Kudou Kensuke, Saeki Hiroshi, Nakashima Yuichiro, Kimura Koichi, Ando Koji, Oki Eiji, Ikeda Tetsuo, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Endoscopy and Endoscopic Surgery, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka-shi, Fukuoka, 814-0193, Japan.
World J Surg. 2019 Apr;43(4):1068-1075. doi: 10.1007/s00268-018-4873-6.
The relationship between postoperative changes in muscle mass and the prognosis of malignancies remains controversial. We aimed to determine whether a decrease in skeletal muscle mass after surgical resection can predict long-term outcomes in patients with adenocarcinoma of upper stomach (AUS) and esophagogastric junction (AEGJ).
We reviewed 146 patients who underwent curative surgery for AUS and AEGJ. We assessed the skeletal muscle index pre- and post-surgery and 6 months postoperatively. The rate of decrease in skeletal muscle index (SMI) was calculated and its relationship with clinicopathological factors and prognosis was analyzed.
Among the 146 patients studied, 115 underwent re-assessment of SMI 6 months postoperatively. The mean decrease in SMI was more prominent in patients with recurrence than in those without recurrence (19.0 ± 2.3 vs. 7.4 ± 0.9%, respectively, P < 0.0001). AUS and AEGJ patients with a >19% decrease in SMI showed significantly lower 5-year overall survival and recurrence-free rates than those with a <19% decrease in SMI (recurrence-free survival: 33.4 vs. 89.2%, respectively, P < 0.0001; overall survival: 40.6 vs. 90.0%, respectively, P < 0.0001). Multivariate analyses indicated that a ≥19% decrease in SMI could predict poor overall survival independently in patients with AUS and AEGJ (P = 0.0070).
A ≥19% postoperative decrease in SMI was substantially associated with poor survival in patients with AUS and AEGJ.
术后肌肉量变化与恶性肿瘤预后之间的关系仍存在争议。我们旨在确定手术切除后骨骼肌量减少是否可预测上胃癌（AUS）和食管胃交界癌（AEGJ）患者的长期预后。
我们回顾了146例行AUS和AEGJ根治性手术的患者。我们评估了术前、术后及术后6个月的骨骼肌指数。计算骨骼肌指数（SMI）的下降率，并分析其与临床病理因素及预后的关系。
在研究的146例患者中，115例在术后6个月重新评估了SMI。复发患者的SMI平均下降比未复发患者更显著（分别为19.0±2.3%和7.4±0.9%，P<0.0001）。SMI下降>19%的AUS和AEGJ患者的5年总生存率和无复发生存率显著低于SMI下降<19%的患者（无复发生存率：分别为33.4%和89.2%，P<0.0001；总生存率：分别为40.6%和90.0%，P<0.0001）。多因素分析表明，SMI下降≥19%可独立预测AUS和AEGJ患者的总生存不良（P=0.0070）。
AUS和AEGJ患者术后SMI下降≥19%与生存不良显著相关。
