BACKGROUND Sarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radiotherapy is the standard treatment for locally-advanced tumour, not accessible to surgical resection. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy. METHODS The clinical, nutritional, anthropometric, and functional-imaging (18FDG-PET/CT) data were collected in 97 patients treated between 2006 and 2012 in our institution. The skeletal muscle area was automatically delineated on cross-sectional CT images acquired at the 3rd. lumbar vertebra level and divided by the patient's squared height (SML3/h2) to obtain the Skeletal Muscle Index (SMI). The primary endpoint was overall survival probability. RESULTS Seventy-six deaths were reported. The median survival time was 27 [95% Confidence Interval 23-40] months for the whole population. Univariate analyses (Cox Proportional Hazard Model) showed decreased survival probabilities in patients with reduced SMI, WHO > 0, Body Mass Index ≤21, and Nutritional Risk Index ≤97.5. Multivariate analyses showed that sarcopenia was the only significant prognostic factor (HR 2.32 [1.24-4.34], p = 0.008). Using Receiver Operating Characteristics curves, the Area Under the Curve (AUC) was 0.73 in males (p = 0.0002], the optimal threshold being 51.5 cm2/m2. In women, the AUC was 0.65 (p = 0.19). CONCLUSION Sarcopenia is a powerful independent prognostic factor, associated with a rise of the overall mortality in patients treated exclusively by radiochemotherapy for a locally advanced oesophageal cancer. L3 CT images are easily gathered from 18FDG-PET/CT acquisitions.

中文翻译：

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少肌症在放射化学治疗局部晚期食管癌患者中的预后价值。

背景技术少肌症的定义是骨骼肌质量的损失，或没有或没有脂肪量。肌肉减少症与癌症患者包括接受有限食道癌手术的患者的治疗耐受性降低和预后较差有关。伴随化学放疗是局部晚期肿瘤的标准治疗，无法通过手术切除。使用骨骼肌的自动描绘，我们研究了肌肉减少症对通过根治性化学放疗治疗的局部晚期食道癌（LAOC）患者的预后价值。方法收集2006年至2012年间在我院接受治疗的97例患者的临床，营养，人体测量学和功能成像（18FDG-PET / CT）数据。在第3次获取的横截面CT图像上自动划定骨骼肌区域。腰椎水平除以患者的平方高（SML3 / h2），即可得出骨骼肌指数（SMI）。主要终点是总体生存概率。结果报告死亡76人。整个人群的中位生存时间为27 [95％置信区间23-40]月。单因素分析（Cox比例危害模型）显示，SMI降低，WHO> 0，体重指数≤21和营养风险指数≤97.5的患者的生存概率降低。多因素分析表明，肌肉减少症是唯一的重要预后因素（HR 2.32 [1.24-4.34]，p = 0.008）。使用接收器工作特性曲线，男性的曲线下面积（AUC）为0.73（p = 0.0002]，最佳阈值为51.5 cm2 / m2。女性的AUC为0.65（p = 0.19）。结论肌肉减少症是一个有力的独立预后因素，与仅通过放化疗治疗局部晚期食管癌的患者的总死亡率上升有关。从18FDG-PET / CT采集中可以轻松收集L3 CT图像。