食管鳞癌患者同步放化疗前骨骼肌量减少与放化疗急性不良反应的研究  

Sarcopenia Before Concurrent Chemoradiotherapy May Develop Severe Adverse Reactions in Patients with Esophageal Squamous Cell Carcinoma

作　　者：陈晓霞 王飞[2] 刘彩云 李晓峰[2] 拾博[2] 王强[3] CHEN Xiaoxia;WANG Fei;LIU Caiyun;LI Xiaofeng;SHI Bo;WANG Qiang(Department of Radiology,Huishan Traditional Chinese Medicine Hospital,Wuxi 214100,China;Department of Radiology,Xuzhou Tumor Hospital,Xuzhou 221005,China;Department of Radiation Oncology,Xuzhou Tumor Hospital,Xuzhou 221005,China)

机构地区：[1]无锡市惠山区中医医院影像科,无锡214100 [2]徐州市肿瘤医院影像科,徐州221005 [3]徐州市肿瘤医院放疗科,徐州221005

出　　处：《肿瘤防治研究》2023年第12期1203-1208,共6页Cancer Research on Prevention and Treatment

基　　金：徐州市科技局重点研发课题(KC18200);江苏大学课题(JLY20180119)。

摘　　要：目的探讨进展期食管鳞状细胞癌(ESCC)同步放化疗前骨骼肌减少(肌少症)与发生3级及以上急性不良反应(AAR)和生存期的相关性。方法回顾性分析2018年8月—2022年7月间经病理证实并接受同步放化疗(FP方案)的进展期ESCC患者的病历资料,放化疗前在C T图像上测量骨骼肌量及身体组成成分,分为肌少症组和非肌少症组。根据CTCAE5.0版及美国RTOG急性放射损伤标准诊断≥3级AAR。分析发生≥3级AAR的危险因素,Kaplan-Meier法计算生存率。结果132例ESCC患者中肌少症组87例、非肌少症组45例,23例(17.4%)发生3级及以上AAR。肌少症(OR:6.034,95%CI:1.206~30.190,P=0.029)、骨骼肌密度降低(OR:0.693,95%CI:0.492~0.976,P=0.036)、SMI(骨骼肌指数)降低(OR:0.841,95%CI:0.721~0.982,P=0.028)、脂肪量增加(OR:2.433,95%CI:1.194~4.958,P=0.014)与发生3级及以上AAR的风险相关。与非肌少症组(19.27(95%CI:14.45~24.09)月)相比,肌少症组总生存期(16.01(14.89~17.13)月)降低(χ2=5.326,P=0.021);与发生0~2级AAR患者(16.67月)相比,3级及以上AAR患者总生存期(14.86月)减少(χ2=5.470,P=0.019)。3级及以上AAR患者中,肌少症组总生存期(12.13月)低于非肌少症组(18.69(12.85~21.88)月,χ2=4.466,P=0.035)。结论肌少症、骨骼肌密度减低及脂肪量增加是发生3级及以上AAR的重要预测因子,进展期ESCC合并肌少症患者发生3级及以上AAR有生存期减少的风险。Objective To investigate whether sarcopenia before concurrent chemoradiotherapy is prone to grade≥3 acute adverse reactions(AAR)and shorten survival in patients with advanced esophageal squamous cell carcinoma(ESCC).Methods Data of advanced patients with pathologically diagnosed ESCC and CCRT(FP regimen)from August 2018 to July 2022 were reviewed retrospectively.Skeletal muscle mass and body composition were measured using pre-treatment CT images,and patients were divided into sarcopenia and non-sarcopenia groups.Grade≥3 AAR was diagnosed based on CTCAE5.0 and acute radiation injury criteria of the US RTOG.Risk factors for developing grade≥3 AAR were analyzed,and survival rates were calculated by Kaplan-Meier method.Results Among 132 patients with ESCC(87 in the sarcopenia group and 45 in the non-sarcopenia group),23(17.4%)experienced grade≥3 AAR.In multivariate regression analysis,independent risk factors for grade≥3 AAR included the following:sarcopenia(OR:6.034,95%CI:1.206-30.190,P=0.029),decreased SMD(OR:0.693,95%CI:0.492-0.976,P=0.036),decreased SMI(OR:0.841,95%CI:0.721-0.982,P=0.028),and increased FMI(OR:2.433,95%CI:1.194-4.958;P=0.014).The OS rates were 16.01 months(95%CI:14.89-17.13)in the sarcopenia group and 19.27 months(95%CI:14.45-24.09)in the non-sarcopenia group(χ2=5.326,P=0.021)as well as 14.86 months(95%CI:11.30-18.42)for patients with grade≥3 AAR and 16.67 months(95%CI:14.91-18.43)for patients with grade 0-2 AAR(χ2=5.47,P=0.019).Among patients with grade≥3 AAR,the OS rates were 12.13 months(95%CI:10.15-14.11)in the sarcopenia group and 18.69 months(95%CI:12.85-21.88)in the non-sarcopenia group(χ2=4.466,P=0.035).Conclusion Sarcopenia,decreased skeletal muscle density,and increased fat mass are important predictors of grade≥3 AAR.The OS of patients with sarcopenia and grade≥3 AAR may be reduced.

关 键 词：食管鳞状细胞癌 身体组成成分 肌肉减少症 放化疗 急性不良反应 

分 类 号：R735.1[医药卫生—肿瘤] R685[医药卫生—临床医学]