本研究旨在探讨宫颈癌治疗期间基线肌肉减少症和身体成分变化对生存的影响。纳入了 2002 年至 2022 年间诊断为 IB1-IVB 期宫颈癌并接受初次同步放化疗 (CCRT) 的患者。排除标准是既往接受过根治性子宫切除术、缺乏治疗前计算机断层扫描 (CT) 成像或存在明显的合并症。基于人工智能的自动分割程序通过分析 CT 图像来评估身体成分，定义 L3 骨骼肌指数 [SMI] <39cm2/m2）和体积肌少症（体积 SMI <180.4 cm3/m3）。比较和多变量分析确定了预后因素。研究人员探讨了 CCRT 期间身体成分变化的影响。在 347 名患者中，有 125 例复发，59 例死亡（中位随访时间为 50.5 个月）。由于基线 CT 数据不完整，7 名患者被排除在体积肌少症分析之外，175 名患者被纳入身体成分变化分析。 L3 肌少症患者的 5 年无进展生存率 (PFS) 较低（55.6% 比 66.2%，p = 0.027），而体积肌少症患者的 5 年总生存率较差（76.5% 比 66.2%，p = 0.027）。 85.1%，p = 0.036）。 CCRT 期间总脂肪减少的患者的 5 年 PFS 率比总脂肪增加的患者更差（61.9% vs. 73.8%，p = 0.029）。多变量分析显示，总脂肪减少（调整后的风险比 [aHR]，2.172；95% 置信区间 [CI]，1.066-4.424；p = 0.033）是复发的重要因素，而 L3 肌少症则不是。体积性肌少症使死亡风险增加 1.75 倍（aHR，1.750；95% CI，1.012-3.025；p = 0.045）。在接受 CCRT 的宫颈癌患者中，初始体积性肌少症和治疗期间的脂肪减少是生存危险因素。这些发现表明个性化支持护理的潜在重要性，包括量身定制的营养和运动干预措施。版权所有 © 2024 Elsevier Inc. 保留所有权利。

This study aimed to investigate the influence of baseline sarcopenia and changes in body composition on survival during cervical cancer treatment.Patients diagnosed with stage IB1-IVB cervical cancer who underwent primary concurrent chemoradiation therapy (CCRT) between 2002 and 2022 were included. The exclusion criteria were prior radical hysterectomy, lack of pretreatment computed tomography (CT) imaging, or significant comorbidities. An artificial intelligence-based automatic segmentation program assessed body composition by analyzing CT images, defining L3 sarcopenia (L3 skeletal muscle index [SMI] <39cm2/m2) and volumetric sarcopenia (volumetric SMI <180.4 cm3/m3). Comparative and multivariate analyses identified the prognostic factors. The impact of body component changes during CCRT was explored.Among 347 patients, there were 125 recurrences and 59 deaths (median follow-up, 50.5 months). Seven patients were excluded from the volumetric sarcopenia analysis because of incomplete baseline CT data, and 175 patients were included in the analysis of body composition changes. Patients with L3 sarcopenia had a lower 5-year progression-free survival (PFS) rate (55.6% vs. 66.2%, p = 0.027), while those with volumetric sarcopenia showed a poorer 5-year overall survival rate (76.5% vs. 85.1%, p = 0.036). Patients with total fat loss during CCRT had a worse 5-year PFS rate than those with total fat gain (61.9% vs. 73.8%, p = 0.029). Multivariate analyses revealed that total fat loss (adjusted hazard ratio [aHR], 2.172; 95% confidence interval [CI], 1.066-4.424; p = 0.033) was a significant factor for recurrence, whereas L3 sarcopenia was not. Volumetric sarcopenia increased the risk of death by 1.75-fold (aHR, 1.750; 95% CI, 1.012-3.025; p = 0.045).Among patients with cervical cancer undergoing CCRT, initial volumetric sarcopenia and fat loss during treatment are survival risk factors. These findings suggest the potential importance of personalized supportive care, including tailored nutrition and exercise interventions.Copyright © 2024 Elsevier Inc. All rights reserved.