Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Colorectal Dis. 2019 May;21(5):538-547. doi: 10.1111/codi.14558. Epub 2019 Feb 4.
Sarcopenia is a robust prognostic indicator of outcomes after surgery for colorectal cancer (CRC). However, there are no serum markers routinely available for estimating skeletal muscle mass (SMM). The present study aimed to describe a new sarcopenia index (SI), serum creatinine (Scr) × cystatin C-based glomerular filtration rate, and investigate its association with short-term complications after curative resection of CRC.
Consecutive patients who underwent curative resection of CRC from December 2011 to January 2017 were retrospectively identified. Skeletal muscle cross-sectional area was analysed on L3 computed tomographic images. Receiver operating characteristic curve analysis showed that the cutoff points of SI for sarcopenia were below 56.1 in men and below 43.7 in women. Patients were classified into low and high SI groups in accordance with these cutoff values. The association between SI and body composition and the impact of preoperative SI on postoperative outcomes were analysed.
Among 417 patients, SI showed a stronger correlation with skeletal muscle area (SMA) (r = 0.537, P < 0.001) than with the Scr/cystatin C ratio (r = 0.469, P < 0.001) and Scr (r = 0.447, P < 0.001). The low SI group had a lower SMA, lower preoperative haemoglobin, a higher prevalence of sarcopenia and experienced more postoperative complications compared with the high SI group (all P < 0.001). Multivariate logistic regression analysis showed that the independent risk factors for overall complications were low preoperative haemoglobin, low SI, sarcopenia and American Society of Anesthesiologists grade ≥ 3.
This new SI is a simple and useful surrogate marker for estimating SMM, and is associated with outcomes after CRC surgery.
肌肉减少症是结直肠癌（CRC）手术后结局的一个强有力的预后指标。然而，目前尚无用于估计骨骼肌量（SMM）的常规血清标志物。本研究旨在描述一种新的肌减少症指数（SI），即血清肌酐（Scr）×胱抑素 C 估算的肾小球滤过率，并探讨其与 CRC 根治性切除术后短期并发症的关系。
回顾性分析 2011 年 12 月至 2017 年 1 月期间接受 CRC 根治性切除术的连续患者。在 L3 计算机断层扫描图像上分析骨骼肌横截面积。受试者工作特征曲线分析显示，男性肌减少症 SI 的截断点低于 56.1，女性低于 43.7。根据这些截断值，患者被分为低 SI 组和高 SI 组。分析了 SI 与身体成分的关系，以及术前 SI 对术后结局的影响。
在 417 例患者中，SI 与骨骼肌面积（SMA）的相关性（r=0.537，P<0.001）强于与 Scr/胱抑素 C 比值（r=0.469，P<0.001）和 Scr（r=0.447，P<0.001）。低 SI 组的 SMA 较低，术前血红蛋白较低，肌减少症的患病率较高，术后并发症较多（均 P<0.001）。多变量 logistic 回归分析显示，总体并发症的独立危险因素为术前血红蛋白低、SI 低、肌减少症和美国麻醉医师协会分级≥3 级。
这种新的 SI 是一种简单而有用的 SMM 估计替代标志物，与 CRC 手术后的结局相关。
