Zhang Y, Wang J P, Wang X L, Tian H, Gao T T, Tang L M, Tian F, Wang J W, Zheng H J, Zhang L, Gao X J, Li G L, Wang X Y
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R.C.
Department of Cardiothoracic Surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R.C.
Curr Oncol. 2018 Oct;25(5):e411-e422. doi: 10.3747/co.25.4014. Epub 2018 Oct 31.
Malnutrition is a common and critical problem that influences outcome in cancer patients. Body composition reflects a patient's metabolic profile and physiologic reserves, which might be the true determinant of prognosis. In the present study, which aimed to identify valuable new prognostic indicators, we investigated the association between computed tomography-quantified body composition and short-term outcomes after gastrectomy for gastric cancer.
Skeletal muscle index, mean muscle attenuation, and ratio of visceral-to-subcutaneous adipose tissue area (vsr) were calculated from preoperative computed tomography images. Low skeletal muscle index, low mean muscle attenuation, and high vsr were respectively termed "sarcopenia," "myosteatosis," and "visceral obesity." The association of body composition with postoperative complications and serum markers of nutrition and inflammation after radical gastrectomy were analyzed.
The overall complication rate was significantly higher in the sarcopenia (62.5% vs. 27.3%, = 0.001) and myosteatosis groups (38.2% vs. 4%, = 0.002). Patients with visceral obesity had a higher incidence of inflammatory complications (20.3% vs. 6.5%, = 0.01). Multivariate logistic regression analysis demonstrated that sarcopenia ( = 0.013), myosteatosis ( = 0.017), and low serum retinol-binding protein ( = 0.019) were independent risk factors for overall complications. Compared with control subjects, patients with sarcopenia had lower postoperative levels of serum retinol-binding protein ( = 0.007), and patients with visceral obesity had higher levels of C-reactive protein ( = 0.026).
Sarcopenia, myosteatosis, and visceral obesity were significantly associated with increased rates of postoperative complications and affected the postoperative nutrition and inflammation status of patients with gastric cancer.
营养不良是影响癌症患者预后的常见且关键的问题。身体组成反映了患者的代谢状况和生理储备，这可能是预后的真正决定因素。在本旨在识别有价值的新预后指标的研究中，我们调查了计算机断层扫描定量的身体组成与胃癌胃切除术后短期预后之间的关联。
从术前计算机断层扫描图像计算骨骼肌指数、平均肌肉衰减以及内脏与皮下脂肪组织面积比（vsr）。低骨骼肌指数、低平均肌肉衰减和高vsr分别被称为“肌肉减少症”、“肌少脂性肥胖”和“内脏肥胖”。分析了身体组成与根治性胃切除术后并发症以及营养和炎症血清标志物之间的关联。
肌肉减少症组（62.5%对27.3%，P = 0.001）和肌少脂性肥胖组（38.2%对4%，P = 0.002）的总体并发症发生率显著更高。内脏肥胖患者炎症并发症的发生率更高（20.3%对6.5%，P = 0.01）。多因素逻辑回归分析表明，肌肉减少症（P = 0.013）、肌少脂性肥胖（P = 0.017）和低血清视黄醇结合蛋白（P = 0.019）是总体并发症的独立危险因素。与对照组相比，肌肉减少症患者术后血清视黄醇结合蛋白水平较低（P = 0.007），内脏肥胖患者C反应蛋白水平较高（P = 0.026）。
肌肉减少症、肌少脂性肥胖和内脏肥胖与术后并发症发生率增加显著相关，并影响胃癌患者术后的营养和炎症状态。
