Amini Neda, Spolverato Gaya, Gupta Rohan, Margonis Georgios A, Kim Yuhree, Wagner Doris, Rezaee Neda, Weiss Matthew J, Wolfgang Christopher L, Makary Martin M, Kamel Ihab R, Pawlik Timothy M
Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
J Gastrointest Surg. 2015 Sep;19(9):1593-602. doi: 10.1007/s11605-015-2835-y. Epub 2015 Apr 30.
While sarcopenia is typically defined using total psoas area (TPA), characterizing sarcopenia using only a single axial cross-sectional image may be inadequate. We sought to evaluate total psoas volume (TPV) as a new tool to define sarcopenia and compare patient outcomes relative to TPA and TPV.
Sarcopenia was assessed in 763 patients who underwent pancreatectomy for pancreatic adenocarcinoma between 1996 and 2014. It was defined as the TPA and TPV in the lowest sex-specific quartile. The impact of sarcopenia defined by TPA and TPV on overall morbidity and mortality was assessed using multivariable analysis.
Median TPA and TPV were both lower in women versus men (both P < 0.001). TPA identified 192 (25.1%) patients as sarcopenic, while TPV identified 152 patients (19.9%). Three hundred sixty-nine (48.4%) patients experienced a postoperative complication. While TPA-sarcopenia was not associated with higher risk of postoperative complications (OR 1.06; P = 0.72), sarcopenia defined by TPV was associated with morbidity (OR 1.79; P = 0.002). On multivariable analysis, TPV-sarcopenia remained independently associated with an increased risk of postoperative complications (OR 1.69; P = 0.006), as well as long-term survival (HR 1.46; P = 0.006).
The use of TPV to define sarcopenia was associated with both short- and long-term outcomes following resection of pancreatic cancer. Assessment of the entire volume of the psoas muscle (TPV) may be a better means to define sarcopenia rather than a single axial image.
虽然肌肉减少症通常使用腰大肌总面积（TPA）来定义，但仅使用单个轴向横截面图像来表征肌肉减少症可能并不充分。我们试图评估腰大肌总体积（TPV）作为定义肌肉减少症的新工具，并比较与TPA和TPV相关的患者结局。
对1996年至2014年间因胰腺腺癌接受胰腺切除术的763例患者进行肌肉减少症评估。将其定义为性别特异性最低四分位数中的TPA和TPV。使用多变量分析评估由TPA和TPV定义的肌肉减少症对总体发病率和死亡率的影响。
女性的TPA和TPV中位数均低于男性（均P < 0.001）。TPA将192例（25.1%）患者确定为肌肉减少症患者，而TPV确定了152例患者（19.9%）。369例（48.4%）患者发生了术后并发症。虽然TPA定义的肌肉减少症与术后并发症的较高风险无关（OR 1.06；P = 0.72），但TPV定义的肌肉减少症与发病率相关（OR 1.79；P = 0.002）。在多变量分析中，TPV定义的肌肉减少症仍然独立地与术后并发症风险增加相关（OR 1.69；P = 0.006），以及长期生存相关（HR 1.46；P = 0.006）。
使用TPV来定义肌肉减少症与胰腺癌切除术后的短期和长期结局均相关。评估腰大肌的整体体积（TPV）可能是定义肌肉减少症的更好方法，而不是单个轴向图像。
