First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland.
Department of Radiology, Jagiellonian University Medical College, Krakow, Poland.
J Surg Oncol. 2019 Sep;120(3):473-482. doi: 10.1002/jso.25509. Epub 2019 May 23.
Sarcopenia is highly prevalent in patients with gastrointestinal malignancies, including gastric cancer, but there is a lack of adequate data from Western populations.
Computed tomography scans of 138 Caucasian patients subject to stomach resections due to gastric adenocarcinoma between 2012 and 2015 were reviewed to evaluate the impact of sarcopenia. The definition of sarcopenia was based on the lumbar skeletal muscle index (SMI) using cut-off values formulated by the international consensus definitions of sarcopenia (SMI <52.4 cm /m for men and <38.5 cm /m for women).
Sixty (43%) of 138 patients were sarcopenic. Sarcopenia was associated with postoperative morbidity (43% vs 23%; P = .011), major postoperative complications (Clavien-Dindo ≥3a; 36% vs 21%; P = .035), and reoperations (23% vs 9%; P = .020). Patients with sarcopenia also had prolonged postoperative hospital stay (8.0 vs 6.5 days; P = .010). The overall median survival of patients with sarcopenia was significantly lower than those with normal skeletal muscles (11.0 vs 36.7 months; P = .005) and sarcopenia remained an independent prognostic factor with an odds ratio of 1.94 (95% confidence interval, 1.08 to 3.48; P = .026).
Sarcopenia, defined by SMI, is associated with an increased risk of postoperative morbidity and impaired long-term survival.
包括胃癌在内的胃肠道恶性肿瘤患者中，肌肉减少症的患病率很高，但西方人群缺乏足够的数据。
回顾了 2012 年至 2015 年间因胃腺癌接受胃切除术的 138 例白种人患者的计算机断层扫描，以评估肌肉减少症的影响。肌肉减少症的定义是基于腰椎骨骼肌指数（SMI），采用国际肌肉减少症共识定义制定的截断值（男性 SMI <52.4 cm / m，女性 SMI <38.5 cm / m）。
138 例患者中 60 例（43%）存在肌肉减少症。肌肉减少症与术后发病率（43% vs 23%；P = 0.011）、主要术后并发症（Clavien-Dindo ≥3a；36% vs 21%；P = 0.035）和再次手术（23% vs 9%；P = 0.020）有关。肌肉减少症患者的术后住院时间也较长（8.0 天 vs 6.5 天；P = 0.010）。肌肉减少症患者的总体中位生存时间明显低于骨骼肌正常患者（11.0 个月 vs 36.7 个月；P = 0.005），且肌肉减少症仍然是一个独立的预后因素，优势比为 1.94（95%置信区间，1.08 至 3.48；P = 0.026）。
SMI 定义的肌肉减少症与术后发病率增加和长期生存受损相关。
