Tolonen Antti, Lehtomäki Kaisa, Kerminen Hanna, Huhtala Heini, Bärlund Maarit, Österlund Pia, Arponen Otso
Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland; Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland.
Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland; Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland.
J Geriatr Oncol. 2025 Mar;16(2):102171. doi: 10.1016/j.jgo.2024.102171. Epub 2024 Dec 14.
Treatment decisions are challenging in older adults with solid tumors. Geriatric 8 (G8)-screening and comprehensive geriatric assessment (CGA) are important but additional methods are needed. We examined the association of computed tomography (CT)-derived high visceral adipose tissue index (VATI) with or without low skeletal muscle index (SMI) on three-month and overall survival (OS).
Vulnerability was evaluated with G8 in patients ≥75 years referred for systemic anticancer treatment. Vulnerable/frail patients (G8 ≤ 14) received CGA and were included. VATI and SMI were retrospectively measured from CT scans. We examined associations between high VATI with or without low SMI and three-month and OS with Cox regression models and Kaplan-Meier estimation.
Seventy-nine patients with median age of 80 (range 75-91) years were evaluated. In the palliative-intent group (n = 58), three-month OS rates were 88 % and 58 % in the normal and high VATI groups, respectively (hazard ratio 4.3; 95 % confidence interval 1.3-14), and 88 % vs. 47 % in group without and with 'high VATI+low SMI', respectively (5.5; 1.9-17). The median OS was 12.7 vs. 9.5 months in normal VATI/SMI and 'high VATI+low SMI' (1.9; 1.1-3.2), respectively. In Cox multivariable models with established predictive factors (ECOG PS, Clinical Frailty Scale, and sex), only high VATI (4.9; 1.0-24) or 'high VATI+low SMI' (8.9; 1.7-46) remained significant predictors of three-month OS.
High VATI with or without low SMI were associated with impaired three-month OS in the palliative-intent group and with OS in the whole cohort independently of oncologic and geriatric functional status measures; thus, they may aid in treatment decision-making.
对于患有实体瘤的老年人来说，治疗决策具有挑战性。老年8项（G8）筛查和综合老年评估（CGA）很重要，但还需要其他方法。我们研究了计算机断层扫描（CT）得出的高内脏脂肪组织指数（VATI）伴或不伴低骨骼肌指数（SMI）与三个月生存率和总生存期（OS）之间的关联。
对年龄≥75岁、接受全身抗癌治疗的患者进行G8脆弱性评估。脆弱/虚弱患者（G8≤14）接受CGA并纳入研究。VATI和SMI通过CT扫描进行回顾性测量。我们使用Cox回归模型和Kaplan-Meier估计法研究高VATI伴或不伴低SMI与三个月生存率和总生存期之间的关联。
评估了79例患者，中位年龄为80岁（范围75-91岁）。在姑息治疗组（n = 58）中，正常VATI组和高VATI组的三个月总生存率分别为88%和58%（风险比4.3；95%置信区间1.3-14），无“高VATI + 低SMI”组和有“高VATI + 低SMI”组分别为88%和47%（5.5；1.9-17）。正常VATI/SMI组和“高VATI + 低SMI”组的中位总生存期分别为12.7个月和9.5个月（1.9；1.1-3.2）。在包含既定预测因素（东部肿瘤协作组体能状态评分、临床衰弱量表和性别）的Cox多变量模型中，只有高VATI（4.9；1.0-24）或“高VATI + 低SMI”（8.9；1.7-46）仍然是三个月总生存期的显著预测因素。
在姑息治疗组中，高VATI伴或不伴低SMI与三个月总生存期受损有关，并且在整个队列中与总生存期有关，与肿瘤学和老年功能状态指标无关；因此，它们可能有助于治疗决策。
