内容紹介
Skeletal Mass Depletion Is a Negative Prognostic Factor in Gastrointestinal Cancer Patients in the Terminal Stage
Summary
Background: Skeletal mass depletion has been reported to be a prognostic factor for cancer patients. However, special and expensive devices are required to measure skeletal mass, and this is a major reason why skeletal mass is not used extensively for prognostic marker in clinical settings. We developed a new method to measure skeletal mass for use as a prognostic marker using CT images without special and expensive devices. In this study, we evaluated the usefulness of skeletal mass as measured by this new method as a prognostic marker for gastrointestinal cancer patients. Method: Patients who died from gastrointestinal cancer between March 2010 and October 2013 were included. We measured the right-sided maximum psoas muscle cross sectional area(MPCA)by using CT images before surgery and after the patients developed a terminal condition. The maximum psoas muscle cross sectional area ratio(MPCA-R)was defined as follows: MPCA-R=MPCA before surgery/MPCA after developing a terminal condition. We evaluated the correlation between MPCA-R and survival. Result: Fifty-nine patients were included. The median survival was 44 days, and MPCA-R was significantly correlated with survival(p=0.001). On receiver operating characteristic(ROC)analysis, the area under the curve(AUC)to predict 30-day and 90-day survival was 0.710 and 0.748, respectively. Conclusion: MPCA-R is a new and novel prognostic marker for gastrointestinal cancer patients in terminal condition.
要旨
全身骨格筋量(以下,骨格筋量)は癌の予後因子である。骨格筋量の測定には特殊な器機を必要とするため,CT画像にて得られる最大大腰筋断面積(MPCA)を骨格筋量の代替指標とする方法を開発し,骨格筋量の減少と癌終末期における生命予後との相関を検討した。対象は当科で胃癌または大腸癌に対し切除術を行い,すでに死亡した59例。術前および死亡前に施行したCTを用い,MPCAを測定した。死亡前のMPCAを術前値で除したものを最大大腰筋断面積比(MPCA-R)とし,生存期間との相関を検討した。対象症例の生存期間中央値は44日であり,MPCR-Rは生存期間と有意に相関した(p=0.001)。生存期間30日以下,90日以下をendpointとしROC解析を行った結果,AUCはそれぞれ0.710,0.748であった。胃癌および大腸癌において,骨格筋量の増減を反映するMPCR-Rは終末期における予後を予測する有効な指標となり得ると考えられた。
目次
Summary
Background: Skeletal mass depletion has been reported to be a prognostic factor for cancer patients. However, special and expensive devices are required to measure skeletal mass, and this is a major reason why skeletal mass is not used extensively for prognostic marker in clinical settings. We developed a new method to measure skeletal mass for use as a prognostic marker using CT images without special and expensive devices. In this study, we evaluated the usefulness of skeletal mass as measured by this new method as a prognostic marker for gastrointestinal cancer patients. Method: Patients who died from gastrointestinal cancer between March 2010 and October 2013 were included. We measured the right-sided maximum psoas muscle cross sectional area(MPCA)by using CT images before surgery and after the patients developed a terminal condition. The maximum psoas muscle cross sectional area ratio(MPCA-R)was defined as follows: MPCA-R=MPCA before surgery/MPCA after developing a terminal condition. We evaluated the correlation between MPCA-R and survival. Result: Fifty-nine patients were included. The median survival was 44 days, and MPCA-R was significantly correlated with survival(p=0.001). On receiver operating characteristic(ROC)analysis, the area under the curve(AUC)to predict 30-day and 90-day survival was 0.710 and 0.748, respectively. Conclusion: MPCA-R is a new and novel prognostic marker for gastrointestinal cancer patients in terminal condition.
要旨
全身骨格筋量(以下,骨格筋量)は癌の予後因子である。骨格筋量の測定には特殊な器機を必要とするため,CT画像にて得られる最大大腰筋断面積(MPCA)を骨格筋量の代替指標とする方法を開発し,骨格筋量の減少と癌終末期における生命予後との相関を検討した。対象は当科で胃癌または大腸癌に対し切除術を行い,すでに死亡した59例。術前および死亡前に施行したCTを用い,MPCAを測定した。死亡前のMPCAを術前値で除したものを最大大腰筋断面積比(MPCA-R)とし,生存期間との相関を検討した。対象症例の生存期間中央値は44日であり,MPCR-Rは生存期間と有意に相関した(p=0.001)。生存期間30日以下,90日以下をendpointとしROC解析を行った結果,AUCはそれぞれ0.710,0.748であった。胃癌および大腸癌において,骨格筋量の増減を反映するMPCR-Rは終末期における予後を予測する有効な指標となり得ると考えられた。