Sarcopenia is associated with higher toxicity and poor prognosis of nasopharyngeal carcinoma
Sarcopenia is associated with higher toxicity and poor prognosis of nasopharyngeal carcinoma
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肌肉减少症与鼻咽癌的较高毒性和不良预后相关
DOI：
10.1177/1758835920947612
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发表时间：
2020-08-01
影响因子：
4.9
通讯作者：
Lin, Huan-Xin
中科院分区：
文献类型：
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作者：
Hua, Xin;Liao, Jun-Fang;Lin, Huan-Xin
背景：鉴于越来越多的证据表明肌肉减少症与各种癌症的毒性和生存有关，我们研究了它在接受同步放化疗（CCRT）的鼻咽癌（NPC）患者中的意义。方法：回顾性分析2010 - 2014年间接受CCRT治疗的862例鼻咽癌患者。使用常规放射治疗前计算机断层扫描（CT）模拟扫描确定第三颈椎水平的肌肉减少症。利用接收机工作特性曲线分析确定最佳截止值。倾向评分匹配（PSM）应用于有或无肌肉减少症患者的可比较队列。结果：共纳入862例患者作为主要队列，308例患者匹配并视为匹配队列。在主要队列中，肌少症组与非肌少症组的5年总生存率（OS）、局部无复发生存率和远处无转移生存率（DMFS）分别为78.2%对93.6% （p < 0.001）、89.4%对87.9% （p = 0.918）和82.5%对89.0% （p = 0.007）。单因素和多因素生存分析显示，肌肉减少症是OS （p < 0.001和p < 0.001）和DMFS （p = 0.009, p = 0.034）的独立预测因子。与没有肌肉减少症的患者相比，肌肉减少症患者的治疗相关毒性发生率明显更高（p = 0.032）。此外，肌少症患者的治疗反应也明显差于非肌少症患者（p = 0.004）。在PSM队列中也发现了类似的结果。结论：目前的研究结果支持肌少症是预测接受CCRT的鼻咽癌患者临床预后的一个有希望的指标。对CT模拟图像进行简单快速的分析，可以提供治疗毒性和生存预后的信息，从而指导CCRT期间个性化的多模式干预。
Background: Given the growing evidence that sarcopenia is associated with toxicity and survival in various cancers, we investigated its significance in patients with nasopharyngeal carcinoma (NPC) receiving concurrent chemoradiotherapy (CCRT). Methods: In this retrospective analysis, we studied 862 NPC patients who had received CCRT between 2010 and 2014. Sarcopenia was determined using routine pre-radiotherapy computed tomography (CT) simulation scans at the third cervical vertebral level. Receiver-operating characteristic curve analyses were used to determine the optimal cutoff values. Propensity score matching (PSM) was applied to develop comparable cohorts of patients with or without sarcopenia. Results: A total of 862 patients were included as the primary cohort, and 308 patients were matched and regarded as the matched cohort. In the primary cohort, the 5-year overall survival (OS), locoregional recurrence-free survival, and distant metastasis-free survival (DMFS) rates for the sarcopenia group versus non-sarcopenia group were 78.2% versus 93.6% (p < 0.001), 89.4% versus 87.9% (p = 0.918), and 82.5% versus 89.0% (p = 0.007), respectively. Univariate and multivariate survival analyses revealed that sarcopenia was an independent predictor of OS (p < 0.001 and p < 0.001) and DMFS (p = 0.009, p = 0.034). Patients with sarcopenia experienced significantly higher rates of treatment-related toxicities compared with patients without sarcopenia (p = 0.032). In addition, patients with sarcopenia also experienced significantly worse treatment response than those without sarcopenia (p = 0.004). Similar results were found in a PSM cohort. Conclusion: The current findings support that sarcopenia is a promising indicator for predicting clinical outcomes in NPC patients receiving CCRT. A simple and rapid analysis on CT simulation images can provide information about the therapeutic toxicity and survival prognosis, consequently guiding personalized multi-modality interventions during CCRT.