肌肉减少症对胃癌患者胃切除术后的临床结局产生不利影响：一项前瞻性研究。

Sarcopenia Adversely Impacts Postoperative Clinical Outcomes Following Gastrectomy in Patients with Gastric Cancer: A Prospective Study.

作者信息

Wang Su-Lin, Zhuang Cheng-Le, Huang Dong-Dong, Pang Wen-Yang, Lou Neng, Chen Fan-Feng, Zhou Chong-Jun, Shen Xian, Yu Zhen

机构信息

Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.

Department of Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China.

出版信息

Ann Surg Oncol. 2016 Feb;23(2):556-64. doi: 10.1245/s10434-015-4887-3. Epub 2015 Dec 14.

DOI:10.1245/s10434-015-4887-3

PMID:26668085

Abstract

BACKGROUND

Sarcopenia is characterized by decreased skeletal muscle plus low muscle strength and/or physical performance. This study was performed to determine the association of sarcopenia with short-term postoperative outcomes after gastrectomy for gastric cancer.

METHODS

We conducted a prospective study of 255 consecutive patients with gastric cancer who underwent curative gastrectomy. The sarcopenia elements, including lumbar skeletal muscle index, handgrip strength, and gait speed, were measured before surgery. Patients were followed up after gastrectomy to gain the actual clinical outcomes. Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis.

RESULTS

Sarcopenia was present in 32 of 255 patients (12.5 %), and was significantly correlated with advance age, lower body mass index, higher nutritional risk screening (NRS) 2002 score, and lower preoperative serum albumin and hemoglobin. Compared with non-sarcopenic patients, sarcopenic patients had a higher risk of postoperative complications, longer postoperative hospital stay, and more hospital costs. In univariate analysis, sarcopenia (p < 0.001), nutritional risk (NRS 2002 score ≥3; p = 0.003), advanced age (≥75 years; p = 0.014), anemia (p = 0.012), hypoalbuminemia (p = 0.029), and diabetes (p = 0.014) were associated with postoperative complications. Multivariable analysis revealed that sarcopenia (p < 0.001) and diabetes (p = 0.006) were independent predictors of postoperative complications.

CONCLUSIONS

Sarcopenia is an independent predictor of postoperative complications in patients with gastric cancer after gastrectomy.

摘要

背景

肌肉减少症的特征是骨骼肌减少以及肌肉力量和/或身体机能下降。本研究旨在确定肌肉减少症与胃癌胃切除术后短期预后的相关性。

方法

我们对255例连续接受根治性胃切除术的胃癌患者进行了一项前瞻性研究。术前测量肌肉减少症相关指标，包括腰椎骨骼肌指数、握力和步速。胃切除术后对患者进行随访以获取实际临床结果。通过单因素和多因素分析来分析导致术后并发症的因素。

结果

255例患者中有32例（12.5%）存在肌肉减少症，且与高龄、较低的体重指数、较高的营养风险筛查（NRS）2002评分以及较低的术前血清白蛋白和血红蛋白显著相关。与非肌肉减少症患者相比，肌肉减少症患者术后并发症风险更高、术后住院时间更长且住院费用更多。在单因素分析中，肌肉减少症（p<0.001）、营养风险（NRS 2002评分≥3；p = 0.003）、高龄（≥75岁；p = 0.014）、贫血（p = 0.012）、低白蛋白血症（p = 0.029）和糖尿病（p = 0.014）与术后并发症相关。多因素分析显示，肌肉减少症（p<0.001）和糖尿病（p = 0.006）是术后并发症的独立预测因素。