Sarcopenia in an Overweight or Obese Patient Is an Adverse Prognostic Factor in Pancreatic Cancer
Sarcopenia in an Overweight or Obese Patient Is an Adverse Prognostic Factor in Pancreatic Cancer
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DOI：
10.1158/1078-0432.ccr-09-1525
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发表时间：
2009-11-15
影响因子：
11.5
通讯作者：
Fearon, Kenneth C. H.
中科院分区：
文献类型：
--
作者：
Tan, Benjamin H. L.;Birdsell, Laura A.;Fearon, Kenneth C. H.
目的：接受姑息治疗的平均体重减轻的胰腺癌患者通常超重而不是体重不足，这可能会混淆用于风险分层的常规措施。本研究的目的是评估通过诊断性计算机断层扫描（CT）评估的体重和身体成分，特别是肌肉减少症，是否对胰腺癌患者具有预后价值。随后几个月的性质和程度的组织损失也evaluated.Experimental设计：共111例患者进入姑息治疗计划，谁有CT图像，并进行了营养筛查，进行了研究。在患者的后续扫描（n = 44），纵向变化的身体成分进行了研究，平均为230 +/-62和95 +/-60 daybefore death. Results：六十二例（55.9%）是sarcopenic，44（39.6%）超重/肥胖，和18（16.2%）都。年龄≥ 59岁（风险比，1.71; 95%可信区间，1.10 - 2.66; P = 0.018）和超重/肥胖性肌肉减少症（风险比，2.07; 95%可信区间，1.23 - 3.50; P = 0.006）被确定为多变量分析中生存的独立预测因素。纵向分析显示，总无脂体重指数从15.5 +/-2.5 kg/m2降至14.5 +/-2.0 kg/m2（P = 0.002），总脂肪量指数从7.5 +/-2.0 kg/m2降至6.0 +/-1.5 kg/m2结论：超重/肥胖晚期胰腺癌患者的肌减少症是一种隐匿性疾病，但可以通过CT扫描识别。这种情况是一个独立的不良预后指标，应考虑患者进入临床试验，系统治疗或支持护理计划分层。(Clin Cancer Res 2009; 15（22）：6973 - 9）
Purpose: The average weight-losing pancreatic cancer patient undergoing palliative therapy is frequently overweight rather than underweight, and this can confound conventional measures used for risk stratification. The aim of this study was to evaluate if weight and body composition, specifically sarcopenia, assessed from diagnostic computed tomography (CT) scans, is of prognostic value in patients with pancreatic cancer. The nature and extent of tissue loss over subsequent months was also evaluated.Experimental Design: A total of 111 patients entering a palliative therapy program, who had CT images and had undergone nutritional screening, were studied. In patients for whom follow-up scans were available (n = 44), longitudinal changes in body composition were studied at a mean of 230 +/- 62 and 95 +/- 60 days prior to demise.Results: Sixty-two patients (55.9%) were sarcopenic, 44 (39.6%) were overweight/obese, and 18 (16.2%) were both. Age >= 59 years (hazard ratio, 1.71; 95% confidence interval, 1.10-2.66; P = 0.018), and overweight/obese sarcopenia (hazard ratio, 2.07; 95% confidence interval, 1.23-3.50; P = 0.006) were identified as independent predictors of survival on multivariate analysis. Longitudinal analysis revealed that total fat-free mass index decreased from 15.5 +/- 2.5 kg/m(2) to 14.5 +/- 2.0 kg/m(2) (P = 0.002), and total fat mass index decreased from 7.5 +/- 2.0 kg/m(2) to 6.0 +/- 1.5 kg/m(2) (P < 0.0001) over 135 days.Conclusions: Sarcopenia in overweight/obese patients with advanced pancreatic cancer is an occult condition but can be identified using CT scans. This condition is an independent adverse prognostic indicator that should be considered for stratification of patients' entering clinical trials, systemic therapy, or support care programs. (Clin Cancer Res 2009;15(22):6973-9)