局部晚期宫颈癌患者同步放化疗后机体成分变化CT定量分析与预后的关系

Relationship Between Changes in Body Composition and Prognosis of Local Advanced Cervical Cancer after Concurrent Chemoradiotherapy

目的:评估局部晚期(ⅡB~ⅣA期)宫颈癌患者同步放化疗前后腹部脂肪及肌肉组织变化和预后的关系。方法:回顾分析127例经病理学证实为ⅡB~ⅣA期宫颈癌患者,所有患者经历同步放化疗,测量治疗前后L3横突水平内脏脂肪横截面积(VFA)、皮下脂肪横截面积(SFA)、肌肉横截面积(SMA)和总脂肪面积(TFA),计算VFA/SFA和体重指数(BMI),统计患者无进展生存期和总生存率,分析治疗前后身体成分变化与预后的关系。结果:与晚期宫颈癌患者无进展生存期有关的因素是肿瘤最大径≥5cm,低分化,同步放化疗后VFA减少、VFA/SFA减少、TFA减少、SMA减少≥10%和BMI减少≥0.38kg/m^(2);与较低生存率有关的因素是肿瘤分期≥ⅢA,肿瘤最大径≥5cm,腺癌,同步放化疗后VFA减少、VFA/SFA减少和SMA减少≥10%。其中SMA减少≥10%、VFA/SFA降低与患者无进展生存期短和生存率低独立相关。结论:局部晚期宫颈癌患者预后不仅与肿瘤本身特异性因素有关,同步放化疗过程中机体成分改变同样和患者预后有关,CT测量机体成分变化可给临床医生提供治疗参考。

Purpose: To evaluate the relationship between abdominal fat and muscle tissue changes before and after concurrent chemoradiotherapy and prognosis in patients with advanced cervical cancer(stage Ⅱ B-Ⅳ A).Methods: A retrospective analysis was conducted on the case of Ⅱ B-Ⅳ A which was diagnosed by pathological results. All patients underwent concurrent chemoradiotherapy. Cross-sectional area of abdominal fat area(VFA),subcutaneous fat area(SFA), skeletal muscle area(SMA) and total fat(TFA) at the level of L3 transverse were measured before and after treatment. VFA/SFA and body mass index(BMI) were also calculated. Progression-free survival and overall survival of the patients were calculated. The relationship between changes in body composition and prognosis before and after treatment was analyzed.Results: The factors associated with progression-free survival of patients with advanced cervical cancer were tumor maximum diameter≥5 cm, low differentiation, VFA reduction,VFA/SFA reduction, TFA reduction, SMA reduction≥10% and BMI reduction≥0.38 kg/m^(2) after concurrent chemoradiotherapy. The factors associated with lower survival were tumor stage≥ⅢA, maximum tumor diameter ≥5 cm, adenocarcinoma, reduction of VFA, reduction of VFA/SFA, and reduction of SMA≥10% after concurrent chemoradiotherapy. Of all the factors, reduction of SMA≥10% and a decrease in VFA/SFA were independently associated with shorter progression-free survival and lower survival. Conclusion: The prognosis of patients with advanced cervical cancer is not only related to the specific factors of the tumor itself, but also the changes of body composition after chemoradiotherapy. The prognosis of patients can be improved when the CT measurement of changes in body composition is provided to the clinicians for treatment reference.