Clinical Features and Body Composition in Men with Hormone-Sensitive Metastatic Prostate Cancer: A Pilot Study Examining Differences by Race.
Clinical Features and Body Composition in Men with Hormone-Sensitive Metastatic Prostate Cancer: A Pilot Study Examining Differences by Race.
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接受转移性前列腺癌（MPC）一线治疗的黑人男性显示出比接受类似治疗的非黑人男性更好的临床结局。身体成分的变化可能有助于这些发现。然而，需要初步数据来支持这一概念。我们对所有在我们中心评估的MPC男性患者进行了一项回顾性队列研究，为期4年，收集了人口统计学和临床数据（N = 74）。其中，55名男性进行了诊断性计算机断层扫描图像，以量化脂肪组织和骨骼肌，特别是肌肉减少症和肌肉脂肪变性。19名男性重复成像以探索随时间的变化。按人种分层列出频率、中位数、四分位数间距和至事件发生时间分析（风险比（HR）;置信区间（CI））。总体而言，49%（n = 27）的男性患有肌肉减少症，49%（n = 27）患有肌肉脂肪变性，29%（n = 16）同时患有肌肉减少症和肌肉脂肪变性。未观察到体重指数（对数秩p=0.86; HR：1.05，95% CI：0.45-2.49）或肌肉减少症（对数秩p =0.92; HR：1.01，95% CI：0.46-2.19）与总生存期之间存在显著相关性。然而，诊断时存在的脂肪肌变性与总生存率下降有关（对数秩p=0.09; HR：2.34，95% CI：1.05-5.23），（统计学上无显著性）与黑人的负面关联（HR：4.39，95% CI：0.92-21.1，p=0.06）与非黑人男性（HR：1.89，95% CI：0.79-4.54，p=0.16）。在两次成像之间的中位12.5个月内，所有男性骨骼肌的中位下降率为4%。黑人男性比非黑人男性更容易获得更多的脂肪组织，特别是皮下脂肪（p=0.01）。由于该试验中可能存在II型错误，未来的研究应寻求进一步评估身体成分对结果的影响。这将需要更大规模的、有充分把握度的调查，并有不同的患者代表。
Black men treated with frontline therapies for metastatic prostate cancer (MPC) show better clinical outcomes than non-Black men receiving similar treatments. Variations in body composition may contribute to these findings. However, preliminary data are required to support this concept. We conducted a retrospective cohort study for all men with MPC evaluated at our center over a 4-year period, collecting demographic and clinical data (N = 74). Of these, 55 men had diagnostic computed tomography images to quantify adipose tissue and skeletal muscle, specifically sarcopenia and myosteatosis. Nineteen men had repeat imaging to explore changes over time. Frequencies, medians, interquartile ranges, and time to event analyses (hazard ratios (HR); confidence interval (CI)) are presented, stratified by race. Overall, 49% (n = 27) of men had sarcopenia, 49% (n = 27) had myosteatosis, and 29% (n = 16) had sarcopenia and myosteatosis simultaneously. No significant relationship between body mass index (Log-rank p=0.86; HR: 1.05, 95% CI: 0.45–2.49) or sarcopenia (Log-rankp=0.92; HR: 1.01, 95% CI: 0.46–2.19) and overall survival was observed. However, the presence of myosteatosis at diagnosis was associated with decreased overall survival (Log-rank p=0.09; HR: 2.34, 95% CI: 1.05–5.23), with more pronounced (statistically nonsignificant) negative associations for Black (HR: 4.39, 95% CI: 0.92–21.1, p=0.06) versus non-Black men (HR: 1.89, 95% CI: 0.79–4.54, p=0.16). Over the median 12.5 months between imaging, the median decline in skeletal muscle was 4% for all men. Black men displayed a greater propensity to gain more adipose tissue than non-Black men, specifically subcutaneous (p=0.01). Because of the potential for Type II errors in this pilot, future studies should seek to further evaluate the implications of body composition on outcomes. This will require larger, adequately powered investigations with diverse patient representation.
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