Miyachi Yosuke, Kaido Toshimi, Yao Siuan, Shirai Hisaya, Kobayashi Atsushi, Hamaguchi Yuhei, Kamo Naoko, Yagi Shintaro, Uemoto Shinji
Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
World J Surg. 2019 Mar;43(3):920-928. doi: 10.1007/s00268-018-4861-x.
We have reported the impact of sarcopenia and body composition on patients undergoing hepatectomy for hepatocellular carcinoma (HCC). However, the impact of bone mineral density (BMD) on outcomes after hepatectomy for HCC and correlation with other parameters including sarcopenia are unclear.
We retrospectively analyzed 465 patients who underwent primary hepatectomy for HCC between April 2005 and March 2015. We analyzed the plain CT images at the level of the eleventh thoracic vertebra with the region of interest and defined as preoperative BMD.
In this cohort, male (n = 367) and female (n = 98) patients showed significant heterogeneity in age, body composition markers, tumor factors, peri-operative parameters and so on. The median preoperative BMD in male and female patients was 155 and 139 HU, respectively (P = 0.005). BMD was negatively correlated with age in female (r = -0.590, P < 0.001) and intramuscular adipose tissue content in both male and female (r = -0.332 and -0.359, respectively, P < 0.001). For males, BMD < 160 HU was associated with worse cancer-specific survival post-hepatectomy (P = 0.015). In contrast, females were not (P = 0.135). For male patients, multivariate analysis identified low BMD as an independent risk factor for death (hazard ratio 1.720, 95% confidence interval 1.038-2.922, P = 0.035) after hepatectomy for HCC.
Preoperative low BMD was an independent risk factor for cancer-specific mortality after hepatectomy for HCC.
我们已经报道了肌肉减少症和身体成分对肝细胞癌（HCC）肝切除患者的影响。然而，骨密度（BMD）对HCC肝切除术后结局的影响以及与包括肌肉减少症在内的其他参数的相关性尚不清楚。
我们回顾性分析了2005年4月至2015年3月期间接受HCC初次肝切除术的465例患者。我们分析了第11胸椎水平的平扫CT图像，并划定感兴趣区域，将其定义为术前骨密度。
在该队列中，男性（n = 367）和女性（n = 98）患者在年龄、身体成分指标、肿瘤因素、围手术期参数等方面存在显著异质性。男性和女性患者术前骨密度的中位数分别为155 HU和139 HU（P = 0.005）。骨密度与女性年龄呈负相关（r = -0.590，P < 0.001），与男性和女性的肌内脂肪组织含量均呈负相关（分别为r = -0.332和-0.359，P < 0.001）。对于男性，骨密度<160 HU与肝切除术后更差的癌症特异性生存率相关（P = 0.015）。相比之下，女性则不然（P = 0.135）。对于男性患者，多变量分析确定低骨密度是HCC肝切除术后死亡的独立危险因素（风险比1.720，95%置信区间1.038 - 2.922，P = 0.035）。
术前低骨密度是HCC肝切除术后癌症特异性死亡的独立危险因素。
