Boshier P R, Heneghan R, Markar S R, Baracos V E, Low D E
Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Centre, Seattle, USA.
Department of Surgery and Cancer, Imperial College London, UK.
Dis Esophagus. 2018 Aug 1;31(8). doi: 10.1093/dote/doy047.
There has recently been increased interest in the assessment of body composition in patients with esophageal cancer for the purpose of nutritional evaluation and prognostication. This systematic review and meta-analysis intends to summarize and critically evaluate the current literature concerning the assessment of body composition in patients with esophageal cancer and to assess its potential implication upon early and late outcomes. A systematic literature search (up to August, 2017) was conducted for studies describing the assessment of body composition in patients with esophageal and gastroesophageal junctional cancer. Meta-analysis of postoperative outcomes including long-term survival was performed using random effects models. Twenty-nine studies reported the assessment of body composition in 3193 patients. Methods used to assess body composition in patients with esophageal cancer included computerized tomography (n = 18 studies), bioelectrical impedance analysis (n = 10), and dual-energy X-ray absorptiometry (n = 1). Significant variability was observed in regard to study design and the criteria used to define individual parameters of body composition. Sarcopenic patients had a higher incidence of postoperative pulmonary complications (7 studies, OR 2.03, 95% CI 1.32-3.11, P = 0.001) after esophagectomy. Meta-analysis of six studies presenting long-term outcomes after esophagectomy identified significantly worse survival in patients who were sarcopenic (HR 1.70, 95% CI 1.33- 2.17, P < 0.0001). The assessment of body composition has the potential to become a clinically useful tool that could support decision-making in patients with esophageal cancer. Current evidence is however weakened by inconsistencies in methods of assessing and reporting body composition in this patient group.
最近，为了进行营养评估和预后判断，对食管癌患者身体成分评估的兴趣有所增加。本系统评价和荟萃分析旨在总结并批判性评价目前有关食管癌患者身体成分评估的文献，并评估其对早期和晚期结局的潜在影响。我们进行了一项系统的文献检索（截至2017年8月），以查找描述食管和胃食管交界癌患者身体成分评估的研究。使用随机效应模型对包括长期生存在内的术后结局进行荟萃分析。29项研究报告了对3193例患者的身体成分评估。用于评估食管癌患者身体成分的方法包括计算机断层扫描（18项研究）、生物电阻抗分析（10项）和双能X线吸收法（1项）。在研究设计和用于定义身体成分各个参数的标准方面观察到显著差异。肌少症患者在食管切除术后发生肺部并发症的发生率更高（7项研究，OR 2.03，95%CI 1.32 - 3.11，P = 0.001）。对六项报告食管切除术后长期结局的研究进行的荟萃分析发现，肌少症患者生存率显著更差（HR 1.70，95%CI 1.33 - 2.17，P < 0.0001）。身体成分评估有可能成为一种临床有用的工具，可为食管癌患者的决策提供支持。然而，目前的证据因该患者群体身体成分评估和报告方法的不一致而受到削弱。
