Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China.
Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China.
Nutrition. 2024 Nov;127:112536. doi: 10.1016/j.nut.2024.112536. Epub 2024 Jul 18.
We assessed the impact and prognostic significance of alterations in muscle quality and quantity (myosteatosis and sarcopenia, respectively) in patients with esophageal cancer treated with radiotherapy (RT).
We retrospectively pooled 258 patients with esophageal squamous cell cancer who underwent RT. Myosteatosis and sarcopenia were determined based on the skeletal muscle index derived from the muscle area and attenuation at the L3 level from computed tomography images. Subgroups were formed as 2 subgroups of non-sarcopenia/myosteatosis and sarcopenia/myosteatosis (with or without other muscle status) at either timepoint of RT, 3 subgroups of only-sarcopenia, only myosteatosis (without other muscle status), and the co-presence of sarcopenia and myosteatosis at either timepoint of RT, as well as 4 subgroups of continuous sarcopenia/myosteatosis, developed sarcopenia/myosteatosis, reduced sarcopenia/myosteatosis and non-sarcopenia/myosteatosis according to alterations of muscle status at both timepoints of RT. Overall survival (OS) was compared. Univariate and multivariate analyses based on Cox regression identified independent risk factors for prognosis.
Either pre- or post-RT, patients with sarcopenia and myosteatosis (with or without other muscle status) had poor OS. Patients with only myosteatosis (without other muscle status) showed the best OS (1352 days pre-RT vs. 1648 days post-RT), while patients with concurrent myosteatosis and sarcopenia had the worst OS (907 days pre-RT vs. 706 days post-RT). The ascending order of OS for sarcopenia alterations was as follows: continuous sarcopenia (1093 days), non-sarcopenia (1740 days), developed sarcopenia (2187 days), and reduced sarcopenia (2208 days) (P = 0.002). The ascending order of OS for myosteatosis alterations was ranked as follows: continuous myosteatosis (1165 days), reduced myosteatosis (1275 days), developed myosteatosis (1783 days), and non-myosteatosis (1942 days) (P = 0.061). Univariate and multivariate Cox regression analyses revealed that increased age, longer tumor length, developed myosteatosis, and continuous myosteatosis were independent prognostic factors for OS.
Muscle mass status at presentation and alterations in patients with esophageal cancer before and after RT should be considered prognostic indicators.
评估肌肉质量和数量改变（分别为肌内脂肪增多和肌肉减少症）对接受放射治疗（RT）的食管癌患者的影响和预后意义。
我们回顾性汇总了 258 例接受 RT 的食管鳞状细胞癌患者。通过从 CT 图像上的 L3 水平的肌肉面积和衰减得出骨骼肌指数来确定肌内脂肪增多和肌肉减少症。根据 RT 时任意时间点是否存在非肌肉减少症/肌内脂肪增多、肌肉减少症/肌内脂肪增多（伴或不伴其他肌肉状态），将患者分为 2 个亚组；根据 RT 时任意时间点是否仅存在肌肉减少症、仅存在肌内脂肪增多（无其他肌肉状态）、以及肌肉减少症和肌内脂肪增多同时存在，将患者分为 3 个亚组；根据 RT 时 2 个时间点的肌肉状态变化，将患者分为连续肌肉减少症/肌内脂肪增多、出现肌肉减少症/肌内脂肪增多、减少肌肉减少症/肌内脂肪增多和非肌肉减少症/肌内脂肪增多 4 个亚组。比较总生存率（OS）。基于 Cox 回归的单因素和多因素分析确定了预后的独立危险因素。
在 RT 前或 RT 后，存在肌肉减少症和肌内脂肪增多（伴或不伴其他肌肉状态）的患者 OS 较差。仅存在肌内脂肪增多（无其他肌肉状态）的患者 OS 最佳（RT 前为 1352 天，RT 后为 1648 天），而同时存在肌内脂肪增多和肌肉减少症的患者 OS 最差（RT 前为 907 天，RT 后为 706 天）。肌肉减少症改变的 OS 顺序如下：连续肌肉减少症（1093 天）、非肌肉减少症（1740 天）、出现肌肉减少症（2187 天）和减少肌肉减少症（2208 天）（P = 0.002）。肌内脂肪增多改变的 OS 顺序为：连续肌内脂肪增多（1165 天）、减少肌内脂肪增多（1275 天）、出现肌内脂肪增多（1783 天）和非肌内脂肪增多（1942 天）（P = 0.061）。单因素和多因素 Cox 回归分析显示，年龄较大、肿瘤长度较长、出现肌内脂肪增多和连续肌内脂肪增多是 OS 的独立预后因素。
在接受 RT 之前和之后，食管癌患者的肌肉质量状态和改变应被视为预后指标。
