ALT值为11.44 IU/L，而较高ALT水平组的平均值为24.32 IU/L（<0.001）。低ALT组患者年龄更大（74.7岁对71.4岁；<0.001），体重指数更低（25.8对27；<0.001），血红蛋白值更低（11.7对12.6 g/dL；<0.001）。在单因素分析中，低ALT水平与死亡率增加45%相关（95%CI 1.31 - 1.60，<0.001）。在控制年龄、肾功能和血红蛋白的多变量模型中，低ALT水平仍与死亡率增加22%相关。
低ALT值表明存在肌肉减少症和衰弱，与膀胱癌患者及幸存者的生存降低相关，并可能潜在地用于优化个体治疗决策。
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