咬肌指数、咬肌放射密度及全球免疫-营养-炎症指数在接受根治性放疗的喉癌中的预后价值

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中文摘要

背景： 本回顾性研究评估了治疗前咬肌指数（MMI）、咬肌放射密度（HUAC）和全球免疫-营养-炎症指数（GINI）作为接受根治性放疗的喉鳞状细胞癌患者预后标志物的价值。
方法： MMI和HUAC在模拟计算机断层扫描上测量，GINI根据治疗前实验室值计算。生物标志物以连续变量方式使用Firth惩罚Cox模型分析，并针对年龄、体能状态、肿瘤部位以及T和N分期进行调整。使用限制性立方样条评估非线性。联合模型和多重插补评估稳健性。HUAC的关联随时间进行评估。探索性截断值通过考虑删失的三年时间依赖性受试者工作特征分析得出，以放疗开始作为时间零点。
结果： 在146例患者中，30例死亡，48例出现进展或死亡；116例有GINI数据。MMI每降低一个标准差与更差的总生存期（OS；调整后风险比1.92，95%置信区间1.21-3.05；p = 0.002）和无进展生存期（PFS；1.91，1.35-2.71；p < 0.001）相关。在进一步调整体重指数和同期全身治疗后，这些关联减弱。GINI的发现经调整、联合和缺失数据分析后并不稳健。较低的HUAC在随访后期显示出与较差结局的探索性关联，但基于少数晚期事件。MMI > 2.830 vs ≤2.830 cm2/m2的三年OS/PFS估计分别为92.5%/81.1% vs 68.9%/59.5%，GINI < 139.67 vs ≥139.67的三年OS/PFS估计分别为90.2%/81.9% vs 45.1%/38.0%。GINI截断值不稳定，95%自助法区间为20.104-180.985。
结论： 较低的MMI显示出最一致的预后关联。这是GINI在喉癌中的初步评估，支持对其预后潜力进行进一步研究。HUAC的发现和队列衍生截断值仍属探索性，需要外部验证。

英文摘要

BACKGROUND: This retrospective study evaluated pretreatment masseter muscle index (MMI), masseter radiodensity (HUAC), and Global Immune-Nutrition-Inflammation Index (GINI) as prognostic markers in patients with laryngeal squamous cell carcinoma treated with definitive radiotherapy.
METHODS: MMI and HUAC were measured on simulation computed tomography, and GINI was calculated from pretreatment laboratory values. Biomarkers were analyzed continuously using Firth penalized Cox models adjusted for age, performance status, tumor site, and T and N categories. Nonlinearity was assessed using restricted cubic splines. Joint models and multiple imputation assessed robustness. HUAC associations were assessed over time. Exploratory cutoffs were derived using censoring-aware three-year time-dependent receiver operating characteristic analysis, with radiotherapy initiation as time zero.
RESULTS: Among 146 patients, 30 died and 48 experienced progression or death; GINI was available in 116. Each standard-deviation decrease in MMI was associated with worse overall survival (OS; adjusted hazard ratio 1.92, 95% confidence interval 1.21-3.05; p = 0.002) and progression-free survival (PFS; 1.91, 1.35-2.71; p < 0.001). These associations weakened after further adjustment for body mass index and concurrent systemic therapy. GINI findings were not robust in adjusted, joint, and missing-data analyses. Lower HUAC showed an exploratory association with poorer outcomes later in follow-up, based on few late events. Three-year OS/PFS estimates were 92.5%/81.1% versus 68.9%/59.5% for MMI > 2.830 versus ≤2.830 cm2/m2, and 90.2%/81.9% versus 45.1%/38.0% for GINI < 139.67 versus ≥139.67. The GINI cutoff was unstable, with a 95% bootstrap interval of 20.104-180.985.
CONCLUSIONS: Lower MMI showed the most consistent prognostic association. This initial evaluation of GINI in laryngeal cancer supports further investigation of its prognostic potential. HUAC findings and cohort-derived cutoffs remain exploratory and require external validation.