体重稳定掩盖了结直肠癌患者身体成分的变化：一项回顾性队列研究。
Weight stability masks changes in body composition in colorectal cancer: a retrospective cohort study.
机构信息
Cancer Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
Stanley S Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
出版信息
Am J Clin Nutr. 2021 Jun 1;113(6):1482-1489. doi: 10.1093/ajcn/nqaa440.
BACKGROUND
There is an emerging viewpoint that change in body weight is not sufficiently sensitive to promptly identify clinically meaningful change in body composition, such as skeletal muscle depletion.
OBJECTIVES
We aimed to determine whether body weight stability is associated with skeletal muscle depletion and whether skeletal muscle depletion is prognostic of death independently of change in body weight.
METHODS
This retrospective cohort included 1921 patients with stage I-III colorectal cancer. Computed tomography (CT)-based skeletal muscle characteristics and body weight were measured at diagnosis and after a mean 15.0-mo follow-up. Body weight stability was defined as weight change less than ±5% during follow-up. Sarcopenia and myosteatosis were defined using established thresholds for patients with cancer. Multivariable-adjusted logistic and flexible parametric proportional hazards survival models were used to quantify statistical associations.
RESULTS
At follow-up, 1026 (53.3%) patients were weight stable. Among patients with weight stability, incident sarcopenia and myosteatosis occurred in 8.5% (95% CI: 6.3%, 10.6%) and 13.5% (95% CI: 11.1%, 15.9%), respectively. Men were more likely to be weight stable than were women (56.7% compared with 49.9%; P = 0.04). Weight-stable men were less likely to develop incident sarcopenia (5.4% compared with 15.4%; P = 0.003) and myosteatosis (9.3% compared with 20.8%; P = 0.001) than weight-stable women. Among all patients, the development of incident sarcopenia (HR: 1.40; 95% CI: 1.02, 1.91) and of myosteatosis (HR: 1.41; 95% CI: 1.05, 1.90) were associated with a higher risk of death, independently of change in body weight. Patient sex did not modify the relation between skeletal muscle depletion and death.
CONCLUSIONS
Body weight stability masks clinically meaningful skeletal muscle depletion. Body composition quantified using clinically acquired CT images may provide a vital sign to identify patients at increased risk of death. These data may inform the design of future cachexia trials.
背景
有一种新观点认为，体重的变化不够敏感，无法及时识别身体成分的临床意义变化，例如骨骼肌耗竭。
目的
我们旨在确定体重稳定是否与骨骼肌耗竭有关，以及骨骼肌耗竭是否独立于体重变化预测死亡。
方法
本回顾性队列纳入了 1921 例 I-III 期结直肠癌患者。在诊断时和平均 15.0 个月的随访后测量了基于 CT 的骨骼肌特征和体重。体重稳定定义为随访期间体重变化小于±5%。使用癌症患者的既定阈值定义了肌肉减少症和肌内脂肪过多症。采用多变量调整的逻辑和灵活参数比例风险生存模型来量化统计关联。
结果
随访时，1026 例（53.3%）患者体重稳定。在体重稳定的患者中，新发肌肉减少症和肌内脂肪过多症的发生率分别为 8.5%（95%CI：6.3%，10.6%）和 13.5%（95%CI：11.1%，15.9%）。与女性相比，男性更有可能体重稳定（56.7%比 49.9%；P=0.04）。与体重稳定的女性相比，体重稳定的男性发生新发肌肉减少症（5.4%比 15.4%；P=0.003）和肌内脂肪过多症（9.3%比 20.8%；P=0.001）的可能性更小。在所有患者中，新发肌肉减少症（HR：1.40；95%CI：1.02，1.91）和肌内脂肪过多症（HR：1.41；95%CI：1.05，1.90）的发生与死亡风险增加相关，独立于体重变化。患者性别并未改变骨骼肌耗竭与死亡之间的关系。
结论
体重稳定掩盖了具有临床意义的骨骼肌耗竭。使用临床获得的 CT 图像量化的身体成分可能提供一个生命体征，以识别死亡风险增加的患者。这些数据可能为未来恶病质试验的设计提供信息。
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