Muscle loss during primary debulking surgery and chemotherapy predicts poor survival in advanced-stage ovarian cancer
Muscle loss during primary debulking surgery and chemotherapy predicts poor survival in advanced-stage ovarian cancer
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DOI：
10.1002/jcsm.12524
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发表时间：
2020-01-30
影响因子：
8.9
通讯作者：
Lee, Jie
中科院分区：
文献类型：
--
作者：
Huang, Chueh-Yi;Yang, Yuh-Cheng;Lee, Jie
背景：在晚期上皮性卵巢癌（EOC）患者中常见肌肉减少症。然而，在原发性肿瘤减积手术（PDS）和辅助铂类化疗期间，身体成分变化对晚期EOC患者预后的影响尚不清楚。本研究旨在评价接受PDS和辅助铂类化疗的III期EOC患者的身体成分变化与结局之间的相关性。方法分析139例III期卵巢癌患者治疗前后的CT图像。所有CT图像均为对比增强扫描，并根据标准化方案采集。使用在L3椎骨水平获得的CT图像测量骨骼肌指数（SMI）、骨骼肌放射密度（SMD）和总脂肪组织指数。使用考克斯回归模型确定总生存期的预测因子。结果中位随访37.9个月。治疗前和治疗后CT之间的中位持续时间为182天（四分位距：161-225天）。患者的平均SMI损失为1.8%/180天（95%置信区间：-3.1至-0.4; P = 0.01），SMD损失为1.7%/180天（95%置信区间：-3.3至-0.03; P = 0.046）。SMI和SMD变化与体重指数变化弱相关（SMI的斯皮尔曼rho为0.15，P = 0.07; SMD的rho为0.02，P = 0.82）。改良的格拉斯哥预后评分与SMI丢失相关（比值比：2.42，95%置信区间：1.03-5.69; P = 0.04）。治疗后SMI丢失>= 5%的患者的中位疾病复发时间显著短于SMI丢失的患者
Background Sarcopenia is commonly observed in patients with advanced-stage epithelial ovarian cancer (EOC). However, the effect of body composition changes-during primary debulking surgery (PDS) and adjuvant platinum-based chemotherapy-on outcomes of patients with advanced-stage EOC is unknown. This study aimed to evaluate the association between body composition changes and outcomes of patients with stage III EOC treated with PDS and adjuvant platinum-based chemotherapy. Methods Pre-treatment and post-treatment computed tomography (CT) images of 139 patients with stage III EOC were analysed. All CT images were contrast-enhanced scans and were acquired according to a standardized protocol. The skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and total adipose tissue index were measured using CT images obtained at the L3 vertebral level. Predictors of overall survival were identified using Cox regression models. Results The median follow-up was 37.9 months. The median duration between pre-treatment and post-treatment CT was 182 days (interquartile range: 161-225 days). Patients experienced an average SMI loss of 1.8%/180 days (95% confidence interval: -3.1 to -0.4; P = 0.01) and SMD loss of 1.7%/180 days (95% confidence interval: -3.3 to -0.03; P = 0.046). SMI and SMD changes were weakly correlated with body mass index changes (Spearman rho for SMI, 0.15, P = 0.07; rho for SMD, 0.02, P = 0.82). The modified Glasgow prognostic score was associated with SMI loss (odds ratio: 2.42, 95% confidence interval: 1.03-5.69; P = 0.04). The median time to disease recurrence was significantly shorter in patients with SMI loss >= 5% after treatment than in those with SMI loss