Effects of sarcopenia on the clinical efficacy and prognosis of radical radiotherapy in elderly patients with esophageal cancer

doi:10.3760/cma.j.cn371439-20210526-00035

Abstract

Abstract:

Objective To explore the relationships between sarcopenia and the clinical efficacy and prognosis of elderly patients with esophageal cancer who were treated by radical radiotherapy. Methods The clinicopathological data of 134 elderly patients with esophageal cancer who received radical radiotherapy in Department of Radiotherapy, Affiliated Hospital of Yangzhou University from January 2013 to December 2018 were retrospectively analyzed. The muscle cross-sectional area at the level of the third lumbar vertebra was measured by using computed tomography （CT） images. These patients were divided into sarcopenia group （n=56） and non-sarcopenia group （n=78） according to the skeletal muscle index before radiotherapy. The efficacy and incidence of adverse reactions of the two groups were compared. Kaplan-Meier method was used to plot the survival curve, and Cox regression model was used to analyze prognostic factors. Results There was a significant difference in the objective response rate between the sarcopenia and non-sarcopenia group at 1 month after radiotherapy [53.57% （30/56） vs. 71.79% （56/78）, χ²=4.71, P=0.030]. There was no significant difference in the disease control rate between the two groups [94.64% （53/56） vs. 91.03% （71/78）, χ²=0.21, P=0.651]. There was a significant difference in the total incidence of adverse reactions between the sarcopenia and non-sarcopenia group [67.86% （38/56） vs. 47.44% （37/78）, χ²=5.52, P=0.019]. By the end of the follow-up, the 1-, 3- and 5-year overall survival （OS） rates of 134 elderly patients with esophageal cancer who received radical radiotherapy were 91.0%, 73.1% and 55.2% respectively. The median OS of patients in the sarcopenia and non-sarcopenia group were 14 months and 26 months respectively, with a statistically significant difference （χ²=9.84, P=0.002）. The median progression-free survival （PFS） of the two groups were 7 months and 18 months respectively, with a statistically significant difference （χ²=9.91, P=0.002）. Univariate analysis showed that cT stage （HR=2.45, 95%CI： 1.26-4.74, P=0.008）, cN stage （HR=1.63, 95%CI：1.06-2.50, P=0.027）, cTNM stage （HR=2.04, 95%CI： 1.28-3.27, P=0.003）, body mass index （BMI）（HR=2.23, 95%CI： 1.01-4.90, P=0.046）, pre-radiotherapy sarcopenia （HR=2.45, 95%CI： 1.27-4.72, P=0.007） and chemotherapy （HR=0.30, 95%CI： 0.11-0.83, P=0.020） were prognostic factors for OS; cT stage （HR=2.27, 95%CI： 1.18-4.39, P=0.015）, cN stage （HR=1.61, 95%CI： 1.04-2.47, P=0.030）, cTNM stage （ HR=1.90, 95%CI： 1.19-3.02, P=0.007）, BMI （HR=1.98, 95%CI： 1.06-3.79, P=0.032）, pre-radiotherapy sarcopenia （HR=1.79, 95%CI： 1.06-3.04, P=0.031） and adverse reactions （HR=0.60, 95%CI： 0.38-0.97, P=0.037） were prognostic factors for PFS. Multivariate analysis showed that pre-radiotherapy sarcopenia （HR=1.91, 95%CI： 1.22-3.00, P=0.005） was an independent prognostic factor for OS; BMI （HR=1.80, 95%CI： 1.03-3.15, P=0.039） and pre-radiotherapy sarcopenia （HR=2.00, 95%CI： 1.27-3.14, P=0.003） were independent prognostic factors for PFS. Conclusion Sarcopenia before radiotherapy can be a useful predictor for prognosis in elderly patients with esophageal cancer who received radical radiotherapy, and patients with sarcopenia benefit less from treatment.

Key words: Esophageal neoplasms, Chemoradiotherapy, Prognosis, Sarcopenia

Ye Qian, Ling Zhi, Liu Shenxiang, Lu Guotao, Yin Xudong. Effects of sarcopenia on the clinical efficacy and prognosis of radical radiotherapy in elderly patients with esophageal cancer[J]. Journal of International Oncology, 2022, 49(4): 199-205.

Figures/Tables 9

References 14

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临床特征	肌肉减少症组（n=56）	非肌肉减少症组（n=78）	χ²/t值	P值
年龄（岁）
65~75	18	29
76~85	35	46	0.44	0.506
>85	3	3
性别
男	40	42	4.22	0.039
女	16	36	4.22	0.039
肿瘤位置
颈部	3	6	0.18	0.672
胸上段	10	13
胸中段	23	34
胸下段	20	25
cT分期
T₂	1	16
T₃	48	60	14.12	0.001
T₄	7	2
cN分期
N₀	14	31	3.18	0.075
N₊	42	47	3.18	0.075
cTNM分期
Ⅱ	8	29
Ⅲ	38	44	10.70	0.005
Ⅳa	10	5
治疗方案
根治性放疗	50	63	1.79	0.181
同步放化疗	6	15	1.79	0.181
放疗剂量（Gy）	60.00±1.82	59.50±1.99	-2.39	0.018
BMI（kg/m²）	19.78±0.40	23.10+0.36	12.45	<0.001
SMI（cm²/m²）	33.92±0.58	45.81±0.76	6.15	<0.001

代谢指标	肌肉减少症组（n=56）	非肌肉减少症组（n=78）	Z/t值	P值
空腹血糖（mmol/L）	5.04（0.54）	5.22（1.02）	-1.58	0.115
血红蛋白（g/L）	122.23±1.90	128.82±1.95	2.31	0.023
总蛋白（g/L）	67.36±1.01	69.22±7.08	1.55	0.124
白蛋白（g/L）	39.57±0.53	41.64±0.43	3.05	0.003
前白蛋白（g/L）	168.45±6.57	213.16±6.36	4.78	<0.001
尿酸（μmol/L）	301.95（153.48）	315.50（169.00）	-0.19	0.848
肌酐（μmol/L）	71.73±3.95	74.62±2.32	0.67	0.507
尿素氮（mmol/L）	6.10（2.13）	5.26（2.68）	2.10	0.036
GPT（U/L）	11.00（13.88）	11.00（7.50）	-0.62	0.539
GOT（U/L）	19.25（7.90）	19.00（9.00）	0.42	0.674

炎症指标	肌肉减少症组（n=56）	非肌肉减少症组（n=78）	Z/t值	P值
白细胞（×10⁹）	5.48（2.39）	5.51（2.48）	-0.18	0.855
中性粒细胞（×10⁹）	3.48（1.77）	3.80（2.09）	-0.31	0.757
淋巴细胞（×10⁹）	1.23（0.70）	1.30（0.72）	-1.35	0.177
单核细胞（×10⁹）	0.41（0.18）	0.35（0.21）	1.95	0.051
血小板（×10⁹）	182.29±7.90	184.64±6.12	0.24	0.074
NLR	2.97（2.35）	2.58（2.30）	0.86	0.389
PLR	150.51（91.09）	130.43（68.84）	1.06	0.289
LMR	3.21±0.21	4.01±1.82	2.88	0.005

组别	CR	PR	SD	PD	客观缓解	疾病控制
肌肉减少症组（n=56）	5（8.92）	25（44.64）	23（41.07）	3（5.36）	30（53.57）	53（94.64）
非肌肉减少症组（n=78）	16（20.51）	40（51.28）	15（19.23）	7（8.97）	56（71.79）	71（91.03）
χ²值					4.71	0.21
P值					0.030	0.651

不良反应	肌肉减少症组（n=56）	非肌肉减少症组（n=78）
放射性食管炎	28（50.00）	17（21.79）
放射性肺炎	2（3.57）	3（3.85）
恶性、呕吐	0（0）	3（3.85）
白细胞减少症	3（5.36）	8（10.26）
血红蛋白减少症	3（5.36）	3（3.85）
血小板减少症	2（3.57）	3（3.85）