Prognostic Significance of Sarcopenia in Patients with Metastatic Renal Cell Carcinoma
Prognostic Significance of Sarcopenia in Patients with Metastatic Renal Cell Carcinoma
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DOI：
10.1016/j.juro.2015.08.071
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发表时间：
2016-01-01
影响因子：
6.6
通讯作者：
Koga, Fumitaka
中科院分区：
文献类型：
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作者：
Fukushima, Hiroshi;Nakanishi, Yasukazu;Koga, Fumitaka
目的：肌肉减少症是一个反映骨骼肌质量退行性损失的新概念，是癌症恶病质发展过程中的关键生理变化。我们回顾性研究了肌肉减少症在转移性肾细胞癌患者中的预后作用。材料和方法：在诊断转移性肾细胞癌时使用计算机断层扫描计算骨骼肌指数。肌肉减少症的定义是，体重指数低于25 kg/m(2)的男性骨骼肌指数低于43 cm(2)/m(2)，体重指数25 kg/m(2)或以上的男性骨骼肌指数低于53 cm(2)/m(2)，女性体重指数低于41 cm(2)/m(2)。使用 Cox 比例风险模型评估了 92 名转移性肾细胞癌患者的肌少症与总生存率之间的关系。使用 c 指数评估这些模型的预测准确性。 结果：共有 63 名 (68%) 患者被分类为患有肌少症，52 名 (57%) 患者在随访期间（中位总生存期 27 个月）死亡（中位总生存期 27 个月）。多变量分析确定肌少症是总生存率的重要且独立的预测因素（HR 2.58，p = 0.015），此外还有既往肾切除术（p < 0.001）、转移部位数量（p = 0.017）、校正钙（p = 0.026）和乳酸脱氢酶（p = 0.006）。肌肉减少症和非肌肉减少症病例的 3 年总生存率分别为 31% 和 73% (p < 0.001)。将肌肉减少症纳入纪念斯隆凯特琳癌症中心风险模型，将 c 指数从 0.726 提高到 0.758（在原始模型中添加肌肉减少症）和 0.755（用肌肉减少症替代卡诺夫斯基体能状态）。 结论：肌肉减少症是转移性肾细胞癌的一个重要预后因素。
Purpose: Sarcopenia, a novel concept reflecting the degenerative loss of skeletal muscle mass, is a critical physiological change during the development of cancer cachexia. We retrospectively investigated the prognostic role of sarcopenia in patients with metastatic renal cell carcinoma.Materials and Methods: Skeletal muscle index was calculated using computerized tomography performed at the diagnosis of metastatic renal cell carcinoma. Sarcopenia was defined as skeletal muscle index less than 43 cm(2)/m(2) for males with a body mass index less than 25 kg/m(2), less than 53 cm(2)/m(2) for males with a body mass index 25 kg/m(2) or greater, and less than 41 cm(2)/m(2) for females. The relationship between sarcopenia and overall survival was assessed in 92 patients with metastatic renal cell carcinoma using Cox proportional hazards models. The predictive accuracy of these models was evaluated using the c-index.Results: A total of 63 (68%) patients were classified as having sarcopenia and 52 (57%) died (median overall survival 27 months) during followup (median 19 months). A multivariate analysis identified sarcopenia as a significant and independent predictor of overall survival (HR 2.58, p = 0.015), along with prior nephrectomy (p < 0.001), number of metastatic sites (p = 0.017), corrected calcium (p = 0.026) and lactate dehydrogenase (p = 0.006). The 3-year overall survival rates were 31% and 73% for sarcopenic and nonsarcopenic cases, respectively (p < 0.001). The integration of sarcopenia into the Memorial Sloan Kettering Cancer Center risk model improved the c-index from 0.726 to 0.758 (addition of sarcopenia to the original model) and 0.755 (substitution of sarcopenia for Karnofsky performance status).Conclusions: Sarcopenia is a significant prognostic factor in metastatic renal cell carcinoma.