Sarcopenia in Advanced Serous Ovarian Cancer
Sarcopenia in Advanced Serous Ovarian Cancer
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DOI：
10.1097/igc.0000000000000867
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发表时间：
2017-02-01
影响因子：
4.8
通讯作者：
Schmalfeldt, Barbara
中科院分区：
文献类型：
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作者：
Bronger, Holger;Hederich, Philipp;Schmalfeldt, Barbara
目的：癌症恶病质是一种副肿瘤性综合征，包括非自愿的体重减轻和肌肉萎缩(骨质疏松症)。虽然体重减轻与不良的临床结局有关，但迄今为止，关于卵巢癌患者骨质疏松症的患病率和预后影响的信息有限。方法：通过对128例晚期浆液性卵巢癌患者第三腰部骨骼肌横截面积的CT图像分析，测定总骨骼肌质量。对43例患者的209次连续CT扫描的肌块纵向变化进行了研究。结果：首次诊断时骨质疏松症的发生率为11%(12/105；95%可信区间[CI]，6%Y20%)。骨质疏松症患者的无进展(风险比，2.64；95%可信区间，1.24Y5.64；P=0.012)和总存活率(风险比，3.17；95%可信区间，1.29Y7.80；P=0.012)显著降低。在多变量分析中，在调整了年龄、国际妇产科联合会分期和术后残留疾病后，这些预后影响仍然显著。纵向分析证实，这两个患者都有肌肉质量的丧失和增加。然而，随着时间的推移，肌肉质量的变化与生存无关。结论：基线石蜡减少是晚期浆液性卵巢癌的一个预后因素。因此，识别骨肉瘤患者和及早参加体育或营养教育计划可能是改善结果的可行方法，应在前瞻性临床试验中进一步评估。
Objective: Cancer cachexia is a paraneoplastic syndrome comprising involuntary weight loss and muscle depletion (sarcopenia). Although weight loss has been associated with poor clinical outcome, there is only limited information on the prevalence and prognostic impact of sarcopenia in ovarian cancer so far.Methods: Total skeletal muscle mass was determined by computed tomography image analysis of the third lumbar skeletal muscle cross-sectional area in 128 patients with advanced serous ovarian cancer. Longitudinal change of muscle mass was studied in 209 consecutive computed tomography scans from 43 patients. Association with survival was determined using Cox proportional hazards model.Results: The prevalence of sarcopenia at first diagnosis was 11% (12/105; 95% confidence interval [CI], 6% Y20%). Sarcopenic patients had a significantly reduced progression-free (hazard ratio, 2.64; 95% CI, 1.24Y5.64; P = 0.012) and overall survival (hazard ratio, 3.17; 95% CI, 1.29Y7.80; P = 0.012). On multivariable analysis, these prognostic effects remained significant after adjustment for age, International Federation of Gynecology and Obstetrics stage, and postsurgical residual disease. Longitudinal analyses identified both patients with loss and gain of muscle mass. However, change in muscle mass over time was not associated with survival.Conclusions: Baseline sarcopenia is a prognostic factor in advanced serous ovarian cancer. Identification of sarcopenic patients and early enrollment in physical or nutritional education programs might thus be a feasible way to improve outcome and should be further evaluated in prospective clinical trials.