术前肌内脂肪组织含量是肝细胞癌肝切除术后一种新的预后预测指标。

Preoperative intramuscular adipose tissue content is a novel prognostic predictor after hepatectomy for hepatocellular carcinoma.

作者信息

Hamaguchi Yuhei, Kaido Toshimi, Okumura Shinya, Ito Takashi, Fujimoto Yasuhiro, Ogawa Kohei, Mori Akira, Hammad Ahmed, Hatano Etsuro, Uemoto Shinji

机构信息

Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.

出版信息

J Hepatobiliary Pancreat Sci. 2015 Jun;22(6):475-85. doi: 10.1002/jhbp.236. Epub 2015 Mar 5.

DOI:10.1002/jhbp.236

PMID:25755128

Abstract

BACKGROUND

Sarcopenia has been shown to be an independent predictor of lower disease-free and overall survival in various kinds of diseases. The quality of skeletal muscle has recently attracted much attention as a new parameter of sarcopenia.

METHODS

We performed a retrospective analysis of 477 patients undergoing hepatectomy for hepatocellular carcinoma (HCC) between April 2005 and August 2014. The quality of skeletal muscle was evaluated by intramuscular adipose tissue content (IMAC) using preoperative computed tomography (CT) imaging. The impact of IMAC on outcomes after hepatectomy for HCC was analyzed.

RESULTS

Patients with high IMAC showed older age, higher body mass index, higher indocyanine green retention test at 15 min, and more operative blood loss. The overall and recurrence-free survival rates were significantly lower in patients with high IMAC than in patients with normal IMAC (P < 0.0001, P = 0.0012, respectively). Multivariate analysis showed that high IMAC was the significant risk factor for death (hazard ratio [HR] = 2.942; P < 0.0001) and for HCC recurrence (HR = 1.529; P = 0.0007) after hepatectomy.

CONCLUSIONS

Preoperative quality of skeletal muscle was closely correlated with postoperative mortality and HCC recurrence. IMAC could be incorporated into new selection criteria for hepatectomy for HCC.

摘要

背景

肌肉减少症已被证明是各类疾病中无病生存期和总生存期降低的独立预测因素。骨骼肌质量作为肌肉减少症的一个新参数，最近备受关注。

方法

我们对2005年4月至2014年8月期间因肝细胞癌（HCC）接受肝切除术的477例患者进行了回顾性分析。使用术前计算机断层扫描（CT）成像通过肌内脂肪组织含量（IMAC）评估骨骼肌质量。分析IMAC对HCC肝切除术后结局的影响。

结果

IMAC高的患者年龄更大、体重指数更高、15分钟时吲哚菁绿滞留试验结果更高且手术失血量更多。IMAC高的患者的总生存率和无复发生存率显著低于IMAC正常的患者（分别为P < 0.0001，P = 0.0012）。多变量分析表明，高IMAC是肝切除术后死亡（风险比[HR] = 2.942；P < 0.0001）和HCC复发（HR = 1.529；P = 0.0007）的显著危险因素。