Introduction

We investigated the associations among frailty, as determined via the comprehensive geriatric assessment (CGA), muscle measures (i.e., sarcopenia), and treatment-related toxicity in older adults with cancer in Israel.

Materials and methods

This prospective cohort study enrolled patients ≥65 years with newly-diagnosed stage IV lung, breast, or genitourinary cancer. Patients were enrolled and completed CGA before their first line of systemic therapy (chemotherapy, biologic therapy, immunologic therapy, or a combination thereof). CGA was used to classify patients as robust, pre-frail, or frail, and routine pre-treatment computed tomography (CT) images were used to quantify skeletal muscle index (SMI) and skeletal muscle density (SMD) at L3 cross-section. Two sarcopenia definitions were used: i. for women SMI <41 cm²/m² regardless of body mass index (BMI), and for men SMI <43 cm²/m² for those with BMI of <25 and < 53 cm²/m² for those with BMI ≥25; and ii. SMI <38 cm²/m² for women and < 41 cm²/m² for men, regardless of BMI. The associations between frailty and muscle measures with the occurrence of at least one adverse event (AE) grade ≥ 2 were examined using the chi-square test, and logistic regression to determine odds ratio (OR) and 95% confidence interval (CI).

Results

In total, 51 patients were included in the analysis. The median (interquartile range) age was 72 (68–76) years, 30 (59%) were male, and 26 (51%) had lung cancer. CGA data were available for 48 patients: fifteen (31%), thirteen (27%), and twenty (42%) were defined as robust, pre-frail, and frail, respectively. Overall, 33 (65%) were sarcopenic by the first aforementioned definition, and sixteen (31%) by the second. No statistically significant associations were identified between frailty and having at least one AE grade ≥ 2, or between frailty and sarcopenia. Statistically significant associations were found between having sarcopenia (the second definition) and having at least one AE grade ≥ 2 (P = 0.0217). The corresponding odds ratio (95% CI) was 4.2 (1.2–15.0), P = 0.026.

Discussion

Our findings suggests that sarcopenia is significantly associated with treatment-related toxicity. Further studies with larger sample sizes are warranted.

中文翻译：

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老年人癌症评估、肌肉测量和治疗相关毒性之间的关联：以色列的一项前瞻性研究

介绍

我们调查了虚弱之间的关联，这些关联是通过综合老年评估 (CGA)、肌肉测量（即肌肉减少症）和以色列老年癌症患者的治疗相关毒性确定的。

材料和方法

这项前瞻性队列研究招募了年龄≥65 岁且新诊断为 IV 期肺癌、乳腺癌或泌尿生殖系统癌的患者。患者在一线全身治疗（化疗、生物治疗、免疫治疗或其组合）之前被纳入并完成了 CGA。CGA 用于将患者分类为健壮、虚弱或虚弱，常规治疗前计算机断层扫描 (CT) 图像用于量化 L3 横截面的骨骼肌指数 (SMI) 和骨骼肌密度 (SMD)。使用了两个肌肉减少症定义：i . 女性 SMI <41 cm ² /m ²无论体重指数 (BMI) 为何，男性 SMI <43 cm ² /m ²对于 BMI <25 和 < 53 cm ^2的人/m ²对于BMI≥25的人；和二。SMI <38 cm ² /m ²女性和 < 41 cm ² /m ²男性，无论 BMI。使用卡方检验检查虚弱和肌肉测量与至少一种不良事件 (AE) ≥ 2 级发生之间的关联，并使用逻辑回归来确定比值比 (OR) 和 95% 置信区间 (CI)。

结果

总共有 51 名患者被纳入分析。中位（四分位间距）年龄为 72（68-76）岁，30 名（59%）男性，26 名（51%）肺癌患者。48 名患者的 CGA 数据可用：15 名 (31%)、13 名 (27%) 和 20 名 (42%) 分别被定义为健壮、虚弱前和虚弱。总体而言，根据上述第一个定义，33 人 (65%) 患有肌肉减少症，根据第二个定义，16 人 (31%) 患有肌肉减少症。在虚弱和至少有一个 ≥ 2 级的 AE 之间，或虚弱和肌肉减少症之间，没有发现统计学上显着的关联。在患有肌肉减少症（第二个定义）和至少有一个 AE 等级 ≥ 2 之间发现了统计学上显着的关联（P  = 0.0217）。相应的比值比 (95% CI) 为 4.2 (1.2–15.0)，P  = 0.026。

讨论

我们的研究结果表明，肌肉减少症与治疗相关毒性显着相关。有必要进行更大样本量的进一步研究。