Avaliação da sarcopenia como fator prognóstico em mulheres com câncer de colo uterino
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2021-06-01
Autores
Resende, Leandro Santos de Araujo
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Universidade Estadual Paulista (Unesp)
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Introdução: o câncer de colo uterino ainda apresenta alta incidência em países em desenvolvimento, como o Brasil, e é responsável por muitas mortes, especialmente quando diagnosticado na fase avançada. A sarcopenia é definida como perda generalizada de massa muscular e, quando presente nas pacientes com câncer de colo uterino, apresenta desfechos clínicos com pior prognóstico. Objetivo: avaliar a relação entre a sarcopenia pré tratamento, e as características da paciente e do tumor, tempo livre de progressão e a sobrevida global em mulheres com câncer de colo uterino tratadas com radioterapia. Sujeitos e métodos: coorte retrospectiva com 210 mulheres com câncer de colo uterino atendidas e tratadas com radioterapia entre janeiro de 2016 e dezembro de 2018, no Caism/Unicamp. O diagnóstico de sarcopenia pré tratamento foi realizado por exames de tomografia computadorizada (TC). O nível de significância estatística foi considerado <0,05. Resultados: entre as 210 mulheres incluídas, 79 (38%) apresentavam sarcopenia pré tratamento. A taxa de sarcopenia pré tratamento foi significativamente maior em mulheres com menos de 50 anos (p=0,03), no menacme (p=0,04), com menor índice de massa corpórea (p<0,001) e com anemia (p=0,02). A sarcopenia pré tratamento não foi associada com o estádio, tipo histológico, trombocitopenia e efeitos adversos do tratamento. A sarcopenia pré tratamento também esteve significativamente associada com a resposta ao tratamento (p<0,05). A sarcopenia pré tratamento e o estádio da doença foram significativamente associados com menor intervalo livre de progressão (ILP) e menor sobrevida global (SG). Mulheres com doença em estádios iniciais (I e II) com sarcopenia tiveram menor ILP [HR=1,82 (IC95%=0,94 a 3,5) p<0.01] e menor SG [HR=2,33 (IC95%=0,92 a 5,92) p<0,01]. Da mesma forma, mulheres com doença em estádios avançados (III e IV) com sarcopenia apresentaram menor ILP [HR=1,8 (IC95%=1,15 a 2,8) p<0,01] e menor SG [HR=1,69 (IC95%=1,03 a 2,79) p<0,01] Conclusão: a sarcopenia foi um fator de mal prognóstico nas mulheres com câncer do colo uterino tratadas com radioterapia. Sendo potencialmente modificável, a sarcopenia vem sendo motivo de estudos para diversos tipos de câncer.
Introduction: cervical cancer still has a high incidence in developing countries, such as Brazil, and is responsible for many deaths, especially when diagnosed at an advanced stage. Sarcopenia is defined as a generalized loss of muscle mass and, when present in patients with cervical cancer, it has clinical outcomes with a worse prognosis. Objective: To assess the relationship between pre-treatment sarcopenia, patient and tumor characteristics, progression-free survival (PFS) and overall survival (OS) in women with cervical cancer treated with radiotherapy. Subjects and methods: retrospective cohort of 210 women with cervical cancer treated and treated with radiotherapy between January 2016 and December 2018, at Caism/Unicamp. The diagnosis of pre-treatment sarcopenia was performed by computed tomography (CT) scans. The level of statistical significance was considered <0.05. Results: among the 210 women included, 79 (38%) had pre-treatment sarcopenia. The pre-treatment sarcopenia rate was significantly higher in women under 50 years (p=0.03), in menacme (p=0.04), with lower body mass index (p<0.001) and with anemia (p =0.02). Pretreatment sarcopenia was not associated with stage, histological type, thrombocytopenia and adverse effects of treatment. However, pre-treatment sarcopenia was significantly associated with treatment response (p<0.05). Pretreatment sarcopenia and disease stage were significantly associated with shorter PFS and shorter OS. Women with disease in early stages (I and II) with sarcopenia had lower ILP [HR=1.82 (95%CI=0.94 to 3.5) p<0.01] and lower OS [HR=2.33 (95%CI) =0.92 to 5.92) p<0.01]. Likewise, women with disease in advanced stages (III and IV) with sarcopenia had lower ILP [HR=1.8 (95%CI=1.15 to 2.8) p<0.01] and lower OS [HR= 1.69 (95%CI=1.03 to 2.79) p<0.01] Conclusion: sarcopenia was a poor prognostic factor in women with cervical cancer treated with radiotherapy. Being potentially modifiable, sarcopenia has been the subject of studies for several types of cancer.
Introduction: cervical cancer still has a high incidence in developing countries, such as Brazil, and is responsible for many deaths, especially when diagnosed at an advanced stage. Sarcopenia is defined as a generalized loss of muscle mass and, when present in patients with cervical cancer, it has clinical outcomes with a worse prognosis. Objective: To assess the relationship between pre-treatment sarcopenia, patient and tumor characteristics, progression-free survival (PFS) and overall survival (OS) in women with cervical cancer treated with radiotherapy. Subjects and methods: retrospective cohort of 210 women with cervical cancer treated and treated with radiotherapy between January 2016 and December 2018, at Caism/Unicamp. The diagnosis of pre-treatment sarcopenia was performed by computed tomography (CT) scans. The level of statistical significance was considered <0.05. Results: among the 210 women included, 79 (38%) had pre-treatment sarcopenia. The pre-treatment sarcopenia rate was significantly higher in women under 50 years (p=0.03), in menacme (p=0.04), with lower body mass index (p<0.001) and with anemia (p =0.02). Pretreatment sarcopenia was not associated with stage, histological type, thrombocytopenia and adverse effects of treatment. However, pre-treatment sarcopenia was significantly associated with treatment response (p<0.05). Pretreatment sarcopenia and disease stage were significantly associated with shorter PFS and shorter OS. Women with disease in early stages (I and II) with sarcopenia had lower ILP [HR=1.82 (95%CI=0.94 to 3.5) p<0.01] and lower OS [HR=2.33 (95%CI) =0.92 to 5.92) p<0.01]. Likewise, women with disease in advanced stages (III and IV) with sarcopenia had lower ILP [HR=1.8 (95%CI=1.15 to 2.8) p<0.01] and lower OS [HR= 1.69 (95%CI=1.03 to 2.79) p<0.01] Conclusion: sarcopenia was a poor prognostic factor in women with cervical cancer treated with radiotherapy. Being potentially modifiable, sarcopenia has been the subject of studies for several types of cancer.
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Palavras-chave
Câncer de colo uterino, Sarcopenia, Radioterapia, Prognóstico, Tomografia computadorizada, Cervical cancer, Radiotherapy, Computed tomography