食道がんの術前化学療法前後での著明な身体組成変化

食道がんの術前化学療法前後での著明な身体組成変化に関する論文を紹介します。

Awad S, Tan BH, Cui H, Bhalla A, Fearon KC, Parsons SL, Catton JA, Lobo DN. Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr. 2011 Aug 27. doi:10.1016/j.clnu.2011.08.008
食道がん患者47人を対象に、術前化学療法前後で筋肉量・サルコペニアの有無を評価しました。筋肉量はL3レベルでの腹部CTから推計しています。

サルコペニアの割合は術前化学療法前が57％、術前化学療法後が79％と、有意に増加しています。また、術前化学療法の前後で除脂肪体重（2.9 ± 4.7 kg）、脂肪（1.3 ± 3.2 kg）とも有意に減少しました。ただし、除脂肪体重の減少と、術前化学療法が終了できなかった割合、入院期間延長、死亡率との間には、相関を認めませんでした。

術前化学療法の適応となる食道がん患者ではサルコペニアがもともと多く、術前化学療法によってさらに増加します。今回の研究では予後との相関は明らかではありませんでしたが、他の研究でサルコペニアではADLや死亡率との関連が指摘されています。サルコペニアの存在を念頭に置くことは重要だと思います。
Abstract
BACKGROUND & AIMS: Patients with sarcopenia [reduced fat free mass (FFM)] have a higher incidence of chemotherapy-related toxicity and decreased survival. As there are no such data in patients with oesophagogastric cancer (OGC), this study investigated changes in body composition in OGC patients receiving neoadjuvant chemotherapy (NAC).
METHODS: OGC patients who had CT scans before and after NAC were studied. CT images at the L3 vertebral level were analysed using SliceOmatic(®) software to derive estimates of FFM and fat mass (FM). Comparisons were made between pre- and post-NAC CT images. Data are reported as mean ± SD.
RESULTS: Forty-seven patients (34 male) aged 63 ± 12 years were studied and 79% completed their course of NAC. The interval between CT scans was 107 ± 27 days. The proportion of patients with sarcopenia increased from 57% pre-NAC to 79% post-NAC (p = 0.046). During NAC there were significant reductions in estimated FFM and FM (2.9 ± 4.7 kg, p < 0.0001 and 1.3 ± 3.2 kg, p = 0.007, respectively). No association was demonstrated between loss of FFM and non-completion of NAC, increased hospital stay or mortality.
CONCLUSIONS: In patients with OGC commencing NAC, sarcopenia was present in 57%. NAC was associated with further reductions in FFM and an increase in the proportion of patients becoming sarcopenic.