The relationship between computed tomography-derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago-gastric cancer undergoing neoadjuvant treatment

JCSM clinical reports Pub Date : 2022-12-12 DOI:10.1002/crt2.57

Josh McGovern, Jenna Delaney, Matthew J. Forshaw, Gerard McCabe, Andrew B. Crumley, David McIntosh, Barry J. Laird, Paul G. Horgan, Donald C. McMillan, Stephen T. McSorley, Ross D. Dolan

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引用次数: 2

Abstract

Background

Thought to capture the nutritional and functional reserve of the cancer patient, whether the computed tomography (CT)-derived sarcopenia score (CT-SS) has complimentary prognostic value to commonly utilized pre-treatment host assessments in patients with oesophago-gastric (OG) cancer is unknown. The aim of the present study was to examine if the CT-SS can stratify survival in OG cancer patients with good performance status [Eastern Cooperative Oncology Group Performance Status (ECOG-PS) 0/1]. Furthermore, if the CT-SS had complimentary prognostic value to cardiopulmonary exercise testing (CPET) performance and systemic inflammation.

Methods

Consecutive patients with confirmed OG cancer and good performance status, who received neoadjuvant chemotherapy (NAC) with a view to surgical resection with curative intent, between 1 January 2010 and 31 December 2015, within NHS Greater Glasgow and Clyde (NHSGGC) and NHS Forth Valley (NHSFV), were identified from a prospectively maintained database. CT-SSs were grouped as 0/1/2. CPET variables recorded included VO₂ anaerobic threshold (AT) and peak. Systemic inflammatory response was determined by modified Glasgow prognostic score (mGPS) and neutrophil/lymphocyte ratio (NLR). Associations between categorical variables were examined using χ² test and binary logistics regression analysis.

Results

A total of 232 patients met the inclusion criteria. 75% (n = 174) of patients were male, 54% (n = 126) were 65 years or older, and 60% (n = 139) were overweight [body mass index (BMI) ≥25 kg/m²]; 33% (n = 77) of patients had CT-SS ≥ 1, 36% (n = 83) had a low VO₂ AT (≤11 ml/kg/min), and 57% (n = 132) had a low VO₂ peak (≤19 ml/kg/min). Of the 200 patients who had pre-NAC bloods facilitating calculation of the mGPS, 28% (n = 55) had mGPS ≥ 1. Of the 211 patients who had pre-NAC bloods facilitating calculation of NLR, 38% (n = 80) had an NLR ≥ 3; 82% (n = 190) and 53% (n = 122) were alive at 1 and 3 years post-NAC, respectively. On univariate analysis, CT-SS was significantly associated with sex (P < 0.05), histological cell type (P < 0.05), low VO₂ AT (P < 0.05), low VO₂ peak (P < 0.05), BMI (P < 0.05), mGPS (P < 0.05), and 3-year survival (P < 0.05). On multivariate analysis, tumour, node, and metastasis (TNM) stage (P < 0.05) and CT-SS (P < 0.05) remained significantly associated with 3-year survival. CT-SS was significantly associated with 3-year survival in patients who had mGPS 0 (P < 0.05), but not low VO₂ AT (P = 0.066) or peak (P = 0.065).

Conclusion

The CT-SS would appear to capture the nutritional and functional reserve of the patient and is a useful objective measure for stratifying long-term survival in patients with good performance status undergoing potentially curative treatment for OG cancer.

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接受新辅助治疗的食管胃癌症表现良好患者的计算机断层扫描引起的少肌症、心肺运动测试表现、全身炎症和存活率之间的关系

被认为可以捕捉癌症患者的营养和功能储备，计算机断层扫描（CT）衍生的少肌症评分（CT-SS）是否对癌症食管胃（OG）患者的治疗前宿主评估具有互补的预后价值尚不清楚。本研究的目的是检查CT-SS是否可以对表现良好的OG癌症患者的生存率进行分层[东部肿瘤协作组表现状态（ECOG-PS）0/1]。此外，CT‐SS是否对心肺运动测试（CPET）性能和全身炎症具有互补的预后价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JCSM clinical reports

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12 weeks