Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index.
Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index.
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DOI：
10.1371/journal.pone.0139749
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Bang YJ
中科院分区：
文献类型：
--
作者：
Choi Y;Oh DY;Kim TY;Lee KH;Han SW;Im SA;Kim TY;Bang YJ
身体成分已成为癌症患者预后的一个因素。我们研究了胰腺癌患者诊断时的肌肉减少和姑息化疗期间骨骼肌的丧失是否与生存有关。我们回顾性回顾了2003年至2010年间接受姑息性化疗的胰腺癌患者的临床结果。应用Rapidia 3D软件分析骨骼肌L3层计算机断层扫描截面积。我们将骨骼肌减少症定义为骨骼肌指数(SMI)< 42.2 cm2/m2（男性）和< 33.9 cm2/m2（女性）。在484例患者中，103例（21.3%）患者在诊断时肌肉减少。化疗期间，有156例（60.9%）男性患者和65例（40.6%）女性患者出现SMI下降。149例（37.3%）患者体重指数（BMI）下降，无性别差异。通过多因素分析，化疗期间肌肉减少症（P< 0.001）、bmi和SMI下降（P = 0.002, P = 0.004）是总生存期（OS）的不良预后因素。男性患者的OS受肌肉减少症（P< 0.001）和SMI下降（P = 0.001）的影响，女性患者的OS受诊断时超重（P = 0.006）、BMI下降（P = 0.032）和SMI下降（P = 0.014）的影响。值得注意的是，虽然化疗期间BMI的变化对维持SMI的患者的OS没有影响（P = 0.750），但SMI的下降与维持BMI的患者的不良OS相关（HR 1.502; P = 0.002）。诊断时的肌肉减少症和化疗期间的骨骼肌耗损（独立于BMI变化）是晚期胰腺癌预后不良的因素。
Body composition has emerged as a prognostic factor in cancer patients. We investigated whether sarcopenia at diagnosis and loss of skeletal muscle during palliative chemotherapy were associated with survival in patients with pancreatic cancer. We retrospectively reviewed the clinical outcomes of pancreatic cancer patients receiving palliative chemotherapy between 2003 and 2010. The cross-sectional area of skeletal muscle at L3 by computed tomography was analyzed with Rapidia 3D software. We defined sarcopenia as a skeletal muscle index (SMI)< 42.2 cm2/m2 (male) and < 33.9 cm2/m2 (female) using ROC curve. Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis. Decrease in SMI during chemotherapy was observed in 156 (60.9%) male and 65 (40.6%) female patients. Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference. By multivariate analysis, sarcopenia (P< 0.001), decreasedBMI and SMI during chemotherapy (P = 0.002, P = 0.004, respectively) were poor prognostic factors for overall survival (OS). While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014). Particularly, while the change of BMI during chemotherapy did not have impact on OS within the patients with maintained SMI (P = 0.750), decrease in SMI was associated with poor OS within the patients with maintained BMI (HR 1.502; P = 0.002). Sarcopenia at diagnosis and depletion of skeletal muscle, independent of BMI change, during chemotherapy were poor prognostic factors in advanced pancreatic cancer.