Skeletal Muscle Loss Is an Imaging Biomarker of Outcome after Definitive Chemoradiotherapy for Locally Advanced Cervical Cancer
Skeletal Muscle Loss Is an Imaging Biomarker of Outcome after Definitive Chemoradiotherapy for Locally Advanced Cervical Cancer
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DOI：
10.1158/1078-0432.ccr-18-0788
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发表时间：
2018-10-15
影响因子：
11.5
通讯作者：
Chen, Yu-Jen
中科院分区：
文献类型：
--
作者：
Lee, Jie;Chang, Chih-Long;Chen, Yu-Jen
目的：本研究探讨了局部晚期宫颈癌（LACC）患者同步放化疗（CCRT）期间身体成分变化与预后之间的关系。实验设计：分析了2004年至2015年期间接受治疗的245例LACC患者的治疗前后CT图像。测量两组L3椎体水平CT图像的骨骼肌指数（SMI）和密度（SMD）、皮下脂肪组织指数（SATI）和内脏脂肪组织指数（VATI）。使用已发表的临界点定义肌肉减少症和低SMD。用考克斯回归模型分析总生存期（OS）和癌症特异性生存期（CSS）的预测因素。结果：中位随访时间为62.7个月（范围7.3-152.3）。在245例患者中，127例（51.8%）有治疗前肌肉减少症，154例（62.9%）有低SMD。在CCRT期间，SMI未显著降低，0.6%/150天[ 95%置信区间（CI），- 1.8-0.6; P = 0.35]。然而，CCRT期间SMI损失> 10.0%/150天与较差的OS（HR，6.02; 95%CI，3.04-11.93; P < 0.001）和CSS（HR，3.49; 95%CI，1.44-8.42; P = 0.006）独立相关，当调整FIGO分期、病理学和治疗时。CCRT期间治疗前肌肉减少症和SMD、SATI和VATI的变化与生存率无关。结论：在临床实践中，骨骼肌测量可作为预测LACC患者预后的影像学生物标志物。需要进一步的研究来确定多模式干预是否可以保护骨骼肌质量，从而提高生存率。(C)2018年AACR。
Purpose: This study investigates the association between body composition change during concurrent chemoradiotherapy (CCRT) and outcome in patients with locally advanced cervical cancer (LACC). ExperimentalDesign: Pre- and posttreatment CT images of 245 patients with LACC who were treated between 2004 and 2015 were analyzed. Skeletal muscle index (SMI) and density (SMD), subcutaneous adipose tissue index (SATI), and visceral adipose tissue index (VATI) were measured from two sets of CT images at the level of the L3 vertebra. Sarcopenia and a low SMD were defined using published cut-off points. Predictors of overall survival (OS) and cancer-specific survival (CSS) were analyzed using Cox regression models.Results: The median follow-up was 62.7 (range, 7.3-152.3) months. Among the 245 patients, 127 (51.8%) had pretreat-ment sarcopenia, and 154 (62.9%) had a low SMD. SMI did not decrease significantly during CCRT, 0.6%/150 days [ 95% confidence interval (CI), - 1.8-0.6; P = 0.35]. However, SMI loss during CCRT of > 10.0%/150 days was independently associated with poorer OS (HR, 6.02; 95% CI, 3.04-11.93; P < 0.001) and CSS (HR, 3.49; 95% CI, 1.44-8.42; P = 0.006) when adjusted for FIGO stage, pathology, and treatment. Pretreatment sarcopenia and change of SMD, SATI, and VATI during CCRT were not associated with survival.Conclusions: Skeletal muscle measurements could be imaging biomarkers to predict outcomes for patients with LACC in clinical practice. Further studies are needed to determine whether multimodal interventions can preserve skeletal muscle mass and thereby improve survival. (C) 2018 AACR.