Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Clinical Trial Planning and Management, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg Oncol. 2019 Oct;26(11):3727-3735. doi: 10.1245/s10434-019-07616-0. Epub 2019 Jul 16.
Skeletal muscle loss during the early postoperative period frequently occurs during post-esophagectomy. Preoperative sarcopenia is a known prognostic factor. However, the prognostic significance of postoperative skeletal muscle loss remains unclear. This study was designed to clarify the impact of skeletal muscle loss during the early postoperative period on the prognosis of elderly patients undergoing esophagectomy.
We included 316 patients (age ≥ 65 years) who underwent esophagectomy. The skeletal muscle index (SMI) at the third lumber vertebra's bottom level was measured using computed tomography (CT) before surgery and 4 months after surgery. The SMI reduction rate, patient's prognosis, and recurrence rates were evaluated.
The SMI reduction rates in tertiles were < 1.25% in the first tertile (t1, n = 105), between 1.25 and 9.13% in the second tertile (t2, n = 106), and > 9.13% in the third tertile (t3, n = 105). Both relapse-free survival (RFS) and overall survival (OS) in t3 were significantly worse than those in t1 and t2 (p < 0.001). Therefore, we defined t3 as the massive reduction (MR) group and t1 and t2 as the limited reduction (LR) group. By univariate analysis, both RFS and OS were significantly poorer in the MR group than in LR. By multivariate analysis, the massive skeletal muscle loss during the early postoperative period was an independent factor for both RFS and OS.
Early postoperative skeletal muscle loss predicts both recurrence and poor survival.
食管癌术后早期常发生骨骼肌丢失。术前肌少症是已知的预后因素。然而，术后骨骼肌丢失的预后意义尚不清楚。本研究旨在阐明术后早期骨骼肌丢失对接受食管癌切除术的老年患者预后的影响。
我们纳入了 316 名（年龄≥65 岁）接受食管癌切除术的患者。使用计算机断层扫描（CT）术前和术后 4 个月测量第三腰椎底部的骨骼肌指数（SMI）。评估 SMI 减少率、患者预后和复发率。
第 1 三分位数（t1，n=105）的 SMI 减少率<1.25%，第 2 三分位数（t2，n=106）的 SMI 减少率在 1.25%至 9.13%之间，第 3 三分位数（t3，n=105）的 SMI 减少率>9.13%。t3 的无复发生存率（RFS）和总生存率（OS）均明显低于 t1 和 t2（p<0.001）。因此，我们将 t3 定义为大量减少（MR）组，t1 和 t2 定义为有限减少（LR）组。通过单因素分析，MR 组的 RFS 和 OS 均明显差于 LR 组。通过多因素分析，术后早期骨骼肌大量丢失是 RFS 和 OS 的独立因素。
术后早期骨骼肌丢失预测复发和生存不良。
