Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2024 Oct 2;33(10):1375-1382. doi: 10.1158/1055-9965.EPI-24-0306.
Body composition may be related to survival in patients with clear-cell renal cell carcinoma (ccRCC), but studies have not simultaneously considered adipose and muscle tissue quantity and radiodensity.
We analyzed data from 1,022 patients with ccRCC who underwent nephrectomy between 2000 and 2020 at Memorial Sloan Kettering Cancer Center. Skeletal muscle, visceral adipose tissue, and subcutaneous adipose tissue indexes (cm2/m2) and radiodensities [Hounsfield units (HU)] were assessed from noncontrast presurgical CT scans; clinical and demographic characteristics were available from the time of surgery. HRs and confidence intervals were estimated for overall (OS) and disease-free survival (DFS) through March 2023 in multivariable models that simultaneously accounted for all body composition measures.
The median age of the patients was 58 years, 69% were male, and 90% were White. There were 169 OS events over 8,392 person-years and 253 DFS events over 7,753 person-years of follow-up. In adjusted analyses, poor OS was associated with lower skeletal muscle radiodensity [-10 HU, HR (95% confidence interval), 1.37 (1.05-1.77)] and greater visceral adipose tissue radiodensity [+10 HU, 1.66 (1.06-2.59)], with similar findings for DFS. Poor survival was also associated with greater visceral adipose tissue index [+40 cm2/m2, OS: 1.32 (0.97, 1.79); DFS: 1.33 (1.04, 1.71)]. Associations with skeletal muscle radiodensity were limited to patients with stage 1/2 disease.
Radiodensities of skeletal muscle and visceral adipose tissues may be novel presurgical prognostic factors for patients with ccRCC.
The findings underscore the importance of evaluating the full range of body composition features simultaneously in multivariable models.
人体成分可能与透明细胞肾细胞癌（ccRCC）患者的生存有关，但研究并未同时考虑脂肪和肌肉组织的数量和密度。
我们分析了 2000 年至 2020 年间在 Memorial Sloan Kettering 癌症中心接受肾切除术的 1022 例 ccRCC 患者的数据。从术前非增强 CT 扫描中评估骨骼肌、内脏脂肪组织和皮下脂肪组织指数（cm2/m2）和密度[亨氏单位（HU）]；从手术时获得临床和人口统计学特征。通过多变量模型同时考虑所有身体成分指标，估计截至 2023 年 3 月的总生存（OS）和无病生存（DFS）的 HR 和置信区间。
患者的中位年龄为 58 岁，69%为男性，90%为白人。在 8392 人年的 OS 随访中发生了 169 例 OS 事件，在 7753 人年的 DFS 随访中发生了 253 例 DFS 事件。在调整后的分析中，较差的 OS 与较低的骨骼肌密度[-10 HU，HR（95%置信区间），1.37（1.05-1.77）]和较大的内脏脂肪组织密度[+10 HU，1.66（1.06-2.59）]相关，DFS 也有类似的发现。较差的生存也与较大的内脏脂肪组织指数[+40 cm2/m2，OS：1.32（0.97，1.79）；DFS：1.33（1.04，1.71）]相关。骨骼肌密度与疾病分期 1/2 期患者相关。
骨骼肌和内脏脂肪组织的密度可能是 ccRCC 患者新的术前预后因素。
这些发现强调了在多变量模型中同时评估身体成分特征全貌的重要性。
