定量CT体成分分析与晚期结直肠癌患者基于西妥昔单抗的一线治疗预后之间的关联
Association between quantitative CT body composition analysis and prognosis in cetuximab-based first-line treatment for advanced colorectal cancer patients.
作者信息
Dang Wenxi, Wu Shusheng, Liu Xudong, Shen Hao, Chen Yaolin, Zhang Zhihua, Wang Haoyu, Cai Zhirun, Li Mengge, Sun Mingjie, Gao Fei, He Yifu
机构信息
Department of Medical Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Luyang District, Hefei, 230001, China.
Department of Medical Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230001, China.
出版信息
BMC Cancer. 2024 Dec 26;24(1):1579. doi: 10.1186/s12885-024-13338-8.
BACKGROUND
The objective of this study is to investigate the potential association between change in body composition before and after cetuximab-based therapy and the prognostic outcomes among individuals diagnosed with advanced colorectal cancer.
METHODS
A retrospective analysis was undertaken on a cohort of 81 patients diagnosed with RAS wild-type (WT) metastatic colorectal cancer (mCRC) who were treated with cetuximab-based first-line therapy. To assess relevant body composition parameters, quantitative computed tomography (QCT) scans were conducted both before and after cetuximab treatment. These parameters encompassed measurements of visceral fat area (VFA), subcutaneous fat area (SFA), total muscle area (TMA) at the third lumbar vertebra level (L3), and bone mineral density (BMD) at the first and second vertebrae levels (L1/2). The skeletal muscle index (SMI) was subsequently calculated, and changes in parameters (∆VFA, ∆SFA, ∆SMI, ∆BMD) were standardized.
RESULTS
The cut-off values for ∆VFA, ∆SFA, ∆SMI, and ∆BMD were 0.28%, -2.76%, -2.97%, and -7.98%, respectively. CEA, ∆VFA, ∆SMI, and ∆BMD were associated with poor outcomes of cetuximab-based first-line chemotherapy (P < 0.05). The risk of disease progression was higher when ∆VFA < 0.28%, ∆SFA < -2.76%, ∆SMI < -2.97%, and ∆BMD < -7.98%. Multivariate analysis indicated that CEA (HR: 0.396, 95% CI: 0.160-0.980, P = 0.045), ∆VFA (HR: 0.307, 95% CI: 0.145-0.651, P = 0.002), and∆SMI (HR: 0.725, 95% CI: 0.322-1.630, P = 0.001) have significant prognostic value for progression-free survival (PFS) in RAS WT mCRC patients treated with cetuximab-based first-line chemotherapy.
CONCLUSIONS
CEA, ∆VFA, and ∆SMI are independent predictors for PFS in patients with advanced colorectal cancer. High levels of CEA, ∆VFA, and low levels of ∆SMI may indicate poorer outcomes. CEA, ∆VFA, and ∆SMI can be used to predict PFS in mCRC patients receiving cetuximab-based first-line chemotherapy.
TRIAL REGISTRATION
This study was approved by the Ethics Committee of Anhui Provincial Cancer Hospital of Anhui Medical University (Batch No:2024-ZNY-02). All subjects signed an informed consent form.
背景
本研究的目的是调查接受西妥昔单抗治疗的晚期结直肠癌患者治疗前后身体成分变化与预后结果之间的潜在关联。
方法
对81例诊断为RAS野生型（WT）转移性结直肠癌（mCRC）并接受基于西妥昔单抗的一线治疗的患者进行回顾性分析。为评估相关身体成分参数，在西妥昔单抗治疗前后均进行了定量计算机断层扫描（QCT）。这些参数包括第三腰椎（L3）水平的内脏脂肪面积（VFA）、皮下脂肪面积（SFA）、总肌肉面积（TMA）以及第一和第二腰椎（L1/2）水平的骨密度（BMD）测量。随后计算骨骼肌指数（SMI），并对参数变化（∆VFA、∆SFA、∆SMI、∆BMD）进行标准化。
结果
∆VFA、∆SFA、∆SMI和∆BMD的临界值分别为0.28%、-2.76%、-2.97%和-7.98%。癌胚抗原（CEA）、∆VFA、∆SMI和∆BMD与基于西妥昔单抗的一线化疗的不良预后相关（P < 0.05）。当∆VFA < 0.28%、∆SFA < -2.76%、∆SMI < -2.97%和∆BMD < -7.98%时，疾病进展风险更高。多变量分析表明，CEA（风险比[HR]：0.396，95%置信区间[CI]：0.160 - 0.980，P = 0.045）、∆VFA（HR：0.307，95% CI：0.145 - 0.651，P = 0.002）和∆SMI（HR：0.725，95% CI：0.322 - 1.630，P = 0.001）对接受基于西妥昔单抗一线化疗的RAS WT mCRC患者的无进展生存期（PFS）具有显著预后价值。
结论
CEA、∆VFA和∆SMI是晚期结直肠癌患者PFS的独立预测指标。高水平的CEA、∆VFA和低水平的∆SMI可能表明预后较差。CEA、∆VFA和∆SMI可用于预测接受基于西妥昔单抗一线化疗的mCRC患者的PFS。
试验注册
本研究经安徽医科大学附属安徽省肿瘤医院伦理委员会批准（批号：2024 - ZNY - 02）。所有受试者均签署了知情同意书。
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