Park Seong Yong, Yoon Joon-Kee, Lee Su Jin, Haam Seokjin, Jung Joonho
Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Nuclear Medicine & Molecular Imaging, Ajou University School of Medicine, Suwon, Republic of Korea.
J Thorac Dis. 2017 Feb;9(2):355-361. doi: 10.21037/jtd.2017.02.42.
Although a decrease in the psoas muscle area (PMA) has been reported as a risk factor for survival after esophagectomy in esophageal cancer, no previous studies have focused on the change in the PMA after surgery. We investigated the prognostic role of PMA changes in patients with surgically treated esophageal cancer.
Fifty-eight patients with esophageal cancer who underwent surgical resection and complete lymph node dissection were reviewed retrospectively. The PMA was measured at the level of the L3 vertebrae on preoperative and one-year postoperative follow-up computed tomography images. The percentage change of the PMA was calculated as follows: delta (%) = (postoperative PMA - preoperative PMA) / (preoperative PMA × 100).
The study patients included 54 (93.1%) males and 4 females (mean age, 60.59±9.16 years), of whom 17 (29.3%) were pathological Stage I, 18 (31.0%) were Stage II, and 23 (39.7%) were Stage III. The mean change of the PMA was -10.17% and the postoperative PMA was decreased significantly compared with the preoperative PMA (P<0.001). The PMA was increased in 13 (22.4%) patients, whereas it was decreased in 45 (77.6%). Multivariate analysis revealed that the change of the PMA (hazard ratio, HR =0.688; P=0.001) and the pathologic stage (Stage III . Stage I, HR =3.388; P=0.016) were risk factors for overall survival (OS). The 3-year OS in patients with a PMA decrease of more than 10%, and those with a PMA decrease of less than 10% or an increase, were 18.9% and 59.5%, respectively (P=0.049).
The decrease in the PMA had a negative prognostic effect on OS in patients with surgically treated esophageal cancer.
尽管已有报道称腰大肌面积（PMA）减小是食管癌患者食管切除术后生存的危险因素，但此前尚无研究关注术后PMA的变化。我们调查了PMA变化在接受手术治疗的食管癌患者中的预后作用。
回顾性分析了58例行手术切除及完整淋巴结清扫的食管癌患者。在术前及术后1年的随访计算机断层扫描图像上，于L3椎体水平测量PMA。PMA的百分比变化计算如下：δ（%）=（术后PMA - 术前PMA）/（术前PMA×100）。
研究患者包括54名男性（93.1%）和4名女性（平均年龄60.59±9.16岁），其中17例（29.3%）为病理I期，18例（31.0%）为II期，23例（39.7%）为III期。PMA的平均变化为-10.17%，术后PMA较术前显著降低（P<0.001）。13例（22.4%）患者PMA增加，45例（77.6%）患者PMA降低。多因素分析显示，PMA变化（风险比，HR =0.688；P=0.001）和病理分期（III期. I期，HR =3.388；P=0.016）是总生存（OS）的危险因素。PMA降低超过10%的患者与PMA降低不足10%或增加的患者相比，3年总生存率分别为18.9%和59.5%（P=0.049）。
PMA降低对接受手术治疗的食管癌患者的OS有负面预后影响。
