University of Pennsylvania, Department of Hematology and Oncology, Philadelphia, PA, United States of America.
The University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States of America.
J Geriatr Oncol. 2024 May;15(4):101747. doi: 10.1016/j.jgo.2024.101747. Epub 2024 Mar 20.
Muscle and adipose tissue measures can be quantified from routinely obtained computed tomography (CT) images and are predictors of chemotherapy-related toxicities and survival among patients with gastrointestinal (GI) malignancies. Most studies to date have consisted of predominantly White patients, and the role of body composition among minoritized racial groups is unknown. We examined racial differences in body composition and survival among patients with GI malignancies.
This was a prospective cohort study of patients with GI malignancies. Single slices of axial CT images from L3 segments were analyzed using Slice-O-Matic software. The skeletal muscle area (cm) was divided by height to obtain the skeletal muscle index (SMI, cm/m). Skeletal muscle radiodensity (SMD) in Hounsfield units (HU) was used for muscle composition. We compared body composition parameters between non-Hispanic (NH)-White and NH-Black participants. Cox models were used to examine the impact of body composition on survival. We proposed new race-specific cutoffs for body composition using optimal stratification.
Five hundred forty patients were included, of which 24% were NH-Black. In Cox models stratified by race, each 5 cm/m decrease in SMI was associated with increase in risk of all-cause mortality in NH-Black patients (hazard ratio [HR] 1.25; 95% confidence interval [CI] 1.04-1.49 p = 0.02). With the existing cut points, neither sarcopenia nor myosteatosis was associated with worse survival. Using a new cutoff for sarcopenia in NH-Black patients, NH-Black patients with sarcopenia (HR 2.31 95%CI 1.10-4.88 p = 0.03) and myosteatosis (HR 2.63 95% CI 1.25-5.53 p = 0.01) had worse survival.
NH-Black older patients with GI cancers and sarcopenia or myosteatosis have worse overall survival.
肌肉和脂肪组织的测量值可以从常规获得的计算机断层扫描（CT）图像中定量，并可预测胃肠道（GI）恶性肿瘤患者的化疗相关毒性和生存情况。迄今为止，大多数研究都集中在以白人为主的患者群体中，而少数族裔群体的身体成分的作用尚不清楚。我们研究了胃肠道恶性肿瘤患者的身体成分和生存的种族差异。
这是一项针对胃肠道恶性肿瘤患者的前瞻性队列研究。使用 Slice-O-Matic 软件分析 L3 段的轴向 CT 图像的单一切片。将骨骼肌面积（cm）除以身高以获得骨骼肌指数（SMI，cm/m）。使用 Hounsfield 单位（HU）的骨骼肌密度（SMD）进行肌肉成分分析。我们比较了非西班牙裔（NH）-白人和 NH-黑人参与者之间的身体成分参数。Cox 模型用于检查身体成分对生存的影响。我们使用最优分层提出了新的种族特异性身体成分截断值。
共纳入 540 例患者，其中 24%为 NH-黑人。在按种族分层的 Cox 模型中，SMI 每降低 5 cm/m，NH-黑人患者全因死亡率的风险增加（危险比 [HR] 1.25；95%置信区间 [CI] 1.04-1.49，p = 0.02）。根据现有的截断值，肌少症或肌脂过多均与较差的生存无关。在 NH-黑人患者中使用新的肌少症截断值，NH-黑人患者的肌少症（HR 2.31；95%CI 1.10-4.88；p = 0.03）和肌脂过多（HR 2.63；95%CI 1.25-5.53；p = 0.01）的总生存率更差。
患有 GI 癌症且存在肌少症或肌脂过多的 NH-黑种老年患者的总生存率更差。
