L_(3)椎体骨骼肌密度变化对食管鳞状细胞癌放化疗患者的预后预测价值

Prognostic value of skeletal muscle density change of L_(3)vertebra in patients with esophageal squamous cell carcinoma treated with radiotherapy and chemotherapy

目的探讨放疗前后L_(3)椎体骨骼肌密度(SMD)变化与食管鳞状细胞癌(ESCC)患者预后之间相关性。方法本研究对2012年3月至2018年11月于四川省肿瘤医院诊断为ESCC的患者进行回顾性病例研究,所有研究对象均测量了放疗前后L_(3)椎体SMD、L_(3)椎体骨骼肌面积、L_(3)椎体皮下脂肪面积、L_(3)椎体内脏脂肪面积的变化。根据放疗后L_(3)-SMD相较于放疗前改变情况,将L_(3)-SMD>0定义为增加组,L_(3)-SMD<0定义为降低组。使用风险比评估放疗前后SMD变化与总生存(OS)期之间的关系。生存分析采用Kaplan-Meier曲线和Cox比例风险模型。结果258例ESCC患者中,放疗后L_(3)椎体SMD增加为162例,中位随访时间为22.4个月(从3.3到92.4个月不等)。通过单、多因素Cox比例风险分析,发现放疗后SMD变化、年龄≥60岁和肿瘤长度是影响OS期的独立预后因素(P<0.05)。结论放疗前后SMD的变化可作为ESCC患者OS期的预后生物标志物。

Objective To investigate the correlation between skeletal muscle density(SMD)of L_(3)vertebrabefore and after radiotherapy and prognosis of esophageal squamous cell carcinoma(ESCC).Method This study was a retrospective case study of patients diagnosed with esophageal squamous cell carcinoma between March 2012 and November 2018.The skeletal muscle densi ty of L_(3)cone,skeletal muscle area ofL_(3)cone,subcutaneous fat area of L_(3)cone and visceral fat areaof L_(3)cone were measured beforeand after radiother apy.Hazard ratios were used to assess theassociation between changes in SMD and overall survival(OS)before and after radiotherapy.Kaplan-Meier curve and Cox proportional risk model were used for survival analysis.Result Among 258 patients with esophageal squamous cell carcinoma,162 patients in the L_(3)pyramidal subcutaneous skeletal muscle density increase group after radiotherapy were followed for a median of 22.4 months(ranging from 3.3 to 92.4 months).Through univariate Cox proportional risk analysis,we found that changes in SMD,age≥60 years and tumor length after radiotherapy were independent prognostic factors affec tingoverall survival(P<0.05).Conclusion Changes in subcutaneous skeletal muscle density before and after radiotherapy can be usedas a prognostic biomarker for overall survival in ESCC patients.