Hu Chun-Lei, Jin Xing-Han, Yuan Zhi-Dong, Xiong Shao-Wei, Zhang Lin, Hou Jia-Ning, Ao Sheng, Wu Jian-Long, Shi Han-Ping, Ji Jia-Fu, Lyv Guo-Qing
Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen Peking University- The Hong Kong University of Science and Technology Medical Center, China.
Department of Radiology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, China.
Asia Pac J Clin Nutr. 2019;28(3):442-449. doi: 10.6133/apjcn.201909_28(3).0003.
The association between skeletal muscle status and gastric cancer (GC) prognosis remains unclear. Here, we investigated the impact of the skeletal muscle index (SMI) on overall survival (OS) in GC patients after radical gastrectomy.
We divided 178 patients into four groups: adult men, adult women, elderly men and elderly women. The SMI, calculated using CT images, of patients was graded using cutoff values of group-specific tertiles. Age, body mass index, SMI grade, Charlson comorbidity index, surgical method (total vs distal gastrectomy), tumor stage, and histological type and differentiation were included in Cox regression models to assess the primary outcome parameter of OS. A new prognostic score for 3- year OS was established by combining the SMI grade and tumor stage, and receiver operating characteristic (ROC) curve analyses were used to determine its predictive reliability.
For groups with high, medium, and low SMI grades, the 3-year OS rates were 94.04, 79.08 and 59.09% and 86.09, 70.11 and 49.11% (p<0.001) in patients undergoing distal and total gastrectomy, respectively. In the multivariate analysis, low SMI (hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.14-2.9), advanced stage (HR 2.89, 95% CI 1.43-5.83), and total gastrectomy (HR 1.69, 95% CI 0.95-3.01) were independent risk factors for OS (p<0.010). The areas under the ROC curves for the prognostic score were 0.77 (range 0.61-0.93) and 0.76 (range 0.65-0.86) in patients undergoing distal and total gastrectomy, respectively.
The preoperative SMI was an independent prognostic factor for long-term survival in GC patients after radical gastrectomy.
骨骼肌状态与胃癌（GC）预后之间的关联尚不清楚。在此，我们研究了骨骼肌指数（SMI）对根治性胃切除术后GC患者总生存期（OS）的影响。
我们将178例患者分为四组：成年男性、成年女性、老年男性和老年女性。使用CT图像计算患者的SMI，并根据特定组三分位数的临界值对其进行分级。年龄、体重指数、SMI分级、Charlson合并症指数、手术方式（全胃切除术与远端胃切除术）、肿瘤分期以及组织学类型和分化程度被纳入Cox回归模型，以评估OS的主要结局参数。通过结合SMI分级和肿瘤分期建立了一个新的3年OS预后评分，并使用受试者工作特征（ROC）曲线分析来确定其预测可靠性。
对于SMI分级高、中、低的组，在接受远端和全胃切除术的患者中，3年OS率分别为94.04%、79.08%和59.09%以及86.09%、70.11%和49.11%（p<0.001）。在多变量分析中，低SMI（风险比（HR）1.82，95%置信区间（CI）1.14 - 2.9）、晚期（HR 2.89，95% CI 1.43 - 5.83）和全胃切除术（HR 1.69，95% CI 0.95 - 3.01）是OS的独立危险因素（p<0.010）。在接受远端和全胃切除术的患者中，预后评分的ROC曲线下面积分别为0.77（范围0.61 - 0.93）和0.76（范围0.65 - 0.86）。
术前SMI是根治性胃切除术后GC患者长期生存的独立预后因素。
