Kidd Andrew C, Cowell Gordon W, Martin Geoffrey A, Ferguson Jenny, Fennell Dean A, Evison Matt, Blyth Kevin G
Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; School of Cancer Sciences, University of Glasgow, UK.
School of Cancer Sciences, University of Glasgow, UK; Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK.
Cancer Treat Res Commun. 2024;42:100856. doi: 10.1016/j.ctarc.2024.100856. Epub 2024 Dec 2.
Altered body composition is associated with adverse survival in multiple cancers. We determined the prevalence, prognostic significance and clinicopathological correlates of sarcopenia and adipopenia in Pleural Mesothelioma (PM) patients receiving chemotherapy.
We performed a multi-centre retrospective cohort study. Clinical data and CT images were retrieved for 111 patients from 4 UK centres. Skeletal muscle (at L3 and T4) and fat tissue areas (at L3 only) were measured on pre- and post-chemotherapy CT scans (ImageJ software) and normalised for height. Pre-chemotherapy sarcopenia and adipopenia were defined using validated thresholds, where available or indices <25th percentile. Muscle/fat loss were defined by < 0 % change (%∆) between CT scans. Extreme muscle/fat loss were defined by <25th percentile of %∆. Overall survival associations were evaluated using Kaplan-Meier methodology ± Cox proportional hazards models.
T4 and L3 measurements were possible in 111/111 and 91/111 (82 %). L3 sarcopenia was observed at baseline in 35 % (32/91); all other features were observed in 25 % at baseline, as defined a priori. Body composition changes during chemotherapy were heterogeneous. Overall, 61.5 % and 53.1 % patients lost muscle at L3 and T4. 60.4 % lost fat (at L3 only). Extreme T4 muscle loss and total fat loss were independently prognostic (HR 2.99, p < 0.001; HR 1.92, p = 0.014). Pre-chemotherapy T4 muscle indices were inversely associated with age. No associations were observed with tumour volume, histology, weight, inflammatory markers.
T4 muscle indices were feasible in all cases and outperformed L3 values in prognostication. Extreme T4 muscle and total fat loss were independently prognostic.
身体成分改变与多种癌症的不良生存相关。我们确定了接受化疗的胸膜间皮瘤（PM）患者中肌肉减少症和脂肪减少症的患病率、预后意义及临床病理相关性。
我们进行了一项多中心回顾性队列研究。从英国4个中心检索了111例患者的临床数据和CT图像。在化疗前后的CT扫描上（使用ImageJ软件）测量骨骼肌（在L3和T4水平）和脂肪组织面积（仅在L3水平），并根据身高进行标准化。化疗前的肌肉减少症和脂肪减少症使用经过验证的阈值定义（如有可用阈值）或指数低于第25百分位数来定义。肌肉/脂肪减少定义为CT扫描之间变化百分比（%∆）<0%。极端肌肉/脂肪减少定义为%∆低于第25百分位数。使用Kaplan-Meier方法±Cox比例风险模型评估总生存相关性。
111例患者中有111/111例（100%）和91/111例（82%）可行T4和L3测量。基线时35%（32/91）的患者观察到L3肌肉减少症；按照事先定义，所有其他特征在基线时观察到的比例为25%。化疗期间身体成分变化具有异质性。总体而言，61.5%和53.1%的患者在L3和T4水平出现肌肉减少。60.4%的患者脂肪减少（仅在L3水平）。极端T4肌肉减少和总脂肪减少具有独立预后意义（风险比2.99，p<0.001；风险比1.92，p=0.014）。化疗前T4肌肉指数与年龄呈负相关。未观察到与肿瘤体积、组织学、体重、炎症标志物之间的相关性。
T4肌肉指数在所有病例中均可行，且在预后评估方面优于L3值。极端T4肌肉减少和总脂肪减少具有独立预后意义。
