摘要
目的 探讨第三腰椎骨骼肌指数(L3-SMI)预测食管癌患者总生存(OS)期的最佳截止点与临床应用价值。方法 对2016年1月至2020年10月于南通大学附属海安医院接受手术或根治性放化疗的150例食管癌患者进行回顾性分析,通过分析每例患者的腹部计算机断层扫描(CT)影像,计算L3-SMI。通过受试者操作特征(ROC)曲线认定L3-SMI预测食管癌患者预后的最佳截止点,并将所有患者分为低L3-SMI组与高L3-SMI组进行生存分析。采用Kaplan-Meier曲线计算两组患者的3年OS率,单、多因素Cox回归分析确定L3-SMI在食管癌患者中的独立预后价值。结果 研究队列中,男性患者L3-SMI平均值为(43.8±6.3)cm~2/m~2,女性为(38.7±6.7)cm~2/m~2,L3-SMI预测食管癌患者预后的理想截止点为:男性<42.8 cm~2/m~2,女性<39.2 cm~2/m~2,曲线下面积(AUC)值分别为0.628(95%CI=0.515~0.742)和0.654(95%CI=0.513~0.796)。根据L3-SMI的最佳截止点,将所有患者分为高L3-SMI组(n=79)与低L3-SMI组(n=71)。结果显示,两组患者3年OS率分别为33.5%和54.6%,差异有统计学意义(χ~2=5.358,P=0.021)。亚组分析表明,低L3-SMI与男性患者不良预后显著相关(3年OS率:24.8%比53.6%,χ~2=4.752,P=0.029)。对于女性食管癌患者,低L3-SMI组患者较高L3-SMI组有更低的3年OS率(39.8%比65.4%),但差异无统计学意义(χ~2=1.835,P=0.176)。单、多因素Cox回归分析证实,影响食管癌患者预后的独立因素包括低L3-SMI(HR=1.669,95%CI=1.062~2.625,P=0.027)、预后营养指数(PNI)<50.2(HR=1.700,95%CI=1.033~2.796,P=0.037)与TNM分期Ⅲ期(HR=1.503,95%CI=1.077~2.479,P=0.024)。结论 L3-SMI是一项预测食管癌患者预后的重要影像学参数。
Objective This study aimed to explore the optimal threshold and predictive value of skeletal muscle index at the third lumbar vertebra level( L3-SMI) for the prognosis of esophageal cancer patients.Method 150 esophageal cancer patients who were treated with surgical resection or curative chemoradiotherapy in Haian Hospital Affiliated to Nantong University from January 2016 to October 2020 were analyzed retrospectively.The L3-SMI was measured by analyzing abdominal computed tomography( CT) images.The optimal cutoff values of L3-SMI for survival prediction of male and female patients were identified by the receiver operation characteristics( ROC) curves,respectively.All patients were divided into high and low L3-SMI groups,and Kaplan-Meier curve was used to estimate the 3-year overall survival( OS) rate of the two patient groups.In addition,the independent prognostic factors of L3-SMI for esophageal cancer patients were further determined by the univariate and multivariate Cox regression analysis.Result In this study cohort,the average value of L3-SMI for male and female patients were(43.8±6.3) cm~2/m~2 and(38.7±6.7) cm~2/m~2,respectively.The best cutoff values of L3-SMI for survival prediction of esophageal cancer patients were <42.8 cm~2/m~2 for males and <39.2 cm~2/m~2for females,respectively.The AUC value of the former was 0.628( 95%CI= 0.515-0.742) and the latter had an AUC value of 0.654(95%CI= 0.513-0.796).All patients were divided into high L3-SMI(n= 79) and low L3-SMI groups(n= 71) based on the identified cutoff values.The results of survival analysis indicated that the 3-year OS rate of low L3-SMI and high L3-SMI group were 33.5% and 54.6%,with a significant statistical difference(χ~2= 5.358,P= 0.021).The subgroup analysis showed that low L3-SMI was significantly associated with worse OS in male patients(3-year OS rate:39.8% vs 65.4%,χ~2= 4.752,P= 0.029).For female patients with esophageal cancer,low L3-SMI group had a lower 3-year OS rate than high L3-SMI group(39.8% vs 65.4%),but the survival difference was not statistically significant(χ~2= 1.835,P= 0.176).The results of the univariate and multivariate Cox regression analysis demonstrated that low L3-SMI(HR= 1.669,95%CI= 1.062-2.625,P= 0.027),prognostic nutritional index( PNI) <50.2(HR=1.700,95%CI= 1.033-2.796,P= 0.037) and Ⅲ stage of the TNM stage(HR= 1.503,95%CI= 1.077-2.479,P=0.024) were independent prognostic factors for esophageal cancer patients.Conclusion L3-SMI is a valuable imaging parameter of prognostic assessment for esophageal cancer patients.
作者
吴洁
周晶晶
陈海生
Wu Jie;Zhou Jingjing;Chen Haisheng(Department of Thoracic Surgery,Hai’an People’s Hospital,Hai'an 226600 Jiangsu China)
出处
《肿瘤代谢与营养电子杂志》
2022年第5期602-608,共7页
Electronic Journal of Metabolism and Nutrition of Cancer
关键词
食管癌
第三腰椎骨骼肌指数
肌肉减少症
预后
预测
Esophageal cancer
L3-skeletal muscle index
Sarcopenia
Prognostic
Prediction
