低骨骼肌质量影响接受根治性放化疗的浅表食管癌患者的预后。

Low skeletal muscle mass contributes to the prognosis of patients with superficial esophageal cancer treated with definitive chemoradiotherapy.

作者信息

Nakagawa Kentaro, Hayashi Yoshito, Adachi Yujiro, Tajiri Ayaka, Fukuda Hiromu, Kimura Eiji, Uema Ryotaro, Saiki Hirotsugu, Kato Minoru, Inoue Takanori, Yoshihara Takeo, Yoshii Shunsuke, Tsujii Yoshiki, Takehara Tetsuo

机构信息

Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.

Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

出版信息

Esophagus. 2025 Apr;22(2):198-206. doi: 10.1007/s10388-025-01109-8. Epub 2025 Jan 30.

DOI:10.1007/s10388-025-01109-8

PMID:39883331

Abstract

BACKGROUND

Herein, we aimed to examine the relationship between sarcopenia, neutrophil-lymphocyte ratio (NLR), Charlson comorbidity index (CCI), and prognostic nutritional index (PNI) in patients with superficial esophageal carcinoma who underwent definitive chemoradiotherapy (CRT).

METHODS

We retrospectively analyzed 100 patients (87 males) diagnosed with cT1N0M0 esophageal squamous cell carcinoma. The included patients underwent CRT as an initial treatment. Muscle mass was assessed using the psoas muscle index (PMI). All patients received concurrent chemotherapy (5-fluorouracil plus cisplatin/nedaplatin) and radiotherapy (60 Gy). The duration of follow-up (median range) was 78 (2.5-197) months. During the follow-up period, 23 recurrences occurred, along with 37 deaths (11 deaths from esophageal cancer; only one treatment-related death).

RESULTS

The 5-year survival rate was 78.0%. The median (range) PMI was 6.55 (3.90-10.9) and 4.62 (2.28-6.60) cm/m in males and females, respectively. The PNI was 46.6 (36.2-60.4), NLR was 2.45 (0.61-18.1), and CCI was 0 (0-10). Patients were divided into low PMI (sarcopenia) and high PMI (non-sarcopenia) groups. In the univariate survival time analysis, the low PMI group had a significant hazard ratio (HR) of 2.70 (p = 0.0049), the low Geriatric Nutritional Risk Index (GNRI) group had an HR of 2.30 (p = 0.0161), and the CCI ≥ 1 group had an HR of 2.19 (p = 0.0199). According to the multivariate analysis using these three factors and age (≥ 65 years), PMI was an independent prognostic factor (HR, 2.23; p = 0.0313).

CONCLUSIONS

PMI is a notable predictor of prognosis in patients undergoing CRT for T1N0M0 esophageal cancer.

摘要

背景

在此，我们旨在研究接受根治性放化疗（CRT）的食管表浅癌患者中，肌肉减少症、中性粒细胞与淋巴细胞比值（NLR）、Charlson合并症指数（CCI）和预后营养指数（PNI）之间的关系。

方法

我们回顾性分析了100例（87例男性）诊断为cT1N0M0食管鳞状细胞癌的患者。纳入的患者接受CRT作为初始治疗。使用腰大肌指数（PMI）评估肌肉质量。所有患者均接受同步化疗（5-氟尿嘧啶加顺铂/奈达铂）和放疗（60 Gy）。随访时间（中位范围）为78（2.5 - 197）个月。在随访期间，发生了23例复发，37例死亡（11例死于食管癌；仅1例与治疗相关的死亡）。

结果

5年生存率为78.0%。男性和女性的中位（范围）PMI分别为6.55（3.90 - 10.9）和4.62（2.28 - 6.60）cm/m。PNI为46.6（36.2 - 60.4），NLR为2.45（0.61 - 18.1），CCI为0（0 - 10）。患者被分为低PMI（肌肉减少症）组和高PMI（非肌肉减少症）组。在单因素生存时间分析中，低PMI组的风险比（HR）显著为2.70（p = 0.0049），低老年营养风险指数（GNRI）组的HR为2.30（p = 0.0161），CCI≥1组的HR为2.19（p = 0.0199）。根据使用这三个因素和年龄（≥65岁）的多因素分析，PMI是一个独立的预后因素（HR，2.23；p = 0.0313）。