目的:消化道癌症患者基于计算机断层扫描(CT)的身体成分参数/表型的表征和预后价值仍然不完整。本研究旨在探讨消化道癌症患者的参数/表型与临床预后之间的关系。
方法:在这项前瞻性队列研究中,使用CT扫描评估了8267例消化道癌症患者,以确定身体成分。身体成分数据,包括骨骼肌(SM)区域,皮下脂肪组织(SAT),和内脏脂肪组织(VAT),在手术前30天内获得的CT图像上收集了第三腰椎水平。身体成分表型(肌少症,癌症恶病质,肌少症肥胖)是根据SM确定的,SAT,和增值税区。主要终点是总生存期,从电子病历和电话随访调查中获得。采用Kaplan-Meier和对数秩分析来比较未调整的生存率,虽然多变量生存分析是使用比例风险模型进行调整的年龄,性别,和癌症淋巴结转移(TNM)分期。
结果:计算第二(Q2)的全因死亡率的调整危险比(HR),第三(Q3),和相对于SM区域的第一个分位数(Q1)的第四个(Q4)分位数,显示调整后的汇总HR为0.575(95%CI,0.361-0.916),0.419(95%CI,0.241-0.729),和0.384(95%CI,0.203-0.726),分别。男性患者经肌肉减少症调整后的总HR为1.795(95%CI:1.012-3.181),女性患者为1.925(95%CI:1.065-3.478)。男性患者的癌症恶病质校正汇总HR为1.542(95%CI:1.023-2.324),女性患者为1.569(95%CI:0.820-3.001)。男性患者经肌肉减少性肥胖调整后的总HR为1.122(95%CI:0.759-1.657),女性患者为1.303(95%CI:0.623-2.725)。亚组分析表明不同癌症类型之间的身体成分参数/表型的预后值不同。
结论:我们的研究结果表明,大的SM面积是一个有利的预后指标,而恶性肿瘤恶病质和肌少症对消化道肿瘤患者预后较差。这些发现对于消化道癌症患者的个性化术前身体成分评估具有重要意义。
OBJECTIVE: The characterization and prognostic value of body composition parameter/phenotype based on computed tomography (CT) in patients with digestive tract cancers remain incomplete. This study aimed to investigate the relationship between parameter/phenotype and clinical outcomes in patients with digestive tract cancers.
METHODS: In this prospective cohort study, 8267 patients with digestive tract cancers were assessed using CT scans to determine body composition. Body composition data, including areas of skeletal muscle (SM), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT), were collected at the third lumbar level on CT images obtained within 30 days before surgery. Body composition phenotypes (sarcopenia, cancer cachexia, sarcopenic obesity) were determined based on SM, SAT, and VAT areas. The primary endpoint was overall survival, obtained from electronic medical records and telephone follow-up surveys. Kaplan-Meier and log-rank analyses were employed to compare unadjusted survival, while multivariate survival analyses were conducted using a proportional hazards model adjusted for age, gender, and cancer-node-metastasis (TNM) stages.
RESULTS: Adjusted hazard ratios (HRs) for all-cause mortality were calculated for the second (Q2), third (Q3), and fourth (Q4) quantiles relative to the first quantile (Q1) for SM areas, revealing adjusted summary HRs of 0.575 (95% CI, 0.361-0.916), 0.419 (95% CI, 0.241-0.729), and 0.384 (95% CI, 0.203-0.726), respectively. Sarcopenia-adjusted summary HRs were 1.795 (95% CI: 1.012-3.181) for male patients and 1.925 (95% CI: 1.065-3.478) for female patients. Cancer cachexia-adjusted summary HRs were 1.542 (95% CI: 1.023-2.324) for male patients and 1.569 (95% CI: 0.820-3.001) for female patients. Sarcopenic obesity-adjusted summary HRs were 1.122 (95% CI: 0.759-1.657) for male patients and 1.303 (95% CI: 0.623-2.725) for female patients. Subgroup analyses indicated varying prognostic values of body composition parameter/phenotype among different cancer types.
CONCLUSIONS: Our findings suggest a large SM area is a favorable prognostic indicator, while cancer cachexia and sarcopenia signify poor prognosis in patients with digestive tract cancers. These findings have important implications for the personalized preoperative assessment of body composition in patients with digestive tract cancers.