Deep Learning-Derived Sarcopenia Marker Predicts Benefit from Anti-EGFR Therapy in Patients with RAS Wild-type Metastatic Colorectal Cancer.

We investigated the prognostic and predictive value of the muscle/bone ratio (MBR), a sarcopenia marker automatically derived from computed tomography (CT) images, in patients with mCRC from the prospective PanaMa study and a real-world validation cohort.

我们研究了肌肉/骨骼比（MBR），一种从计算机断层扫描（CT）图像自动衍生的肌肉减少症标志物，在PanaMa研究的mCRC患者和真实世界验证队列中的预后和预测价值。

experimental_design

PanaMa (AIO KRK 0212; NCT01991873) randomized patients with RAS wild-type mCRC, following induction therapy, to maintenance therapy with fluorouracil and folinic acid (FU/FA) with or without panitumumab (Pmab).

PanaMa (AIO KRK 0212; NCT01991873) 随机将接受诱导治疗后的 RAS 野生型转移性结直肠癌（mCRC）患者分配至维持治疗，治疗方案为氟尿嘧啶和亚叶酸（FU/FA）联合或不联合帕尼单抗（Pmab）。

MBR was automatically calculated from baseline CT images using a validated deep learning model, and patients were stratified by MBR tertiles.

MBR（肿瘤代谢体积）通过使用经过验证的深度学习模型从基线 CT 图像自动计算得出，并根据 MBR 三分位数对患者进行分层。

Associations with progression-free survival(PFS) and overall survival(OS) were studied using Kaplan-Meier and Cox regression analyses.

使用Kaplan-Meier和Cox回归分析研究了无进展生存期(PFS)和总生存期(OS)的相关性。

A retrospective real-world cohort of patients with mCRC treated with cetuximab was used for validation.

使用接受西妥昔单抗治疗的转移性结直肠癌(mCRC)患者的回顾性真实世界队列进行验证。

Results

Premaintenance CT images were available for 189 of 248 randomized patients (76.2%) from PanaMa.

在PanaMa研究中，189名随机患者（占248名患者的76.2%）有术前维持治疗的CT图像可用。

In patients receiving FU/FA + Pmab, high MBR was associated with longer PFS [HR, 0.43; 95% confidence interval(CI), 0.25-0.73; P = 0.002] and OS (HR, 0.41; 95% CI, 0.21-0.77; P = 0.006), whereas no association was observed in patients receiving FU/FA alone.

在接受FU/FA + Pmab治疗的患者中，高MBR与更长的无进展生存期（PFS）[风险比（HR），0.43；95%置信区间（CI），0.25-0.73；P = 0.002]和总生存期（OS）（HR，0.41；95% CI，0.21-0.77；P = 0.006）相关，而在仅接受FU/FA治疗的患者中未观察到这种相关性。

Pmab provided a PFS benefit only in patients with high MBR (HR, 0.42; 95% CI, 0.24-0.73; P = 0.002).

Pmab仅在高MBR患者中提供了无进展生存期（PFS）获益（风险比HR，0.42；95% 置信区间CI，0.24-0.73；P = 0.002）。

The association of high MBR with superior PFS (P = 0.002) and OS (P < 0.001) was confirmed in the real-world cohort.

在真实世界队列中，高MBR与更佳的无进展生存期（PFS）（P = 0.002）和总生存（OS）（P < 0.001）之间的关联得到了证实。

Conclusions

The benefit of anti-EGFR therapy in mCRC is confined to patients with a high MBR.

在转移性结直肠癌（mCRC）中，抗表皮生长因子受体（EGFR）治疗的益处仅限于高微卫星不稳定性（MBR）的患者。

Automated sarcopenia assessment holds promise for personalized treatment intensification in mCRC.

自动化的肌肉消瘦评估为mCRC的个性化治疗强度增强带来了希望。