Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of Alberta, 2D4.1 WMC, 8440 -112 St., Edmonton, AB, T6G 2B7, Canada.
School of Public Health, University of Alberta, Edmonton, AB, Canada.
World J Surg. 2019 Oct;43(10):2518-2526. doi: 10.1007/s00268-019-05054-3.
Sarcopenia at time of diagnosis predicts worse survival outcomes. It is currently unknown how changes in muscle mass over time interact with sarcopenia in colorectal patients treated with curative intent. Objectives of this study were to quantify sarcopenia and skeletal muscle loss from time of diagnosis to end of surveillance and determine its effect on survival outcomes after completion of 2 years of surveillance.
Retrospective cohort study of stage I-III colorectal cancer patients from 2007-2009, who underwent resection and had preoperative and 2-year surveillance computed tomography scans, without recurrence during that time. Body composition analysis was done at both time points to determine lumbar skeletal muscle index, radiodensity and adiposity. Change over time was standardized as a percentage per year. Cox proportional hazard regression modeling was used for survival analysis.
Of 667 patients included, median survival from surgery was 7.96 years, with 75 recurrences occurring after 2 years. On average patients lost muscle mass (-0.415%/year; CI -0.789, -0.042) and radiodensity (-5.76 HU/year; CI -6.74, -4.80), but gained total adipose tissue (7.06%/year; CI 4.34, 9.79). Patients with sarcopenia at diagnosis (HR 1.80; CI 1.13, 2.85) or muscle loss over time (HR 1.55; CI 1.01, 2.37) had worse overall survival, with significantly worse joint effect (HR 2.73; CI 1.32, 5.65).
Sarcopenia at diagnosis combined with ongoing skeletal muscle loss over time resulted in significantly worse survival. Patients with these features who are recurrence-free at 2 years are more likely to have a non-colorectal cancer cause of death.
诊断时的肌肉减少症预测预后更差。目前尚不清楚随着时间的推移肌肉质量的变化与接受根治性治疗的结直肠患者的肌肉减少症之间如何相互作用。本研究的目的是量化从诊断到结束监测期间的肌肉减少症和骨骼肌丢失，并确定其对 2 年监测完成后生存结果的影响。
回顾性队列研究了 2007-2009 年接受手术且术前和 2 年监测有计算机断层扫描的 I-III 期结直肠癌患者，在此期间没有复发。在这两个时间点进行身体成分分析以确定腰椎骨骼肌指数、放射密度和脂肪含量。随时间的变化以每年的百分比表示。使用 Cox 比例风险回归模型进行生存分析。
在 667 名患者中，手术中位生存时间为 7.96 年，2 年后有 75 例复发。平均而言，患者的肌肉质量减少（-0.415%/年；CI-0.789，-0.042）和放射密度减少（-5.76 HU/年；CI-6.74，-4.80），但总脂肪组织增加（7.06%/年；CI 4.34，9.79）。诊断时患有肌肉减少症（HR 1.80；CI 1.13，2.85）或随时间肌肉丢失（HR 1.55；CI 1.01，2.37）的患者总体生存率较差，联合效应显著（HR 2.73；CI 1.32，5.65）。
诊断时的肌肉减少症加上随时间推移的骨骼肌持续丢失导致生存率显著降低。在 2 年内无复发的具有这些特征的患者更有可能死于非结直肠癌原因。
