Decreased Skeletal Muscle Mass is Associated with an Increased Risk of Mortality after Radical Nephrectomy for Localized Renal Cell Cancer
Decreased Skeletal Muscle Mass is Associated with an Increased Risk of Mortality after Radical Nephrectomy for Localized Renal Cell Cancer
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DOI：
10.1016/j.juro.2015.08.072
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发表时间：
2016-02-01
影响因子：
6.6
通讯作者：
Tollefson, Matthew K.
中科院分区：
文献类型：
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作者：
Psutka, Sarah P.;Boorjian, Stephen A.;Tollefson, Matthew K.
目的：我们评估了严重骨骼肌缺乏或肌肉减少症与接受根治性肾切除术的局限性肾细胞癌患者的疾病进展、癌症特异性死亡率和全因死亡率之间的关系。在2000年至2010年期间，测量了387例因非转移性肾细胞癌接受根治性肾切除术的患者的基线腰椎骨骼肌指数，计算机断层扫描根据性别特异性共识定义，将肌肉减少症分类为男性骨骼肌指数小于55 cm（2）/m（2），女性骨骼肌指数小于39 cm（2）/m（2）。采用Kaplan-Meier方法估计无进展生存期、癌症特异性生存期和总生存期。与进展，癌症特异性死亡率和全因死亡率的关联进行了总结与hazardratio.Results：387例患者180（47%）有肌肉减少症。患有肌肉减少症的患者年龄较大，更可能是男性（77% vs 56%，p < 0.001），有吸烟史（67% vs 55%，p = 0.02），患有核3级或以上疾病（67% vs 60%，p = 0.05），但在其他方面与没有肌肉减少症的患者相似。中位术后随访时间为7.2年。与无肌肉减少症的患者相比，肌肉减少症患者的5年癌症特异性生存率（79% vs 85%，p = 0.05）较差，5年总生存率（65% vs 74%，p = 0.005）也明显较差。作为一个连续变量，骨骼肌指数的增加与癌症特异性死亡率和全因死亡率的降低呈线性相关。此外，在多变量分析中，肌肉减少症与癌症特异性死亡率（HR 1.70，p = 0.047）和全因死亡率（HR 1.48，p = 0.039）增加相关。结论：肌肉减少症与肾癌根治性肾切除术后癌症特异性死亡率和全因死亡率独立相关。这些发现强调了评估骨骼肌指数对危险分层、患者咨询和治疗计划的重要性。
Purpose: We evaluate the association between severe skeletal muscle deficiency or sarcopenia, and disease progression, cancer specific mortality and all cause mortality in patients with localized renal cell carcinoma treated with radical nephrectomy.Materials and Methods: The baseline lumbar skeletal muscle index of 387 patients treated with radical nephrectomy for nonmetastatic renal cell carcinoma between 2000 and 2010 was measured on preoperative computerized tomography. Sarcopenia was classified according to gender specific consensus definitions as male-skeletal muscle index less than 55 cm(2)/m(2) and female-skeletal muscle index less than 39 cm(2)/m(2) . Progression-free, cancer specific and overall survival was estimated with the Kaplan-Meier method. Associations with progression, cancer specific mortality and all cause mortality were summarized with hazard ratios.Results: Of 387 patients 180 (47%) had sarcopenia. Patients with sarcopenia were older, more likely to be male (77% vs 56%, p < 0.001), to have a smoking history (67% vs 55%, p = 0.02), and to have nuclear grade 3 or greater disease (67% vs 60%, p = 0.05), but were otherwise similar to patients without sarcopenia. Median postoperative followup was 7.2 years. Patients with sarcopenia had inferior 5-year cancer specific survival (79% vs 85%, p = 0.05) compared to those without sarcopenia, as well as significantly worse 5-year overall survival (65% vs 74%, p = 0.005). As a continuous variable, increasing skeletal muscle index was linearly associated with a decreased risk of cancer specific mortality and all cause mortality. Moreover, on multivariable analysis sarcopenia was associated with increased cancer specific mortality (HR 1.70, p = 0.047) and all cause mortality (HR 1.48, p = 0.039).Conclusions: Sarcopenia is independently associated with cancer specific mortality and all cause mortality after radical nephrectomy for renal cell carcinoma. These findings underscore the importance of assessing skeletal muscle index for risk stratification, patient counseling and treatment planning.