对于接受晚期非小细胞肺癌的免疫疗法的患者，胸肌肉减少症是一种较差的预后预测因子
Thoracic Sarcopenia was a Poor Prognostic Predictor in Patients Receiving Immunotherapy for Advanced Non-small-cell Lung Cancer
影响因子:3.90000
分区:医学2区 / 核医学2区
发表日期:2025 Jan
作者:
Minhong Wang, Piao Yang, Lixiang Zhou, Zhan Feng
摘要
在第三腰（L3）水平上测量的肌肉减少症已被证明可以预测癌症患者的存活率。但是，许多患有晚期非小细胞肺癌（NSCLC）的患者不接受常规的腹部成像。这项研究的目的是调查接受NSCLC免疫疗法的患者的胸椎肌肉减少症与生存结果的关联。在这项回顾性研究中，招募了2019年至2022年对晚期NSCLC进行免疫疗法的患者。并收集了详细的患者数据。在预处理胸部计算机断层扫描（CT）扫描上，在第五胸椎（T5）上计算横截面骨骼肌区域。性别特异性的最低四分位数值用于定义肌肉减少症。使用COX分析分析了风险因素。对数秩检验和随机生存森林（RSF）用于比较无进展生存期（PFS）。使用校准曲线和接收器操作特征曲线（ROC）评估了模型的性能。总共包括242名患者（发现队列n = 194，验证队列n = 48）。在发现队列中，肌肉减少症患者的PFS明显差（P <0.001）比没有肌片的患者。单变量COX回归表明，肌肉减少症，肺癌阶段，体重指数，吸烟状况和中性粒细胞与淋巴细胞比率是PFS较差的预测指标。基于上述参数构建了RSF模型，以评估模型的功效，使用了ROC曲线。曲线下的面积可预测6个月的PFS 0.68，而12个月的PFS为0.69。该发现队列建立的生存结果的预测模型在验证队列中表现出相似的表现。T5的骨质减少症是接受晚期NSCLC免疫疗法的患者的独立预后因素。
Abstract
Sarcopenia, as measured at the level of the third lumbar (L3) has been shown to predict the survival of cancer patients. However, many patients with advanced non-small cell lung cancer (NSCLC) do not undergo routine abdominal imaging. The objective of this study was to investigate the association of thoracic sarcopenia with survival outcomes among patients who underwent immunotherapy for NSCLC.In this retrospective study, patients who initiated immunotherapy for advanced NSCLC from 2019 to 2022 were enrolled. and detailed patient data were collected. Cross sectional skeletal muscle area was calculated at the fifth thoracic vertebra (T5) on pretreatment chest computed tomography (CT) scan. Gender-specific lowest quartile values was used to define sarcopenia. The risk factors were analyzed using Cox analyses. The log-rank test and the random survival forest (RSF) were used to compare progression free survival (PFS). The model's performance was assessed using calibration curve and the receiver operating characteristic curve (ROC).A total of 242 patients was included (discovery cohort n = 194, validation cohort n = 48). In the discovery cohort, patients with sarcopenia exhibited significantly poorer PFS (p < 0.001) than patients without sarcopenia. Univariate cox regression revealed that sarcopenia, lung cancer stage, body mass index, smoking status, and neutrophil-to-lymphocyte ratio were predictors of poor PFS. A RSF model was constructed based on the aforementioned parameters, to evaluate the model's efficacy, the ROC curve was utilized. with an area under the curve for predicting 6-month PFS of 0.68 and for 12-month PFS of 0.69. The prediction models for survival outcomes built by the discovery cohort showed similar performance in the validation cohort.Sarcopenia at T5 is independent prognostic factors in patients who received immunotherapy for advanced NSCLC.