Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Gastrointest Surg. 2012 Aug;16(8):1478-86. doi: 10.1007/s11605-012-1923-5. Epub 2012 Jun 13.
Assessing patient-specific risk factors for long-term mortality following resection of pancreatic adenocarcinoma can be difficult. Sarcopenia--the measurement of muscle wasting--may be a more objective and comprehensive patient-specific factor associated with long-term survival.
Total psoas area (TPA) was measured on preoperative cross-sectional imaging in 557 patients undergoing resection of pancreatic adenocarcinoma between 1996 and 2010. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on 90-day, 1-year, and 3-year mortality was assessed relative to other clinicopathological factors.
Mean patient age was 65.7 years and 53.1 % was male. Mean TPA among men (611 mm²/m²) was greater than among women (454 mm²/m²). Surgery involved pancreaticoduodenectomy (86.0 %) or distal pancreatectomy (14.0 %). Mean tumor size was 3.4 cm; 49.9 % and 88.5 % of patients had vascular and perineural invasion, respectively. Margin status was R0 (59.0 %) and 77.7 % patients had lymph node metastasis. Overall 90-day mortality was 3.1 % and overall 1- and 3-year survival was 67.9 % and 35.7 %, respectively. Sarcopenia was associated with increased risk of 3-year mortality (HR = 1.68; P < 0.001). Tumor-specific factors such as poor differentiation on histology (HR = 1.75), margin status (HR = 1.66), and lymph node metastasis (HR = 2.06) were associated with risk of death at 3-years (all P < 0.001). After controlling for these factors, sarcopenia remained independently associated with an increased risk of death at 3 years (HR = 1.63; P < 0.001).
Sarcopenia was a predictor of survival following pancreatic surgery, with sarcopenic patients having a 63 % increased risk of death at 3 years. Sarcopenia was an objective measure of patient frailty that was strongly associated with long-term outcome independent of tumor-specific factors.
评估胰腺腺癌切除术后长期死亡率的患者特异性危险因素可能较为困难。肌肉减少症——肌肉消耗的测量——可能是与长期生存相关的更客观和全面的患者特异性因素。
1996 年至 2010 年间，557 例接受胰腺腺癌切除术的患者在术前横断面成像上测量总腰大肌面积（TPA）。存在 TPA 处于最低性别特定四分位数的患者被定义为存在肌肉减少症。相对于其他临床病理因素，评估肌肉减少症对 90 天、1 年和 3 年死亡率的影响。
患者平均年龄为 65.7 岁，53.1%为男性。男性的平均 TPA 为 611mm²/m²，高于女性的 454mm²/m²。手术包括胰十二指肠切除术（86.0%）或胰体尾切除术（14.0%）。肿瘤平均大小为 3.4cm；49.9%和 88.5%的患者分别存在血管侵犯和神经周围侵犯。切缘状态为 R0（59.0%），77.7%的患者有淋巴结转移。总的 90 天死亡率为 3.1%，总的 1 年和 3 年生存率分别为 67.9%和 35.7%。肌肉减少症与 3 年死亡率增加相关（HR=1.68；P<0.001）。肿瘤特异性因素如组织学上的低分化（HR=1.75）、切缘状态（HR=1.66）和淋巴结转移（HR=2.06）与 3 年死亡风险相关（均 P<0.001）。在控制这些因素后，肌肉减少症仍然与 3 年死亡风险增加独立相关（HR=1.63；P<0.001）。
肌肉减少症是胰腺手术后生存的预测因素，肌肉减少症患者 3 年死亡风险增加 63%。肌肉减少症是患者脆弱性的客观衡量标准，与肿瘤特异性因素无关，与长期结局密切相关。
