Background. Sarcopenia is characterized by the loss of muscle mass and function and is associated with frailty, a syndrome linked to an increased likelihood of falls, fractures, and physical disability. Both frailty and sarcopenia are recognized as markers for shortened survival in a number of medical conditions and in cancer patient populations. Low alanine aminotransferase (ALT) values, representing low muscle mass (sarcopenia), may be associated with increased frailty and subsequently shortened survival in cancer patients. In the current study, we aimed to assess the potential relationship between low ALT and shorter survival in bladder cancer patients and survivors. Patients and Methods. This was a retrospective analysis of bladder cancer patients and survivors, both in and outpatients. We defined patients with sarcopenia as those presenting with ALT < 17 IU/L. Results. A total of 5769 bladder cancer patients’ records were identified. After the exclusion of patients with no available ALT values or ALT levels above the upper normal limit, the final study cohort included 3075 patients (mean age 73.2 ± 12 years), of whom 80% were men and 1362 (53% had ALT ≤ 17 IU/L. The mean ALT value of patients within the low ALT group was 11.44 IU/L, while the mean value in the higher ALT level group was 24.32 IU/L (p< 0.001). Patients in the lower ALT group were older (74.7 vs. 71.4 years;p< 0.001), had lower BMI (25.8 vs. 27;p< 0.001), and their hemoglobin values were lower (11.7 vs. 12.6 g/dL;p< 0.001). In a univariate analysis, low ALT levels were associated with a 45% increase in mortality (95% CI 1.31–1.60,p< 0.001). In a multivariate model controlling for age, kidney function, and hemoglobin, low ALT levels were still associated with 22% increased mortality. Conclusions. Low ALT values, indicative of sarcopenia and frailty, are associated with decreased survival of bladder cancer patients and survivors and could potentially be applied for optimizing individual treatment decisions.
背景。肌肉减少症以肌肉质量和功能丧失为特征，并与衰弱相关，后者是一种与跌倒、骨折和身体残疾风险增加相关的综合征。在多种疾病状态及癌症患者群体中，衰弱和肌肉减少症均被视为生存期缩短的标志物。低丙氨酸氨基转移酶（ALT）值代表低肌肉质量（肌肉减少症），可能与癌症患者衰弱程度增加及后续生存期缩短相关。本研究旨在评估膀胱癌患者及生存者中低ALT水平与较短生存期之间的潜在关联。 患者与方法。本研究对住院及门诊膀胱癌患者和生存者进行回顾性分析。我们将ALT < 17 IU/L的患者定义为肌肉减少症患者。 结果。共纳入5769例膀胱癌患者记录。排除无可用ALT值或ALT水平高于正常上限的患者后，最终研究队列包含3075例患者（平均年龄73.2±12岁），其中80%为男性，1362例（53%）患者ALT ≤ 17 IU/L。低ALT组患者的平均ALT值为11.44 IU/L，而较高ALT水平组的平均值为24.32 IU/L（p<0.001）。低ALT组患者年龄更大（74.7岁 vs. 71.4岁；p<0.001）、体重指数更低（25.8 vs. 27；p<0.001）、血红蛋白值更低（11.7 vs. 12.6 g/dL；p<0.001）。单变量分析显示，低ALT水平与死亡率增加45%相关（95% CI 1.31–1.60，p<0.001）。在控制年龄、肾功能和血红蛋白的多变量模型中，低ALT水平仍与22%的死亡率增加相关。 结论。低ALT值作为肌肉减少症和衰弱的指标，与膀胱癌患者及生存者的生存期缩短相关，可能有助于优化个体化治疗决策。
肿瘤(癌症)患者之家