转移性非小细胞肺癌患者的身体组成、总生存期、治疗决策与患者报告结局之间的关联
The Association Between Body Composition, Overall Survival, Treatment Decisions, and Patient-Reported Outcomes in Metastatic Non-Small-Cell Lung Cancer.
作者信息
Coletta Adriana M, Lee Hyejung, Puri Sonam, Culleton Sinead, Covington Matthew F, Yap Jeffrey T, Maslana Kelsey E, Haaland Benjamin, Akerley Wallace
机构信息
Department of Health and Kinesiology, The University of Utah, Salt Lake City, Utah, USA.
The Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA.
出版信息
Cancer Med. 2025 Jan;14(1):e70534. doi: 10.1002/cam4.70534.
INTRODUCTION
The purpose of this study was to evaluate the association between body composition, overall survival, odds of receiving treatment, and patient-reported outcomes (PROs) in individuals living with metastatic non-small-cell lung cancer (mNSCLC).
METHODS
This retrospective analysis was conducted in newly diagnosed patients with mNSCLC who had computed-tomography (CT) scans and completed PRO questionnaires close to metastatic diagnosis date. Cox proportional hazard models and logistic regression evaluated overall survival and odds of receiving treatment, respectively. Hazard ratios (HR) and odds ratios (OR) were evaluated as the interquartile range for body composition compartments. Multiple linear regression evaluated the association between PROs and body composition. Models were adjusted for gender, age at diagnosis, smoking history, and mutation status. The survival model also included adjustment for tumor histology.
RESULTS
Our sample (n = 69) included men (52%) and women (48%), with a median age of 67.4-years, history of smoking (67%), wild-type genotype (75.4%), and a tumor histology of adenocarcinoma (68%). Greater skeletal muscle area was associated with higher physical function scores. Larger intermuscular adipose tissue area was associated with higher mortality risk (HR 2.03, 95% CI 1.32, 3.11), lower odds of receiving treatment (OR 0.76, 95% CI 0.61, 0.93), and higher fatigue. Larger subcutaneous adipose tissue area was associated with lower mortality risk (HR 0.42, 95% CI 0.22, 0.82) and higher odds of receiving treatment (OR 1.03, 95% CI 1.01, 1.06). Larger total adipose tissue area was linked with improved survival (HR 0.59, 95% CI 0.36, 0.96).
CONCLUSION
Findings support an association between different body composition compartments at mNSCLC diagnosis and survival, decisions to treat, and PROs. This work supports the use of data collected in routine CT scans and PROs to inform treatment decisions and supportive care options.
引言
本研究旨在评估转移性非小细胞肺癌（mNSCLC）患者的身体组成、总生存期、接受治疗的几率与患者报告结局（PROs）之间的关联。
方法
对新诊断的mNSCLC患者进行回顾性分析，这些患者进行了计算机断层扫描（CT），并在接近转移诊断日期时完成了PRO问卷。Cox比例风险模型和逻辑回归分别评估总生存期和接受治疗的几率。风险比（HR）和优势比（OR）被评估为身体组成部分的四分位间距。多元线性回归评估PROs与身体组成之间的关联。模型对性别、诊断时年龄、吸烟史和突变状态进行了调整。生存模型还包括对肿瘤组织学的调整。
结果
我们的样本（n = 69）包括男性（52%）和女性（48%），中位年龄为67.4岁，有吸烟史（67%），野生型基因型（75.4%），肿瘤组织学类型为腺癌（68%）。更大的骨骼肌面积与更高的身体功能评分相关。更大的肌间脂肪组织面积与更高的死亡风险相关（HR 2.03，95%CI 1.32，3.11），接受治疗的几率更低（OR 0.76，95%CI 0.61，0.93），且疲劳程度更高。更大的皮下脂肪组织面积与更低的死亡风险相关（HR 0.42，95%CI 0.22，0.82）和更高的接受治疗几率（OR 1.03，95%CI 1.01，1.06）。更大的总脂肪组织面积与生存期改善相关（HR 0.59，95%CI 0.36，0.96）。
结论
研究结果支持mNSCLC诊断时不同身体组成部分与生存期、治疗决策和PROs之间存在关联。这项工作支持使用常规CT扫描和PROs收集的数据来为治疗决策和支持性护理选择提供信息。
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