评论:Yin等人的“三角肌皮褶白蛋白指数显著预测癌症恶病质的预后:一项多中心队列研究”。

IF 8.9 1区 医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2023-08-07 DOI:10.1002/jcsm.13304
Ping'an Ding, Haotian Wu, Jiaxiang Wu, Chenyu Sun, Muzi Meng, Peigang Yang, Yang Liu, Lingjiao Meng, Qun Zhao
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The different groups showed significant differences in prognostic effects, with normal TA patients being significantly associated with lower mortality and the opposite association found for lower TA patients. Additionally, TA demonstrated a wide discrimination performance for the prognosis of patients of all ages. This study is particularly meaningful for two main reasons. Firstly, despite being calculated by only two sample parameters, TA's accuracy for predicting the prognosis of patients with cancer cachexia is higher than that of previous predictive indices, such as NRI, PNI, and SII. Furthermore, TA is cost-effective and easy to use. Secondly, the gender-specific cut-off values of TA are consistent with the differences in nutrition between men and women. Moreover, this prospective, large sample, and geographically multi-centre cohort study ensures reliable confirmation of the results. Therefore, based on these aspects, TA may be considered a clinically meaningful and promising indicator for predicting the prognosis of patients with cancer cachexia.</p><p>Nonetheless, the generalizability of the previous findings of TA was not confirmed in patients with diverse cancer types or undergoing various treatments. To address this gap, we investigated the clinical applicability of TA as a predictive tool for cancer cachexia in patients with locally advanced gastric cancer (LAGC) across multiple prospective cohorts (NCT01516944, NCT02555358, NCT03349866, and NCT01962246) registered in our institution. The study included 1266 LAGC patients, of which 898 (70.93%) had complete serum albumin values and detailed triceps skinfold thickness (mm) data. Of these patients, 188 (20.94%) were diagnosed with cancer cachexia based on the 2011 International Consensus on Cancer Cachexia criteria outlined by Fearon et al.<span><sup>2</sup></span> The median age of the patients diagnosed with cancerous cachexia was 60 years (interquartile range [IQR], 35–77), with 125 (66.49%) males and 63 (33.51%) females. Our analysis revealed that mean TA was lower in males than in females in the cohort (51.8 vs. 56.3). We stratified the patients into high and low TA groups based on the optimal cut-off values (male: TA &lt; 45.6, female: TA &lt; 49.9) established in the previous study by Yin et al.<span><sup>1</sup></span> Out of 188 patients, 57 (30.32%) were classified in the low TA group. During a median follow-up of 65.8 months (12.9–109.7 months), 20 (36.36%) patients with postoperative pathological stage II and 64 (48.12%) of stage III died. Our results showed that patients in the high TA group had significantly higher overall survival (OS) rates than those in the low TA group (61.83% vs. 40.35%, <i>P</i> = 0.004) (Figure 1A). Additionally, patients in the high TA group had superior disease-free survival (DFS) rates compared with those in the low TA group (56.49% vs. 28.07%, <i>P</i> &lt; 0.001) (Figure 1D). Subgroup analysis based on tumour pTNM staging also demonstrated that high TA was associated with prolonged OS and DFS in both stage II and III patients compared with those in the low TA group [(stage II: OS: 70.59% vs. 52.38%, <i>P</i> = 0.044; DFS: 64.71% vs. 47.62%, <i>P</i> = 0.027); (stage III: OS: 58.76% vs. 33.33%, <i>P</i> = 0.002; DFS: 53.61% vs. 16.67%, <i>P</i> &lt; 0.001)] (Figure 1B,C,E,F). Our findings suggest that TA can be a useful tool to predict the prognosis and recurrence status of LAGC patients with cancer cachexia, similar to the original study by Yin et al.<span><sup>1</sup></span></p><p>Patients with cancer often suffer from concurrent cancer cachexia, which can have a negative impact on their prognosis and survival time.<span><sup>3, 4</sup></span> Therefore, it is crucial to identify reliable and cost-effective prognostic markers for patients with cancer cachexia. Although protein and inflammatory biomarkers have been studied to predict the prognosis of LAGC patients with cachexia,<span><sup>5, 6</sup></span> their high cost and single influencing aspect limit their clinical application. TA, as a comprehensive prognostic predictor that combines fat mass and nutritional status of cancer cachexia, offers a meaningful prognostic stratification and has been demonstrated to be clinically significant for LAGC patients with cachexia of different tumour pathological or different clinical therapies.</p><p>We would like to express our gratitude to Liangyu Yin et al. for their valuable contribution to improving the prognostication of cancer cachexia and for providing a clinically reliable biomarker. Their research has demonstrated that TA is a comprehensive marker that can reflect the fat mass, nutritional status, and inflammatory status of LAGC patients with cachexia. This finding may help clinicians in formulating effective treatment strategies and improving the clinical management of LAGC patients with cachexia. In our own study, we have found that TA is a useful predictor of prognosis for LAGC patients with cachexia. By using TA, we can provide more precise prognostic guidance and improve the survival time of our patients.</p><p>This work was supported by the Cultivating Outstanding Talents Project of Hebei Provincial Government Fund (No. 2019012) and Hebei Public Health Committee County-Level Public Hospitals Suitable Health Technology Promotion and Storage Project (No. 2019024).</p>","PeriodicalId":186,"journal":{"name":"Journal of Cachexia, Sarcopenia and Muscle","volume":null,"pages":null},"PeriodicalIF":8.9000,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcsm.13304","citationCount":"1","resultStr":"{\"title\":\"Comment on: ‘Triceps skinfold-albumin index significantly predicts the prognosis of cancer cachexia: A multicentre cohort study’ by Yin et al.\",\"authors\":\"Ping'an Ding,&nbsp;Haotian Wu,&nbsp;Jiaxiang Wu,&nbsp;Chenyu Sun,&nbsp;Muzi Meng,&nbsp;Peigang Yang,&nbsp;Yang Liu,&nbsp;Lingjiao Meng,&nbsp;Qun Zhao\",\"doi\":\"10.1002/jcsm.13304\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>The study by Yin et al.<span><sup>1</sup></span> is greatly appreciated for their contributions to research, particularly in developing the triceps skinfold-albumin index (TA). This new comprehensive index combines fat mass and nutritional status to evaluate malnutrition and has been identified as independently associated with the prognosis of patients with cancer cachexia. Yin et al.<span><sup>1</sup></span> successfully identified different cut-off values of TA for each gender, which divided patients into normal and low groups. The different groups showed significant differences in prognostic effects, with normal TA patients being significantly associated with lower mortality and the opposite association found for lower TA patients. Additionally, TA demonstrated a wide discrimination performance for the prognosis of patients of all ages. This study is particularly meaningful for two main reasons. Firstly, despite being calculated by only two sample parameters, TA's accuracy for predicting the prognosis of patients with cancer cachexia is higher than that of previous predictive indices, such as NRI, PNI, and SII. Furthermore, TA is cost-effective and easy to use. Secondly, the gender-specific cut-off values of TA are consistent with the differences in nutrition between men and women. Moreover, this prospective, large sample, and geographically multi-centre cohort study ensures reliable confirmation of the results. Therefore, based on these aspects, TA may be considered a clinically meaningful and promising indicator for predicting the prognosis of patients with cancer cachexia.</p><p>Nonetheless, the generalizability of the previous findings of TA was not confirmed in patients with diverse cancer types or undergoing various treatments. To address this gap, we investigated the clinical applicability of TA as a predictive tool for cancer cachexia in patients with locally advanced gastric cancer (LAGC) across multiple prospective cohorts (NCT01516944, NCT02555358, NCT03349866, and NCT01962246) registered in our institution. The study included 1266 LAGC patients, of which 898 (70.93%) had complete serum albumin values and detailed triceps skinfold thickness (mm) data. Of these patients, 188 (20.94%) were diagnosed with cancer cachexia based on the 2011 International Consensus on Cancer Cachexia criteria outlined by Fearon et al.<span><sup>2</sup></span> The median age of the patients diagnosed with cancerous cachexia was 60 years (interquartile range [IQR], 35–77), with 125 (66.49%) males and 63 (33.51%) females. Our analysis revealed that mean TA was lower in males than in females in the cohort (51.8 vs. 56.3). We stratified the patients into high and low TA groups based on the optimal cut-off values (male: TA &lt; 45.6, female: TA &lt; 49.9) established in the previous study by Yin et al.<span><sup>1</sup></span> Out of 188 patients, 57 (30.32%) were classified in the low TA group. 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引用次数: 1

摘要

Yin等人的研究1因其对研究的贡献而受到高度赞赏,特别是在开发肱三头肌皮褶-白蛋白指数(TA)方面。这个新的综合指数结合了脂肪量和营养状况来评估营养不良,并已被确定为与癌症恶病质患者的预后独立相关。Yin等人1成功地识别出不同性别TA的临界值,将患者分为正常组和低组。不同组在预后效果上表现出显著差异,正常TA患者与较低的死亡率显著相关,而较低TA患者的死亡率则相反。此外,TA对所有年龄段患者的预后表现出广泛的判别性能。这项研究之所以特别有意义,主要有两个原因。首先,尽管TA仅由两个样本参数计算,但其预测癌症恶病质患者预后的准确性高于以往的预测指标,如NRI、PNI、SII。此外,TA具有成本效益和易于使用的特点。其次,TA的性别分界值与男女营养差异是一致的。此外,这项前瞻性、大样本、地理上多中心的队列研究确保了结果的可靠确认。因此,基于这些方面,TA可能被认为是预测癌症恶病质患者预后的一项具有临床意义和前景的指标。然而,在不同癌症类型或接受不同治疗的患者中,先前TA发现的普遍性尚未得到证实。为了解决这一差距,我们通过在我院注册的多个前瞻性队列(NCT01516944、NCT02555358、NCT03349866和NCT01962246)研究了TA作为局部晚期胃癌(LAGC)患者癌症恶病质预测工具的临床适用性。本研究纳入1266例LAGC患者,其中898例(70.93%)具有完整的血清白蛋白值和详细的三头肌皮褶厚度(mm)数据。根据Fearon等人提出的2011年国际癌症恶病质共识标准,其中188例(20.94%)被诊断为癌性恶病质。2诊断为癌性恶病质的患者中位年龄为60岁(四分位间距[IQR], 35-77),其中男性125例(66.49%),女性63例(33.51%)。我们的分析显示,该队列中男性的平均TA低于女性(51.8比56.3)。我们根据最佳临界值将患者分为高、低TA组(男性:TA &lt;45.6,女:TA &lt;49.9), Yin等人在之前的研究中建立1 188例患者中,57例(30.32%)被划分为低TA组。中位随访65.8个月(12.9 ~ 109.7个月),术后病理II期患者死亡20例(36.36%),III期患者死亡64例(48.12%)。结果显示,高TA组患者的总生存率(OS)明显高于低TA组(61.83% vs. 40.35%, P = 0.004)(图1A)。此外,高TA组患者的无病生存率(DFS)高于低TA组(56.49% vs 28.07%, P &lt;0.001)(图1D)。基于肿瘤pTNM分期的亚组分析也显示,与低TA组相比,II期和III期患者的高TA与延长的OS和DFS相关[(II期:OS: 70.59% vs. 52.38%, P = 0.044;DFS: 64.71% vs. 47.62%, P = 0.027);(III期:OS: 58.76% vs. 33.33%, P = 0.002;DFS: 53.61%对16.67%,P &lt;0.001)](图1B,C,E,F)。我们的研究结果表明,TA可以作为预测LAGC伴癌恶病质患者预后和复发情况的有用工具,这与Yin等人最初的研究结果相似。1癌症患者常并发癌恶病质,对其预后和生存时间有负面影响。3,4因此,为癌症恶病质患者确定可靠且具有成本效益的预后标志物至关重要。虽然已经研究了蛋白质和炎症生物标志物来预测LAGC恶病质患者的预后5,6,但其成本高和影响单一的方面限制了其临床应用。TA作为一种综合了脂肪量和营养状况的癌症恶病质的综合预后预测指标,提供了有意义的预后分层,已被证明对不同肿瘤病理或不同临床治疗的恶病质LAGC患者具有临床意义。我们要感谢尹良玉等人在改善癌症恶病质预后和提供临床可靠的生物标志物方面做出的宝贵贡献。
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Comment on: ‘Triceps skinfold-albumin index significantly predicts the prognosis of cancer cachexia: A multicentre cohort study’ by Yin et al.

The study by Yin et al.1 is greatly appreciated for their contributions to research, particularly in developing the triceps skinfold-albumin index (TA). This new comprehensive index combines fat mass and nutritional status to evaluate malnutrition and has been identified as independently associated with the prognosis of patients with cancer cachexia. Yin et al.1 successfully identified different cut-off values of TA for each gender, which divided patients into normal and low groups. The different groups showed significant differences in prognostic effects, with normal TA patients being significantly associated with lower mortality and the opposite association found for lower TA patients. Additionally, TA demonstrated a wide discrimination performance for the prognosis of patients of all ages. This study is particularly meaningful for two main reasons. Firstly, despite being calculated by only two sample parameters, TA's accuracy for predicting the prognosis of patients with cancer cachexia is higher than that of previous predictive indices, such as NRI, PNI, and SII. Furthermore, TA is cost-effective and easy to use. Secondly, the gender-specific cut-off values of TA are consistent with the differences in nutrition between men and women. Moreover, this prospective, large sample, and geographically multi-centre cohort study ensures reliable confirmation of the results. Therefore, based on these aspects, TA may be considered a clinically meaningful and promising indicator for predicting the prognosis of patients with cancer cachexia.

Nonetheless, the generalizability of the previous findings of TA was not confirmed in patients with diverse cancer types or undergoing various treatments. To address this gap, we investigated the clinical applicability of TA as a predictive tool for cancer cachexia in patients with locally advanced gastric cancer (LAGC) across multiple prospective cohorts (NCT01516944, NCT02555358, NCT03349866, and NCT01962246) registered in our institution. The study included 1266 LAGC patients, of which 898 (70.93%) had complete serum albumin values and detailed triceps skinfold thickness (mm) data. Of these patients, 188 (20.94%) were diagnosed with cancer cachexia based on the 2011 International Consensus on Cancer Cachexia criteria outlined by Fearon et al.2 The median age of the patients diagnosed with cancerous cachexia was 60 years (interquartile range [IQR], 35–77), with 125 (66.49%) males and 63 (33.51%) females. Our analysis revealed that mean TA was lower in males than in females in the cohort (51.8 vs. 56.3). We stratified the patients into high and low TA groups based on the optimal cut-off values (male: TA < 45.6, female: TA < 49.9) established in the previous study by Yin et al.1 Out of 188 patients, 57 (30.32%) were classified in the low TA group. During a median follow-up of 65.8 months (12.9–109.7 months), 20 (36.36%) patients with postoperative pathological stage II and 64 (48.12%) of stage III died. Our results showed that patients in the high TA group had significantly higher overall survival (OS) rates than those in the low TA group (61.83% vs. 40.35%, P = 0.004) (Figure 1A). Additionally, patients in the high TA group had superior disease-free survival (DFS) rates compared with those in the low TA group (56.49% vs. 28.07%, P < 0.001) (Figure 1D). Subgroup analysis based on tumour pTNM staging also demonstrated that high TA was associated with prolonged OS and DFS in both stage II and III patients compared with those in the low TA group [(stage II: OS: 70.59% vs. 52.38%, P = 0.044; DFS: 64.71% vs. 47.62%, P = 0.027); (stage III: OS: 58.76% vs. 33.33%, P = 0.002; DFS: 53.61% vs. 16.67%, P < 0.001)] (Figure 1B,C,E,F). Our findings suggest that TA can be a useful tool to predict the prognosis and recurrence status of LAGC patients with cancer cachexia, similar to the original study by Yin et al.1

Patients with cancer often suffer from concurrent cancer cachexia, which can have a negative impact on their prognosis and survival time.3, 4 Therefore, it is crucial to identify reliable and cost-effective prognostic markers for patients with cancer cachexia. Although protein and inflammatory biomarkers have been studied to predict the prognosis of LAGC patients with cachexia,5, 6 their high cost and single influencing aspect limit their clinical application. TA, as a comprehensive prognostic predictor that combines fat mass and nutritional status of cancer cachexia, offers a meaningful prognostic stratification and has been demonstrated to be clinically significant for LAGC patients with cachexia of different tumour pathological or different clinical therapies.

We would like to express our gratitude to Liangyu Yin et al. for their valuable contribution to improving the prognostication of cancer cachexia and for providing a clinically reliable biomarker. Their research has demonstrated that TA is a comprehensive marker that can reflect the fat mass, nutritional status, and inflammatory status of LAGC patients with cachexia. This finding may help clinicians in formulating effective treatment strategies and improving the clinical management of LAGC patients with cachexia. In our own study, we have found that TA is a useful predictor of prognosis for LAGC patients with cachexia. By using TA, we can provide more precise prognostic guidance and improve the survival time of our patients.

This work was supported by the Cultivating Outstanding Talents Project of Hebei Provincial Government Fund (No. 2019012) and Hebei Public Health Committee County-Level Public Hospitals Suitable Health Technology Promotion and Storage Project (No. 2019024).

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来源期刊
Journal of Cachexia, Sarcopenia and Muscle
Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine
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期刊介绍: The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.
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