目的 探讨放疗前后 L3 椎体骨骼肌密度(SMD)变化与食管鳞状细胞癌(ESCC)患者预后之间相关性。 方法 本研究 对 2012 年 3 月至 2018 年 11 月于四川省肿瘤医院诊断为 ESCC 的患者进行回顾性病例研究,所有研究对象均测量了放疗前后 L3 椎体 SMD、L3 椎体骨骼肌面积、L3 椎体皮下脂肪面积、L3 椎体内脏脂肪面积的变化。 根据放疗后 L3 -SMD 相较于放疗前改 变情况,将 L3 -SMD>0 定义为增加组,L3 -SMD<0 定义为降低组。 使用风险比评估放疗前后 SMD 变化与总生存(OS)期之间 的关系。 生存分析采用 Kaplan-Meier 曲线和 Cox 比例风险模型。 结果 258 例 ESCC 患者中,放疗后 L3 椎体 SMD 增加为 162 例,中位随访时间为 22. 4 个月(从 3. 3 到 92. 4 个月不等)。 通过单、多因素 Cox 比例风险分析,发现放疗后 SMD 变化、年龄≥ 60 岁和肿瘤长度是影响 OS 期的独立预后因素(P< 0. 05)。 结论 放疗前后 SMD 的变化可作为 ESCC 患者 OS 期的预后生物标 志物。

Objective To investigate the correlation between skeletal muscle density SMD of L radiotherapy and prognosis of esophageal squamous cell carcinoma ESCC . Method This study was a 3 re v t e r r o t s e p b e r c a tiv b e efo c r a e se and after study of patients diagnosed with esophageal squamous cell carcinoma between March 2012 and November 2018. The skeletal muscle density of L3 cone skeletal muscle area of L3 cone subcutaneous fat area of L3 cone and visceral fat area of L3 cone were measured before and after radiotherapy. Hazard ratios were used to assess the association between changes in SMD and overall survival OS before and after radiotherapy. Kaplan-Meier curve and Cox proportional risk model were used for survival analysis. Result Among 258 patients with esophageal squamous cell carcinoma 162 patients in the L3 pyramidal subcutaneous skeletal muscle density increase group after radiotherapy were followed for a median of 22. 4 months ranging from 3. 3 to 92. 4 months . Through univariate Cox proportional risk analysis we found that changes in SMD age ≥60 years and tumor length after radiotherapy were independent prognostic factors affecting overall survival P< 0. 05 . Conclusion Changes in subcutaneous skeletal muscle density before and after radiotherapy can be used as a prognostic biomarker for overall survival in ESCC patients.