Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Clin Nutr. 2019 Dec;38(6):2881-2888. doi: 10.1016/j.clnu.2018.12.025. Epub 2018 Dec 29.
BACKGROUND & AIMS: Sarcopenia has been widely recognized as an important predictor of poor outcomes in patients with cancer after surgery, but the controversy remains, and its impact on surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer is poorly described. The aim of this study was to evaluate the prognostic impact of sarcopenia on surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer.
Six thousand four hundred and forty-seven consecutive patients who underwent abdominal surgery for digestive tract cancer in our institution were prospectively included. Sarcopenia was defined as skeletal muscle index below the lowest sex-specific quartile using computed tomography scan at L3 before surgery. The surgical and oncologic outcomes were recorded, and univariate and multivariate analyses were performed.
Sarcopenia was present in 1638 of 6447 patients (25.4%) with digestive tract cancer before surgery based on the diagnostic cut-off values (43.13 cm/m for men and 37.81 cm/m for women). The incidence of postoperative total and pulmonary complications, and 30-day readmission were significantly higher in sarcopenic group than in nonsarcopenic group (37.4% vs 12.9%, P < 0.001; 3.1% vs 2.1%, P = 0.026; 1.1% vs 0.4%, P = 0.003, respectively). The postoperative hospital stay was significantly longer in sarcopenic patients (9.42 ± 3.40 vs 8.51 ± 3.17 days, P < 0.001). There were significantly more patients receiving postoperative chemotherapy or radiotherapy in sarcopenic group than in nonsarcopenic group (73.1% vs 69.2%, P = 0.003; 10.6% vs 8.8%, P = 0.038, respectively), and patients with sarcopenia had significantly more chemotherapy modifications including delay, dose reduction, or termination (48.5% vs 44.2%, P = 0.018). In addition, during the follow-up period, sarcopenic patients had significantly lower rate of overall survival and disease-free survival than nonsarcopenic patients (53.9% vs 69.3%, P = 0.002; 36.8% vs 59.7%, P = 0.000, respectively). In multivariate analysis, sarcopenia was found to be a risk factor for postoperative complications [odds ratio (OR) = 5.418, 95% confidence interval (CI) = 2.986-9.828, P < 0.001], and was an unfavorable prognostic factor for poor overall survival [hazard ratio (HR) = 0.649, 95% CI = 0.426-0.991, P = 0.045] and disease-free survival (HR = 0.514, 95% CI = 0.348-0.757, P = 0.001).
Sarcopenia could be used as a strong and independent prognostic factor for poor surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer. Identification of preoperative sarcopenia in digestive surgery for cancer and targeted approaches may improve its negative outcomes.
肌肉减少症已被广泛认为是癌症患者手术后不良结局的重要预测指标，但仍存在争议，其对消化道癌腹部手术后手术和肿瘤学结局的影响描述甚少。本研究旨在评估肌肉减少症对消化道癌腹部手术后患者手术和肿瘤学结局的预后影响。
前瞻性纳入我院 6447 例接受消化道癌腹部手术的连续患者。术前使用 CT 扫描在 L3 水平测量骨骼肌指数，低于最低性别特异性四分位数定义为肌肉减少症。记录手术和肿瘤学结局，并进行单因素和多因素分析。
根据诊断截止值（男性 43.13 cm/m，女性 37.81 cm/m），6447 例消化道癌患者中术前存在肌肉减少症的患者为 1638 例（25.4%）。肌肉减少症组的术后总并发症和肺部并发症发生率以及 30 天再入院率明显高于非肌肉减少症组（37.4%比 12.9%，P < 0.001；3.1%比 2.1%，P = 0.026；1.1%比 0.4%，P = 0.003）。肌肉减少症患者的术后住院时间明显延长（9.42 ± 3.40 比 8.51 ± 3.17 天，P < 0.001）。肌肉减少症组术后接受化疗或放疗的患者明显多于非肌肉减少症组（73.1%比 69.2%，P = 0.003；10.6%比 8.8%，P = 0.038），且肌肉减少症患者的化疗方案调整包括延迟、剂量减少或终止的比例明显更高（48.5%比 44.2%，P = 0.018）。此外，在随访期间，肌肉减少症组的总生存率和无病生存率明显低于非肌肉减少症组（53.9%比 69.3%，P = 0.002；36.8%比 59.7%，P = 0.000）。多因素分析发现，肌肉减少症是术后并发症的危险因素（比值比[OR] = 5.418，95%置信区间[CI] = 2.986-9.828，P < 0.001），也是总生存率和无病生存率不良的预后因素（风险比[HR] = 0.649，95%CI = 0.426-0.991，P = 0.045；HR = 0.514，95%CI = 0.348-0.757，P = 0.001）。
肌肉减少症可作为消化道癌腹部手术后不良手术和肿瘤学结局的一个强有力且独立的预后因素。在癌症消化道手术中识别术前肌肉减少症并采取针对性方法可能会改善其不良结局。
