The deterioration of muscle mass and radiodensity is prognostic of poor survival in stage I-III colorectal cancer: a population-based cohort study (C-SCANS)
The deterioration of muscle mass and radiodensity is prognostic of poor survival in stage I-III colorectal cancer: a population-based cohort study (C-SCANS)
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DOI：
10.1002/jcsm.12305
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发表时间：
2018-08-01
影响因子：
8.9
通讯作者：
Prado, Carla M.
中科院分区：
文献类型：
--
作者：
Brown, Justin C.;Caan, Bette J.;Prado, Carla M.
背景 肌肉异常，例如低肌肉质量和低肌肉放射密度，是众所周知的癌症预后不良的危险因素。然而，人们对癌症背景下肌肉质量和放射密度纵向变化的程度和影响知之甚少。在这里，我们在一项针对非转移性结直肠癌 (CRC) 患者的大型人群研究中探讨了肌肉萎缩和死亡率之间的关系。方法 总共纳入了 1924 名在 Kaiser Permanente 北加州卫生系统接受手术切除的 I-III 期 CRC 患者。使用诊断时和大约 14 个月后获得的计算机断层扫描图像对肌肉质量和放射密度进行量化。使用 Cox 比例风险模型来估计全因死亡率的风险比。 结果 与保持稳定的患者（1 SD；0.0 +/- 5.7%）相比，肌肉质量恶化最严重的患者（2 SD；较基线下降 11.4%）的全因死亡率风险比为 2.15 [95% 置信区间 (CI)：1.59-2.92；95% 置信区间 (CI)：1.59-2.92] P<0.001]。与保持稳定的患者（+/- 1 SD；0.0 +/- 10.1%）相比，肌肉放射密度恶化最严重的患者（2 SD；较基线下降 20.2%）的全因死亡率风险比为 1.61（95% CI：1.20-2.15；P = 0.002）。 结论 在 I-III 期 CRC 患者中，肌肉萎缩是死亡的危险因素。独立于体重和其他身体成分参数的变化。
Background Muscle abnormalities such as low muscle mass and low muscle radiodensity are well known risk factors for unfavourable cancer prognosis. However, little is known in regard to the degree and impact of longitudinal changes in muscle mass and radiodensity within the context of cancer. Here, we explore the relationship between muscle wasting and mortality in a large population-based study of patients with non-metastatic colorectal cancer (CRC).Methods A total of 1924 patients with stage I-III CRC who underwent surgical resection in the Kaiser Permanente Northern California Health System were included. Muscle mass and radiodensity were quantified using computed tomography images obtained at diagnosis and after approximately 14 months. Cox proportional-hazards models were used to estimate hazard ratios for all-cause mortality.Results The hazard ratio for all-cause mortality among patients with the largest deterioration in muscle mass (2 SD; 11.4% loss from baseline), as compared with those who remained stable (1 SD; 0.0 +/- 5.7%) was 2.15 [95% confidence interval (CI): 1.59-2.92; P < 0.001]. The hazard ratio for all-cause mortality among patients who experienced the largest deterioration in muscle radiodensity (2 SD; 20.2% loss from baseline), as compared with those who remained stable (+/- 1 SD; 0.0 +/- 10.1%) was 1.61 (95% CI: 1.20-2.15; P = 0.002).Conclusions In patients with stage I-III CRC, muscle wasting is a risk factor for mortality, independent of change in body mass and other body composition parameters.