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Oncotarget. 2017;8(45):79441-79452.

Skeletal muscle depletion predicts survival of patients with advanced biliary tract cancer undergoing palliative chemotherapy.

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제1저자 조경민 · 교신저자 오도연

PMID 29108323 PMC5668056 DOI 10.18632/oncotarget.18345 IF 5.168 혈액종양내과
소속 (3)
  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  2. Department of Internal Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND No prior study has investigated the dynamics of body weight with body muscle mass as a prognostic factor in advanced biliary tract cancer (BTC) patients undergoing palliative chemotherapy. We investigated whether low skeletal muscle mass affects survival in patients with BTC, with a co-analysis of body weight loss and body mass index (BMI).

RESULTS By multivariate analysis, low skeletal muscle mass at diagnosis and decreased SMI during chemotherapy (p = 0.008 and p < 0.001, respectively) were poor prognostic factors for overall survival (OS). Subgroup analysis revealed that low skeletal muscle mass patients who were overweight or obese (BMI ≥ 25 kg/m2) showed worse OS (p < 0.001). Additionally, patients with both decreased BMI and SMI during chemotherapy had worse OS (p < 0.001). Furthermore, patients with decreased SMI had shorter survival regardless of change in BMI. However, for patients with SMI maintained during chemotherapy, decreased BMI had no effect on survival (p = 0.576).

MATERIALS AND METHODS We consecutively enrolled 524 patients with advanced BTC who received palliative chemotherapy between 2003 and 2013. Total muscle cross-sectional area (cm2) at the L3 level assessed by computed tomography was analyzed. We defined low skeletal muscle mass as a skeletal muscle index (SMI) < 48.5 cm2/m2 (men) and < 39.5 cm2/m2 (women) using ROC curves.

CONCLUSIONS Low skeletal muscle mass, obesity and muscle depletion during palliative chemotherapy are meaningful prognostic factors in advanced BTC. Considering muscle depletion with weight change could help to more accurately predict prognoses of patients with BTC.

Keywords

BMIbiliary tract cancerprognosisskeletal muscle depletionweight change

Figures

Figure 1
Figure 1 Receiver operating characteristic (ROC) curve of low muscle mass for both sexes
Figure 2
Figure 2 Scatter plot for skeletal muscle index (SMI) and body mass index (BMI) (A) Relationship between SMI and BMI. (Pearson r = 0.449, p < 0.001 for all patients; men, r = 0.593, p < 0.001; women, r = 0.381, p < 0 .001). (B) Relationship between changes in SMI and BMI. (Pearson r = 0.336, p < 0.001 for all patients; men, r = 0.328, p < 0.001; women, r = 0.349, p = 0.001).
Figure 3
Figure 3 Overall survival according to skeletal muscle index (SMI) Initial low skeletal muscle mass was related to poorer prognosis (A) for the entire patient population (Hazard ratio (HR) 1.569; p = 0.008); (B) for men (HR 1.511; p = 0.032); (C) for women (HR 4.042; p < 0.001).
Figure 4
Figure 4 Overall survival according to change in body mass index (BMI) and skeletal muscle index (SMI) Decrease in BMI (A) for the entire patient population (Hazard ratio (HR) 1.402; p = 0.116); (B) for men (HR 1.584; p = 0.065); (C) for women (HR 0.571; p = 0.238). Decrease in SMI (D) for the entire patient population (HR 2.580; p < 0.001); (E) for men (HR 2.370; p < 0.001); (F) for women (HR 4.042; p < 0.001).
Figure 5
Figure 5 Overall survival (OS) according to correlation between body mass index (BMI) and skeletal muscle index (SMI) upon diagnosis Patients with low skeletal muscle mass who were overweight or obese had the poorest OS. Patients with low skeletal muscle mass who were overweight or obese had a 4.0-month shorter average OS than non-low skeletal muscle mass patients who were not overweight or obese (median OS 11.0 months vs 6.0 months; HR,2.130; p < 0.001).

그림 출처: PubMed Central 공개 논문 (PMC5668056)

Conflict of interest statement

CONFLICTS OF INTEREST All authors have no conflicts of interest to declare.

그 밖의 정보
출판 형태
Journal Article
저널
Oncotarget · eISSN 1949-2553
전자 출판
2017-06-02
참고문헌
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