Assessment of Sarcopenia Measures, Survival, and Disability in Older Adults Before and After Diagnosis With Cancer
Grant R Williams 1, Yanjun Chen 1, Kelly M Kenzik 1, Andrew McDonald 1, Shlomit S Shachar 2 3, Heidi D Klepin 4, Stephen Kritchevsky 4, Smita Bhatia 1
70-79歳の地域住民3075名(男性1491名・平均年齢74.1±2.9歳)が対象で17年追跡
年に1度、四肢の除脂肪量(ALM)・握力・歩行速度を測定し、
がんの発症者(515名)の診断前と診断後の減少率を、がん未発症者(1030名と比較。
対象者の背景;
Table 1.
Patient Characteristicsa
Characteristic | No. (%) | ||
---|---|---|---|
Total sample (N = 3075) | Patients with cancer (n = 515) | Matched controls (n = 1030) | |
Age, mean (SD), ya | 74.1 (2.9) | 74.4 (2.9) | 74.4 (2.9) |
Male | 1491 (48.5) | 323 (62.7) | 646 (62.7) |
Race | |||
White | 1794 (58.3) | 279 (54.2) | 565 (54.9) |
Black | 1281 (41.7) | 236 (45.8) | 465 (45.2) |
Site | |||
Pittsburgh, Pennsylvania | 1548 (50.3) | 264 (51.7) | 507 (49.2) |
Memphis, Tennessee | 1527 (49.7) | 251 (48.7) | 523 (50.8) |
Incident cancer site of origin | |||
Prostate | NA | 117 (23.2) | NA |
Colorectal | NA | 63 (12.5) | NA |
Lung | NA | 61 (12.1) | NA |
Breast | NA | 61 (12.1) | NA |
Other | NA | 213 (42.2) | NA |
Cancer stage | |||
Limited | NA | 293 (56.9) | NA |
Metastatic | NA | 165 (32.0) | NA |
Unknown | NA | 57 (11.1) | NA |
Abbreviation: NA, not applicable.
aVariables presented are baseline values at enrollment in the study.
がんの種類;
前立腺がん:23.2%
大腸がん:12.5%
肺がん:12.1%
乳がん:12.1%
32.0%はがんの転移も認められた。
発症者と未発症者の比較;
診断前の減少率は、歩行速度が低下、ALMや握力は差はなし。
診断後の減少率は、ALMが低下、握力と歩行速度に差はなし。
歩行速度が遅いと死亡率が44%増加(HR:1.44、95%CI1.05-1.98)
Table 3.
Difference in Sarcopenia Indices Between the Participants With Cancer and Matched Controls Without Cancer Before and After Cancer Diagnosisa
Index | Appendicular lean mass | Hand grip strength | Gait speed | |||
---|---|---|---|---|---|---|
Estimate, β (95% CI) | P value | Estimate, β (95% CI) | P value | Estimate, β (95% CI) | P value | |
All cancer vs none | ||||||
Before diagnosis | −0.02 (−0.07 to 0.04) | .49 | −0.21 (−0.43 to 0) | .05 | −0.02 (−0.03 to −0.01) | <.001 |
After diagnosis | −0.14 (−0.23 to −0.05) | <.001 | −0.02 (−0.37 to 0.33) | .92 | 0 (−0.01 to 0.02) | .51 |
Prostate cancer vs none | ||||||
Before diagnosis | 0.03 (−0.09 to 0.16) | .60 | −0.58 (−1.09 to −0.06) | .03 | −0.02 (−0.04 to −0.01) | .002 |
After diagnosis | −0.12 (−0.27 to 0.03) | .13 | 0.07 (−0.57 to 0.71) | .83 | 0 (−0.02 to 0.02) | .87 |
Colorectal vs none | ||||||
Before diagnosis | −0.09 (−0.23 to 0.06) | .25 | −0.65 (−1.24 to −0.05) | .03 | −0.01 (−0.03 to 0.01) | .50 |
After diagnosis | −0.15 (−0.40 to 0.09) | .22 | −0.06 (−1.08 to 0.95) | .90 | 0.01 (−0.03 to 0.05) | .63 |
Lung cancer vs none | ||||||
Before diagnosis | 0 (−0.16 to 0.16) | .99 | −0.46 (−1.07 to 0.15) | .14 | −0.02 (−0.04 to 0) | .04 |
After diagnosis | −0.23 (−0.65 to 0.20) | .30 | −0.30 (−2.02 to 1.42) | .73 | 0.03 (−0.03 to 0.08) | .33 |
Breast cancer vs none | ||||||
Before diagnosis | −0.01 (−0.14 to 0.11) | .82 | 0.07 (−0.35 to 0.48) | .75 | −0.02 (−0.04 to 0) | .06 |
After diagnosis | −0.11 (−0.31 to 0.09) | .27 | −0.02 (−0.72 to 0.68) | .96 | 0.01 (−0.02 to 0.04) | .49 |
Other cancer vs none | ||||||
Before diagnosis | −0.04 (−0.13 to 0.04) | .28 | 0.10 (−0.21 to 0.42) | .51 | −0.03 (−0.04 to −0.01) | <.001 |
After diagnosis | −0.12 (−0.27 to 0.02) | .10 | −0.08 (−0.67 to 0.50) | .78 | 0 (−0.02 to 0.02) | .85 |
Metastatic vs none | ||||||
Before diagnosis | −0.05 (−0.14 to 0.04) | .30 | −0.39 (−0.76 to −0.02) | .04 | −0.03 (−0.04 to −0.02) | <.001 |
After diagnosis | −0.32 (−0.53 to −0.10) | .003 | −0.39 (−1.24 to 0.46) | .37 | 0.01 (−0.02 to 0.04) | .44 |
急に歩行速度が低下しだしたら、がんを発症しているかもしれません。
もちろんそれ以外のこともありますが、精査を促すきっかけにはなるかもしれません。
死亡率とは関連しないようですが、ALMや握力が、診断後は低下するようです。
食事や運動の仕方を考える必要があるかもしれません。