【摘要】 目的：探讨老年局部晚期食管癌（LAEC）病人肌少症与新辅助化疗（NAC）药物相对剂量强度（RDI的关系。方法：采用回顾性队列研究，收集2018年1月至2020年12月河北省人民医院胸外一科年龄≥65岁在NAC后接受根治性食管癌切除术的LAEC病人临床资料。根据第三腰椎（L3）水平的计算机断层扫描图像计算骨骼肌质量指数。采用骨骼肌质量的Youden指数定义肌少症。根据药物的实际剂量强度和标准剂量强度计算平均药物相对剂量。通过多因素Logistic回归分析病人低RDI的独立影响因素，采用Cox生存分析评估低RDI对预后的影响。结果：本研究共纳入了126名老LAEC病人，肌少症46人，非肌少症80人，平均年龄为71.3岁。经过调整年龄、性别、体质量指数、药物治疗方案、临床分期和肌酐清除率等因素,肌少症与低平均药物相对剂量相关（OR:2.193,95%CI:1.107～4.411,P=0.022）。第一个化疗周期后，与非肌少症病人相比，由于中性粒细胞减少，平均RDI较低的肌少症病人减少化疗剂量、延迟或停药的比例较高（41.9%vs 39.0%），并且体能状态下降显著（9.7%vs0）。调整年龄、性别、CCI等因素影响后，低平均化疗RDI是病人的无复发生存（RFS）的独立影响因子。结论：老年局部晚期食管癌病人，肌少症会降低新辅助化疗平均RDI，治疗前应常规进行筛查评估。肌少症可能成为改善食管癌病人临床结局的一个指标。更多还原

【Abstract】 Objective: To explore the relationship between the relative dose intensity of neoadjuvant chemotherapy drugs and the sarcopenia in elderly patients with locally advanced esophageal cancer(LAEC). Methods:A retrospective cohort study was conducted between January 2018 and December 2020 in the Department of Thoracic Surgery, Hebei General hospital. A total of 126 LAEC patients aged ≥65 years who underwent radical esophageal cancer resection after NAC were enrolled in this study. Skeletal muscle mass index was calculated from computed tomography(CT) images at the level of the third lumbar vertebra(L3). Sarcopenia was defined using the Youden index of skeletal muscle mass. The average relative dose of the drug was calculated basing on the actual dose intensity and standard dose intensity of the drug. Multivariate Logistic regression was used to analyze the independent risk factors of low relative dose intensity(RDI), and Cox survival analysis was used to evaluate the effect of low RDI on prognosis. Results: 126patients were retrospectively analyzed, in which 46 patients had sarcopenia and 80 patients had no sarcopenia. The presence of sarcopenia was associated with low RDI and was varied following age, gender, body mass index, drug treatment regimen, clinical stage and creatinine clearance(OR: 2.193, 95%CI: 1.107 ～ 4.411, P = 0.022). After the first cycle of chemotherapy, sarcopenic patients with a lower mean RDI had a higher rate of chemotherapy dose reduction,delay, or discontinuation due to neutropenia compared with non-sarcopenic patients(41.9% vs 39.0%), and the physical fitness was significantly declined(9.7% vs 0%). Low average RDI was an independent influencing factor for recurrencefree survival in the patients. Conclusions: Sarcopenia could be a predictor for reduced mean RDI of NAC in elderly patients with LAEC. The findings have implications for improving the clinical outcomes of patients with esophageal cancer.更多还原