肌少症性肥胖对肝细胞癌患者肝切除术后结局的影响。

Impact of Sarcopenic Obesity on Outcomes in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma.

机构信息

Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

出版信息

Ann Surg. 2019 May;269(5):924-931. doi: 10.1097/SLA.0000000000002555.

DOI:10.1097/SLA.0000000000002555

PMID:29064889

Abstract

OBJECTIVE

To evaluate preoperative body composition, including skeletal muscle and visceral adipose tissue, and to clarify the impact on outcomes after hepatectomy for hepatocellular carcinoma (HCC).

BACKGROUND

Recent studies have indicated that sarcopenia is associated with morbidity and mortality in various pathologies, including cancer, and that obesity or visceral adiposity represents a significant risk factor for several cancers. However, the impact of sarcopenic obesity on outcomes after hepatectomy for HCC has not been fully investigated.

METHODS

We retrospectively analyzed 465 patients who underwent primary hepatectomy for HCC between April 2005 and March 2015. Skeletal muscle mass and visceral adipose tissue were evaluated by preoperative computed tomography to define sarcopenia and obesity. Patients were classified into 1 of 4 body composition groups according to the presence or absence of sarcopenia and obesity.

RESULTS

Body composition was classified as nonsarcopenic nonobesity in 184 patients (39%), nonsarcopenic obesity in 219 (47%), sarcopenic nonobesity in 31 (7%), and sarcopenic obesity in 31 (7%). Compared with patients with nonsarcopenic nonobesity, patients with sarcopenic obesity displayed worse median survival (84.7 vs. 39.1 mo, P = 0.002) and worse median recurrence-free survival (21.4 vs. 8.4 mo, P = 0.003). Multivariate analysis identified sarcopenic obesity as a significant risk factor for death (hazard ratio [HR] = 2.504, P = 0.005) and HCC recurrence (HR = 2.031, P = 0.006) after hepatectomy for HCC.

CONCLUSION

Preoperative sarcopenic obesity was an independent risk factor for death and HCC recurrence after hepatectomy for HCC.

摘要

目的

评估术前体成分，包括骨骼肌和内脏脂肪组织，并阐明其对肝细胞癌（HCC）肝切除术后结局的影响。

背景

最近的研究表明，肌肉减少症与包括癌症在内的各种疾病的发病率和死亡率相关，而肥胖或内脏脂肪过多是多种癌症的重要危险因素。然而，肌肉减少性肥胖对 HCC 肝切除术后结局的影响尚未得到充分研究。

方法

我们回顾性分析了 2005 年 4 月至 2015 年 3 月期间接受 HCC 根治性肝切除术的 465 例患者。通过术前 CT 评估骨骼肌质量和内脏脂肪组织来定义肌肉减少症和肥胖症。根据是否存在肌肉减少症和肥胖症，患者被分为 4 个体成分组之一。

结果

体成分分为非肌肉减少非肥胖组 184 例（39%）、非肌肉减少肥胖组 219 例（47%）、肌肉减少非肥胖组 31 例（7%）和肌肉减少肥胖组 31 例（7%）。与非肌肉减少非肥胖组患者相比，肌肉减少肥胖组患者的中位生存时间更差（84.7 与 39.1 个月，P = 0.002），中位无复发生存时间更差（21.4 与 8.4 个月，P = 0.003）。多因素分析确定肌肉减少肥胖是 HCC 肝切除术后死亡（风险比[HR] = 2.504，P = 0.005）和 HCC 复发（HR = 2.031，P = 0.006）的独立危险因素。