Clinical nutrition ESPEN · 2026
A validation of height- and body mass index-adjusted skeletal muscle Z-scores for cancer prognosis prediction.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Kurokawa Mariko, Gonoi Wataru, Taguchi Satoru, Sugawara Kotaro, Hanaoka Shouhei, Kishitani Kenjiro, Shiomi Shinichiro, Uemura Yukari, Akamatsu Nobuhiko, Inui Shohei, Tanaka Koji, Yagi Koichi, Kawai Taketo, Nakagawa Tohru, Fukuhara Hiroshi, Seto Yasuyuki, Kume Haruki, Gonzalez M Cristina, Prado Carla M, Abe Osamu
Аннотация
BACKGROUND AND AIMS: Although the prognostic significance of low muscle mass has been established in cancer outcomes, standardizing cutoff values remains challenging. Various criteria based on the skeletal muscle index (SMI) have been proposed. The Z-score derived from the body-size-adjusted skeletal muscle area (SMA) has been proposed (Derstine's Z-score), which offers the potential for unbiased assessments across diverse body sizes. However, large-scale cohort validation of clinical outcomes using this approach has not been conducted. This study aimed to validate Derstine's Z-score in a different race than the original paper.
METHODS: This single-center study included 2869 patients with gastrointestinal or genitourinary cancers who underwent radical surgery. The SMA on computed tomography at the third lumbar level was used to calculate Derstine's Z-scores by normalizing the ratio of the SMA to height- or height-squared with the body size-adjusted mean and sex-specific standard deviation. We employed Z-score cutoffs of -2 and -3, the nearest whole number to the optimal cutoff, calculated using maximally selected rank statistics with several p-value approximations. The effects of Derstine's Z-scores on cancer-specific survival (CSS) and overall survival (OS) were calculated and compared with the previously proposed SMI definition.
RESULTS: Kaplan-Meier analysis demonstrated significant discrimination of CSS and OS based on Derstine's Z-scores. A -3 cutoff for Derstine's Z-score, rather than the conventional -2, achieved the highest hazard ratio, with values of 1.61 for CSS and 1.94 for OS. Multivariate analysis revealed that low muscle mass, as defined by Derstine's Z-scores, was associated with poor prognosis, with hazard ratios of 1.42 for CSS and 1.62 for OS, enhancing the predictive capability of survival models comparable to the SMI definition.
CONCLUSION: The Derstine Z-score is a valuable prognostic indicator in patients with cancer. A cutoff value of -3 may better capture low muscle mass in a different race than the original paper.
METHODS: This single-center study included 2869 patients with gastrointestinal or genitourinary cancers who underwent radical surgery. The SMA on computed tomography at the third lumbar level was used to calculate Derstine's Z-scores by normalizing the ratio of the SMA to height- or height-squared with the body size-adjusted mean and sex-specific standard deviation. We employed Z-score cutoffs of -2 and -3, the nearest whole number to the optimal cutoff, calculated using maximally selected rank statistics with several p-value approximations. The effects of Derstine's Z-scores on cancer-specific survival (CSS) and overall survival (OS) were calculated and compared with the previously proposed SMI definition.
RESULTS: Kaplan-Meier analysis demonstrated significant discrimination of CSS and OS based on Derstine's Z-scores. A -3 cutoff for Derstine's Z-score, rather than the conventional -2, achieved the highest hazard ratio, with values of 1.61 for CSS and 1.94 for OS. Multivariate analysis revealed that low muscle mass, as defined by Derstine's Z-scores, was associated with poor prognosis, with hazard ratios of 1.42 for CSS and 1.62 for OS, enhancing the predictive capability of survival models comparable to the SMI definition.
CONCLUSION: The Derstine Z-score is a valuable prognostic indicator in patients with cancer. A cutoff value of -3 may better capture low muscle mass in a different race than the original paper.