肌少症对食管鳞癌术后复发患者放化疗不良反应及预后影响

Effect of sarcopenia on survival and toxicity in postoperative recurrent esophageal squamous cell carcinoma patients receiving chemoradiotherapy

目的探讨基于定位CT分析肌少症对食管鳞癌术后复发患者放化疗期间不良反应及预后的影响。方法回顾性分析2016—2017年于淮安市第一人民医院行放化疗的147例食管鳞癌术后局部复发患者,依据模拟定位CT勾画计算主动脉弓上缘水平横断面双侧胸肌面积(PMA)。PMA身高校正(PMA/身高2)得出胸肌指数(PMI)。将男女患者分别依据PMI三分位数分组,其中低PMI者(男性<11.55 cm^(2)/m^(2),女性<8.69 cm^(2)/m^(2))为肌少症组。比较肌少症组与非肌少症组患者治疗期间不良反应发生率及1年和3年总生存(OS)率的差异。结果147例患者中49例(33.3%)存在肌肉减少,该类患者3-4级不良反应发生率显著高于非肌少症患者(40.8%∶18.4%,P=0.005)。肌少症患者1年和3年OS(61.2%和10.2%)显著低于非肌少症患者(82.7%和28.6%),差异具有统计学意义(P<0.001),多因素分析证实肌少症是预测不良预后的独立危险因素(P<0.001)。结论基于定位CT获得的PMI在诊断肌少症方面具有较好的临床价值,可能可以作为诊断肌少症的新工具。

Objective To evaluate the impact of sarcopenia on survival and treatment-related toxicity in postoperative recurrent esophageal squamous cell carcinoma(ESCC)patients treated with chemoradiotherapy.Methods Clinical data of 147 patients with postoperative locoregional recurrent ESCC receiving chemoradiotherapy in Huai'an First People's Hospital from 2016 to 2017 were retrospectively analyzed.Pectoralis muscle area(PMA)was determined using routine pre-radiotherapy CT simulation scan above the aortic arch level.Sarcopenia was defined as a cut-off value of pectoralis muscle index(PMI)(PMA/height2)<11.55 cm^(2)/m^(2) for males and<8.69 cm^(2)/m^(2) for females.The incidence of toxicity,1-and 3-year overall survival(OS)rates were statistically compared between patients with and without sarcopenia.Results Sarcopenia was detected in 49 of 147(33.3%)patients.The incidence of grade 3-4 toxicities in sarcopenic patients was significantly higher compared to that in their counterparts without sarcopenia(40.8%vs.18.4%,P=0.005).In addition,patients with sarcopenia had significantly worse 1-year(61.2%vs.82.7%)and 3-year OS rates(10.2%vs.28.6%)than those without sarcopenia(both,P<0.001).Multivariate analysis showed that sarcopenia was an independent prognostic factor for poor OS(P<0.001).Conclusion PMI based on CT simulation scan has prognostic value in postoperative locoregional recurrent ESCC patients treated with chemoradiotherapy,which probably serves as a novel diagnostic tool for sarcopenia.