Kanserli Hastalarda Sarkopeni ile Antrasiklin Kullanımına Bağlı Gelişen Kardiyotoksisite İlişkisi

Abstract

Bas O. Relationship Between Sarcopenia and Anthracycline Related Cardiotoxicity in Patients with Cancer Hacettepe University Faculty Of Medicine Department Of Internal Medicine, Thesis Of Specialization in Medicine, Ankara, 2020. Studies have suggested that sarcopenia is associated increased treatment toxicity in patients with cancer. The aim of this study is to evaluate relationship between sarcopenia and anthracycline related cardiotoxicity. Patients who received anthracycline-based chemotherapy between 2014-2018 and had baseline abdominal Computerized tomography (CT) for measuring skeletal muscle index (SMI) and psoas muscle index (PMI) and baseline and follow-up echocardiography after anthracycline treatment were included. Sex-specific cutoffs were used for diagnosis of sarcopenia. European society of Cardiology (ESC) ejection fraction criteria (EF) and American Society of Echocardiography (ASE) diastolic dysfunction criteria were used for definition of cardiotoxicity. A total of 166 patients (75 males, 91 females) were included; 50 (30.1 %) with breast cancer, 82 (49.4 %) with lymphoma, 34 (20.5%) with other cancers. The median age was 48.5 years and median total doxorubicin dose was 238.3 mg/m2. Sarcopenia was determined in 33 patients (19.9 %) according to L3-SMI, in 17 patients (10.2 %) according to L4-SMI and in 45 (27.1 %) patients according to PMI. After anthracycline treatment, 27 patients (16.3 %) developed cardiotoxicity: 18 (10.8%) had systolic dysfunction and 9 (5.4%) had diastolic dysfunction. After adjustment for age, gender, doxorubicin dosage, body mass index, and presence of cardiovascular disease; sarcopenia at any of the three levels was significantly associated with increased risk of cardiotoxicity. (L3-SMI Hazard ratio [HR]= 4.14, 95% confidence interval [CI] 1.665-10.311, p=0.002; L4-SMI HR= 3.65, 95% CI 1.21-11.0, p=0.022; PMI HR= 4.39, 95% CI 1.81-10.65, p=0.001). This is the first study demonstrating a significant association between CT-diagnosed sarcopenia and anthracycline related cardiotoxicity. Routine CT scans performed for cancer staging may help clinicians identify patients at high risk of cardiotoxicity, in whom closer follow-up or preventive measures should be considered.