肌肉质量而非数量预测头颈部鳞状细胞癌患者的生存。
Muscle quality and not quantity as a predictor of survival in head and neck squamous cell carcinoma.
发表日期：2023 Aug 09
作者：
Elisabetta Roberti, Marco Merlano, Marco Ravanelli, Andrea Alberti, Andrea Esposito, Riccardo Gili, Silvia Spinazzé, Cristina Baré, Genny Jocollé, Marco Benasso, Francesca Bertolotti, Stefania Vecchio, Almalina Bacigalupo, Lisa Licitra, Nerina Denaro, Mauro Damico, Luigi Lorini, Cristina Gurizzan, Salvatore Alfieri, Paolo Bossi
来源：
ORAL ONCOLOGY
摘要：
头颈鳞状细胞癌（HNSCC）患者中频繁出现肌肉萎缩症，这是由于与风险因素或肿瘤体积相关的营养不良所致。治疗与毒性有关，导致摄入热量减少和肌肉质量减少。肌肉萎缩与肿瘤控制和生存结果呈负相关。我们的目标是评估肌肉萎缩对接受化放疗的HNSCC患者总生存期（OS）和无进展生存期（PFS）的预后影响。在化放疗与诱导化疗后放疗和曲妥珠单抗（INTERCEPTOR）的前瞻性临床试验中，我们调查了基线CT或MRI中肌肉萎缩的放射学标记与OS和PFS的关联。我们研究了第三颈椎水平的椎旁骨骼肌面积（cm2）、肌肉密度（HU）、肌肉指数（cm2/m2）和肌间脂肪组织（IMAT）面积（cm2）。我们对128名患者的影像进行了评估。我们发现较高的身体质量指数（BMI）与更好的OS（p = 0.02）和PFS（p = 0.04）相关联。骨骼肌面积（p = 0.02）和IMAT（p = 0.02）与PFS呈负相关。IMAT与肌肉面积呈正相关（相关系数0.6, CI95% 0.47-0.7），与肌肉密度呈负相关（相关系数-0.37, CI95% -0.53 - -0.18）。IMAT可用作预测接受化放疗的HNC患者的PFS的指标。肌间脂肪沉积量会使肌肉质量发生改变，而不会影响肌肉数量，进而影响患者的预后。版权所有 © 2023 Elsevier Ltd. 保留所有权利。
Sarcopenia is frequent in head and neck squamous cell carcinoma (HNSCC), as a consequence of malnutrition related to risk factors or tumoral mass. Treatment is associated with toxicities that lead to reduced calories intake and muscle mass wasting. Sarcopenia has been negatively associated with tumor control and survival outcomes.Our aim is to evaluate the prognostic impact of sarcopenia on overall survival (OS) and progression free survival (PFS) in HNSCC patients undergoing chemoradiation therapy within a prospective clinical trial of chemoradiation vs induction chemotherapy followed by radiation and cetuximab (INTERCEPTOR).On baseline CT or MRI, we investigated the association between OS and PFS with radiological markers of sarcopenia, measured at the third cervical vertebra level. We studied paravertebral skeletal muscles area (cm2), muscle density (HU), muscle index (cm2/m2), and intermuscular adipose tissue (IMAT) area (cm2).Imaging of 128 patients was evaluable. We found out that higher body mass index (BMI) was associated with better OS (p = 0.02), and PFS (p = 0.04). Skeletal muscle area (p = 0.02), and IMAT (p = 0.02) were negatively associated with PFS. IMAT was positively correlated with muscle area (Correlation coefficient 0.6, CI95% 0.47-0.7), and negatively associated with muscle density (Correlation coefficient -0.37, CI95% -0.53 - -0.18).IMAT can be used as predictor of PFS in HNC patients undergoing chemoradiation therapy. The amount of intermuscular fat deposits induces alterations of muscle quality, without alterations of muscle quantity, influencing patients' prognosis.Copyright © 2023 Elsevier Ltd. All rights reserved.