低肌肉量和肌脂肪变性与接受结直肠癌手术患者的宿主全身炎症反应相关。

Low Muscularity and Myosteatosis Is Related to the Host Systemic Inflammatory Response in Patients Undergoing Surgery for Colorectal Cancer.

作者信息

Malietzis George, Johns Neil, Al-Hassi Hafid O, Knight Stella C, Kennedy Robin H, Fearon Kenneth C H, Aziz Omer, Jenkins John T

机构信息

*Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK †Antigen Presentation Research Group of Imperial College, St Marks Hospital, Harrow, Middlesex, UK ‡Department of Clinical and Surgical Sciences, University of Edinburgh, Scotland §Department of Surgery and Cancer, Imperial College, Paddington, London, UK ¶Department of Colorectal Surgery, The Christie NHS Foundation Trust, Manchester, UK.

出版信息

Ann Surg. 2016 Feb;263(2):320-5. doi: 10.1097/SLA.0000000000001113.

DOI:10.1097/SLA.0000000000001113

PMID:25643288

Abstract

OBJECTIVE

We examined the relationships between computed tomography (CT)-defined skeletal muscle parameters and the systemic inflammatory response (SIR) in patients with operable primary colorectal cancer (CRC).

BACKGROUND

Muscle depletion is characterized by a reduced muscle mass (myopenia) and increased infiltration by inter- and intramuscular fat (myosteatosis). It is recognized as a poor prognostic indicator in patients with cancer, but the underlying factors remain unclear.

METHODS

A total of 763 patients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included. Image analysis of CT scans was used to calculate Lumbar skeletal muscle index (LSMI), and mean muscle attenuation (MA). The SIR was quantified by the preoperative neutrophil to lymphocyte ratio (NLR) and albumin levels. Correlation and multivariate regression analysis was performed to identify independent relationships between patient SIR and muscle characteristics.

RESULTS

Patients with NLR > 3 had significantly lower LSMI and lower MA than those with NLR < 3 [LSMI = 42.07 cmm vs 44.27 cmm (P = 0.002) and MA = 30.04 Hounsfield unit (HU) vs 28.36 HU (P = 0.016)]. Multivariate logistic regression analysis showed that high NLR [odds ratio (OR) = 1.78 (95% confidence interval [CI]: 1.29-2.45), P < 0.001] and low albumin [OR = 1.80 (95% CI: 1.17-2.74), P = 0.007] were independent predictors of reduced muscle mass. High NLR was significantly related with a low mean MA and hence myosteatosis [OR = 1.60 (95% CI: 1.03-2.49), P = 0.038].

CONCLUSIONS

These results highlight a direct association between myopenia, myosteatosis, and the host SIR in patients with operable CRC. A better understanding of factors that regulate muscle changes such as myopenia and myosteatosis may lead to the development of novel therapies that influence a more metabolically "healthy" skeletal muscle and potentially alter cancer outcomes.

摘要

目的

我们研究了可手术切除的原发性结直肠癌（CRC）患者中，计算机断层扫描（CT）定义的骨骼肌参数与全身炎症反应（SIR）之间的关系。

背景

肌肉消耗的特征是肌肉质量降低（肌肉减少症）以及肌间和肌内脂肪浸润增加（肌肉脂肪变性）。它被认为是癌症患者预后不良的指标，但其潜在因素仍不清楚。

方法

纳入了2006年至2013年间共763例诊断为CRC并接受择期手术切除的患者。通过CT扫描的图像分析来计算腰椎骨骼肌指数（LSMI）和平均肌肉衰减（MA）。通过术前中性粒细胞与淋巴细胞比值（NLR）和白蛋白水平对SIR进行量化。进行相关性和多变量回归分析以确定患者SIR与肌肉特征之间的独立关系。

结果

NLR>3的患者的LSMI和MA显著低于NLR<3的患者[LSMI = 42.07 cmm对44.27 cmm（P = 0.002），MA = 30.04亨氏单位（HU）对28.36 HU（P = 0.016）]。多变量逻辑回归分析表明，高NLR [比值比（OR）= 1.78（95%置信区间[CI]：1.29 - 2.45），P < 0.001]和低白蛋白[OR = 1.80（95% CI：1.17 - 2.74），P = 0.007]是肌肉质量降低的独立预测因素。高NLR与低平均MA显著相关，因此与肌肉脂肪变性相关[OR = 1.60（95% CI：1.03 - 2.49），P = 0.038]。