Skeletal Muscle Measures as Predictors of Toxicity, Hospitalization, and Survival in Patients with Metastatic Breast Cancer Receiving Taxane-Based Chemotherapy.
Skeletal Muscle Measures as Predictors of Toxicity, Hospitalization, and Survival in Patients with Metastatic Breast Cancer Receiving Taxane-Based Chemotherapy.
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DOI：
10.1158/1078-0432.ccr-16-0940
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发表时间：
2017-02-01
期刊：
影响因子：
--
通讯作者：
Muss HB
中科院分区：
文献类型：
--
作者：
Shachar SS;Deal AM;Weinberg M;Nyrop KA;Williams GR;Nishijima TF;Benbow JM;Muss HB
严重的骨骼肌(SM)丧失(骨质疏松症)与癌症预后不良有关，包括生存率降低和毒性增加。这项研究调查了接受一线紫杉烷化疗的转移性乳腺癌(MBC)患者的SM措施，并评估了与治疗毒性和其他结果的相关性。用CT图像评估疾病负担，测量第3腰椎的骨骼肌面积(SMA)和密度(SMD)。骨质疏松症定义为骨骼肌指数(SmI=SmA/Height2)≤41。骨骼肌量规(SMG)由SMI×SMD相乘而成。采用Fisher精确检验、t检验、Kaplan-Meier方法和Cox回归模型。MBC患者(N=40)，中位年龄55岁(范围34-80岁)，58%结节，中位SMG 1296 AU(SD 522)。有5 7%的患者出现3-4级毒性反应，而未发生3-4级毒性反应的患者只有18%(p=0.0 2)。与毒性相关的住院率也较高(39%比0%，p=0.005)，以及任何不良事件--定义为任何3-4级毒性、住院、剂量减少或剂量延迟--(74%比35%，p=0.02)。低SMG与3-4级毒性(p=0.04)、住院(p=0.01)和治疗失败时间(进展或毒性)(p=0.03)相关。低SMG与任何不良事件(p=0.06)和总存活率(p=0.07)存在边缘显著关联。SM措施与接受一线紫杉烷化疗的MBC患者的毒性结果和生存期有关。需要进一步的研究来探索如何将常规获得的CT扫描用于个体化给药和改进治疗计划。
Severe skeletal muscle (SM) loss (sarcopenia), is associated with poor cancer outcomes including reduced survival and increased toxicity. This study investigates SM measures in metastatic breast cancer (MBC) patients receiving first line taxane-based chemotherapy and evaluates associations with treatment toxicity and other outcomes. Using computerized tomography (CT) images taken for the evaluation of disease burden, skeletal muscle area (SMA) and density (SMD) were measured at the 3rd lumbar vertebrae. Sarcopenia was defined as Skeletal Muscle Index (SMI=SMA/height2) ≤41. Skeletal Muscle Gauge (SMG) was created by multiplying SMI x SMD. Fisher’s exact tests, t-tests, the Kaplan-Meier method, and Cox regression modeling were used. MBC patients (N=40), median age 55 (rang 34–80), 58% sarcopenic, median SMG 1296 AU (SD 522). Grade 3–4 toxicity was found in 57% of sarcopenic vs 18% of non-sarcopenic patients (p=0.02). Toxicity-related hospitalizations were also higher in sarcopenic patients (39% vs 0%, p=0.005) as were any adverse events -- defined as any grade 3–4 toxicities, hospitalizations, dose reductions, or dose delay -- (74% vs 35%, p=0.02). Low SMG was associated with grade 3–4 toxicity (p=0.04), hospitalization (p=0.01) and time to treatment failure (for progression or toxicity) (p=0.03). Low SMG had a borderline significant association with any adverse event (p=0.06) and overall survival (p=0.07). SM measures are associated with toxicity outcomes and survival in MBC patients receiving first line taxane-based chemotherapy. Further studies are needed to explore how routinely obtained CT scans can be used to individualize dosing and improve treatment planning.