Changes in Body Composition during Adjuvant FOLFOX Chemotherapy and Overall Survival in Non-Metastatic Colon Cancer
Changes in Body Composition during Adjuvant FOLFOX Chemotherapy and Overall Survival in Non-Metastatic Colon Cancer
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DOI：
10.3390/cancers12010060
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发表时间：
2020-01-01
期刊：
影响因子：
5.2
通讯作者：
Kang, Jeonghyun
中科院分区：
文献类型：
--
作者：
Chung, Eric;Lee, Hye Sun;Kang, Jeonghyun
辅助化疗期间纵向人体测量学变化对非转移性结肠癌长期生存的影响尚不清楚。在此，我们分析了接受手术后接受辅助FOLFOX（亚叶酸、5-氟尿嘧啶、奥沙利铂）化疗的结肠癌患者中计算机断层扫描（CT）测量的身体成分变化的预后意义。分析了167例III期或高危II期结肠癌患者的数据。采用术前和化疗后CT图像数据计算化疗期间骨骼肌指数（SMI）、骨骼肌放射密度（SMR）、内脏脂肪指数（VFI）、皮下脂肪指数（SFI）和总脂肪指数（TFI）的变化。采用考克斯比例风险模型确定人体测量值变化与总生存期（OS）之间的相关性。化疗期间210天内SMI、SMR、VFI、SFI和TFI的中位变化（%）分别为8.7%（p < 0.001）、3.4%（p = 0.001）、-19%（p < 0.001）、-3.4%（p = 0.936）和-11.9%（p < 0.001）。SMI变化的临界值（骨骼肌指数变化，SMIC）和SMR（骨骼肌放射密度变化，SMRC）分别定义为-2%和-2 Hounsfield单位（HU），而VFI变化，（内脏脂肪指数变化，VFIC），SFI皮下脂肪指数变化，SFIC）和TFI（总脂肪指数变化，TFIC）基于在Mantel-Cox检验中提供最大卡方2的值。多变量分析显示，化疗后CT扫描测量的低SMR（风险比，HR：0.32，95%置信区间，CI：0.15-0.70，p = 0.004）和内脏脂肪减少至少46.57%（HR：0.31，95% CI：0.14-0.69,p = 0.004）的平均值FOLFOX化疗期间严重内脏脂肪丢失和化疗后CT扫描测量的低骨骼肌放射密度与III期和III期患者的OS较差相关，高风险的II期结肠癌患者。
The impact of longitudinal anthropometric changes during adjuvant chemotherapy on long-term survival in non-metastatic colon cancer is unclear. Herein, we analyzed the prognostic significance of computed tomography (CT)-measured body composition changes in colon cancer patients who underwent surgery followed by adjuvant FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) chemotherapy. Data of 167 patients with stage III or high-risk stage II colon cancer were analyzed. Skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral fat index (VFI), subcutaneous fat index (SFI), and total fat index (TFI) changes during chemotherapy were calculated using preoperative and postchemotherapy CT image data. The Cox proportional hazard model was used to determine the correlation between changes in anthropometric values and overall survival (OS). The median changes (%) in SMI, SMR, VFI, SFI, and TFI over 210 days during chemotherapy were 8.7% (p < 0.001), 3.4% (p = 0.001), -19% (p < 0.001), -3.4% (p = 0.936), and -11.9% (p < 0.001), respectively. Cut-off values of changes in SMI (skeletal muscle index change, SMIC) and SMR (skeletal muscle radiodensity change, SMRC) were defined at -2% and -2 Hounsfield units (HU) respectively, whereas those of changes in VFI (visceral fat index change, VFIC), SFI (subcutaneous fat index change, SFIC), and TFI (total fat index change, TFIC) were based on values that provided the largest chi 2 on the Mantel-Cox test. Multivariable analysis revealed that low SMR measured on a postchemotherapy CT scan (hazard ratio, HR: 0.32, 95% confidence interval, CI: 0.15-0.70, p = 0.004) and visceral fat loss of at least 46.57% (HR: 0.31, 95% CI: 0.14-0.69, p = 0.004) were independent poor prognostic factors for OS. Severe visceral fat loss during FOLFOX chemotherapy and low skeletal muscle radiodensity measured on postchemotherapy CT scans are associated with poor OS in stage III and high-risk stage II colon cancer patients.