Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer.
Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer.
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DOI：
10.1002/jcsm.12267
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Ryan AM
中科院分区：
文献类型：
--
作者：
Daly LE;Ní Bhuachalla ÉB;Power DG;Cushen SJ;James K;Ryan AM
营养不良、体重减轻和肌肉萎缩在前肠癌（食道癌、胃癌、胰腺癌、肝癌和胆管癌）患者中很常见，并与不良临床结果相关。然而，对这些患者在化疗期间发生的身体成分变化及其对临床结果的影响知之甚少。对2012 - 2016年间接受化疗的成年前肠癌患者进行前瞻性研究。在两个时间点[间隔118天（IQR 92-58天）]评估计算机断层扫描图像的横断面骨骼肌面积（SMA）和脂肪组织面积（ATA）。采用配对t检验检验SMA和ATA的纵向变化。肌肉减少症和低肌肉衰减（MA）的定义采用公布的切点。Cox比例风险模型用于估计关键预测因子的死亡率风险比。共纳入225例前肠癌患者（67%为男性，中位年龄66岁）。基线时，40%的患者肌肉减少，49%的患者MA较低，62%的患者患有癌症恶病质。纵向分析（n = 163）显示SMA显著降低[- 6.1 cm2(3.9%)/100天，P < 0.001]。与接受姑息性化疗的患者相比，接受新辅助化疗的患者SMA和骨骼肌质量损失更大[- 6.6 cm2(95%，置信区间，CI: - 10.2至- 3.1),P < 0.001和- 1.2 kg (95% CI: - 1.8至- 0.5),P < 0.001]。基线时肌少症和低MA均与生存率降低无关。SMA损失6.0%/100天（最高的第4位）独立预测姑息化疗患者的总生存[风险比：2.66,(95% CI: 1.42至4.97),P = 0.002]。前肠癌患者，特别是那些接受新辅助化疗的患者，在化疗期间会经历显著的肌肉损失。高水平的SMA丢失是姑息性化疗患者生存期降低的预后因素。稳定或增加肌肉量和影响结果的多模式干预值得进一步研究。
Malnutrition, weight loss, and muscle wasting are common in patients with foregut cancers (oesophagus, stomach, pancreas, liver, and bile ducts) and are associated with adverse clinical outcomes. However, little is known about the changes in body composition that occur in these patients during chemotherapy and its impacts clinical outcomes. A prospective study of adult foregut cancer patients undergoing chemotherapy between 2012 and 2016 was conducted. Computed tomography images were evaluated for cross‐sectional skeletal muscle area (SMA) and adipose tissue area (ATA) at two time points [interval 118 days (IQR 92–58 days)]. Longitudinal changes in SMA and ATA were examined using paired t‐tests. Sarcopenia and low muscle attenuation (MA) were defined using published cut‐points. Cox proportional hazards models were used to estimate mortality hazard ratios for key predictors. A total of 225 foregut cancer patients were included (67% male, median age 66 years). At baseline, 40% were sarcopenic, 49% had low MA, and 62% had cancer cachexia. Longitudinal analysis (n = 163) revealed significant reductions in SMA [−6.1 cm2 (3.9%)/100 days, P < 0.001]. Patients treated with neoadjuvant chemotherapy experienced greater losses in SMA and skeletal muscle mass compared with patients receiving palliative chemotherapy [−6.6 cm2 (95%, confidence interval, CI: −10.2 to −3.1), P < 0.001 and −1.2 kg (95% CI: −1.8 to −0.5), P < 0.001, respectively]. Neither sarcopenia nor low MA at baseline was associated with reduced survival. A loss of SMA >6.0%/100 days (highest fourth) independently predicted overall survival in patients receiving palliative chemotherapy [hazard ratio: 2.66, (95% CI: 1.42 to 4.97), P = 0.002]. Patients with foregut cancers, particularly those treated with neoadjuvant chemotherapy, experience significant losses of muscle during chemotherapy. A high level of SMA loss is prognostic of reduced survival in patients treated with palliative chemotherapy. Multimodal interventions to stabilize or increase muscle mass and influence outcome warrant further investigation.
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DOI：
10.1111/apha.12224
发表时间：
2014-03
期刊：
Acta physiologica (Oxford, England)
影响因子：
--
作者：
Aubrey J;Esfandiari N;Baracos VE;Buteau FA;Frenette J;Putman CT;Mazurak VC
通讯作者：
Mazurak VC
影响因子：
3.7
作者：
Fukushima, Hiroshi;Yokoyama, Minato;Koga, Fumitaka
通讯作者：
Koga, Fumitaka
影响因子：
3.3
作者：
FRONTERA, WR;MEREDITH, CN;EVANS, WJ
通讯作者：
EVANS, WJ
影响因子：
45.3
作者：
Antoun, Sami;Birdsell, Laura;Baracos, Vickie E.
通讯作者：
Baracos, Vickie E.
影响因子：
8.9
作者：
Fogelman, David R.;Holmes, Holly;Javle, Milind
通讯作者：
Javle, Milind