Laurén Jouni, Keski-Säntti Harri, Mäkitie Antti, Arponen Otso
Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Radiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Acta Oncol. 2024 Dec 17;63:950-957. doi: 10.2340/1651-226X.2024.40481.
A significant proportion of newly diagnosed patients with hypopharyngeal carcinoma (HC) are at risk of early death and may not benefit from cancer treatments. Our objective was to assess whether an image-based evaluation of muscle mass could identify patients at risk of impaired survival.
This retrospective study consisted of male patients diagnosed with HC treated at Helsinki University Hospital between 2005 and 2014 (N = 66). Cross-sectional areas of skeletal muscles at the level of the third cervical vertebra (C3) and at the level of the thoracic aortic apex were analyzed using magnetic resonance images and/or computed tomography images. Survival-based cutoff values for low muscle index values were determined using the receiver operating characteristics curves. Kaplan-Meier analyses and Cox proportional hazard models were used to evaluate the associations between the muscle indexes and survival rates.
Several muscle indexes were associated with 6-month and 5-year survival. The 6-month survival rate of males with a low sternocleidomastoid muscle index (cutoff 1.73 cm2/m2) was 66%, as opposed to the 97% survival rate for those with an above-the-cutoff muscle index (hazard ratio 13.0 [95% CI 1.5, 116.6]). In a multivariate Cox model adjusted for age, sex, tumor stage, and grade, lower sternocleidomastoid muscle index was significantly associated with decreased 6-month survival.
C3-level muscle indexes, particularly the sternocleidomastoid muscle index, are a promising marker in the identification of patients at risk of early mortality and could add confidence in decision-making when choosing between active and palliative care.
相当一部分新诊断的下咽癌（HC）患者有早期死亡风险，可能无法从癌症治疗中获益。我们的目的是评估基于图像的肌肉质量评估是否能识别出生存受损风险的患者。
这项回顾性研究纳入了2005年至2014年在赫尔辛基大学医院接受治疗的男性HC患者（N = 66）。使用磁共振成像和/或计算机断层扫描图像分析第三颈椎（C3）水平和胸主动脉尖水平的骨骼肌横截面积。使用受试者工作特征曲线确定低肌肉指数值的基于生存的截断值。采用Kaplan-Meier分析和Cox比例风险模型评估肌肉指数与生存率之间的关联。
几个肌肉指数与6个月和5年生存率相关。胸锁乳突肌指数低（截断值1.73 cm²/m²）的男性患者6个月生存率为66%，而肌肉指数高于截断值的患者生存率为97%（风险比13.0 [95% CI 1.5, 116.6]）。在根据年龄、性别、肿瘤分期和分级进行调整的多变量Cox模型中，较低的胸锁乳突肌指数与6个月生存率降低显著相关。
C3水平的肌肉指数，特别是胸锁乳突肌指数，是识别早期死亡风险患者的一个有前景的标志物，在选择积极治疗和姑息治疗时可为决策增加信心。
