Zhuang Cheng-Le, Shen Xian, Zou Hong-Bo, Dong Qian-Tong, Cai Hui-Yang, Chen Xiao-Lei, Yu Zhen, Wang Su-Lin
Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China.
Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
Clin Nutr. 2020 Jul;39(7):2301-2310. doi: 10.1016/j.clnu.2019.10.024. Epub 2019 Nov 5.
In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) reached a consensus on sarcopenia (EWGSOP1). In 2018, the EWGSOP met again (EWGSOP2) to update original definition of sarcopenia. This study aimed to investigate the association of sarcopenia and survival and compare the prognostic effects of sarcopenia as defined by EWGSOP1 and EWGSOP2 after gastrectomy.
We conducted a prospective study including patients who underwent curative gastrectomy for gastric cancer from August 2014 to February 2018. The sarcopenia elements, including skeletal muscle index, muscle attenuation, handgrip strength, and gait speed were measured before surgery. Patients were followed up after gastrectomy to gain the actual clinical outcomes.
The prevalence of sarcopenia was 17.0% and 18.9% according to the EWGSOP1 and EWGSOP2 respectively. Sarcopenia was independent risk factor for postoperative complications. Compared with EWGSOP1-sarcopenia, EWGSOP2-sarcopenia and had a higher odds ratio (OR) (2.453 vs. 1.550) in multivariate model. Area under the ROC curve of model including EWGSOP2-sarcopenia was larger than that of the model including EWGSOP1-sarcopenia (AUC 0.653 vs. 0.634, P = 0.021). For both of EWGSOP1 and EWGSOP2, sarcopenia was an independent risk factor for overall survival (OS) and disease-free survival (DFS), but EWGSOP2-sarcopenia seemed to have a higher hazard ratio (OS, 1.667 vs. 1.449; DFS, 1.603 vs. 1.563). In addition, severe sarcopenia, as defined by either EWGSOP2 or EWGSOP1, had a strong predictive power (OR 4.909 vs. 3.827) for postoperative complications. Both versions of severe sarcopenia were significantly predictive of OS and DFS in Cox analysis.
Sarcopenia at uniform diagnosis standard was an independent risk factor for survival in patients undergoing radical gastrectomy for gastric cancer. Sarcopenia defined by EWGSOP2 criteria better predicts clinical outcomes than that defined by EWGSOP1 criteria in patients with gastric cancer after gastrectomy.
2010年，欧洲老年人肌少症工作组（EWGSOP）就肌少症达成了共识（EWGSOP1）。2018年，EWGSOP再次召开会议（EWGSOP2）以更新肌少症的原始定义。本研究旨在调查肌少症与生存率之间的关联，并比较EWGSOP1和EWGSOP2所定义的肌少症在胃癌根治术后的预后效果。
我们进行了一项前瞻性研究，纳入了2014年8月至2018年2月期间接受胃癌根治性胃切除术的患者。在手术前测量肌少症相关指标，包括骨骼肌指数、肌肉衰减、握力和步速。胃切除术后对患者进行随访以获取实际临床结果。
根据EWGSOP1和EWGSOP2，肌少症的患病率分别为17.0%和18.9%。肌少症是术后并发症的独立危险因素。在多变量模型中，与EWGSOP1定义的肌少症相比，EWGSOP2定义的肌少症具有更高的比值比（OR）（2.453对1.550）。包含EWGSOP2定义的肌少症的模型的ROC曲线下面积大于包含EWGSOP1定义的肌少症的模型（AUC 0.653对0.634，P = 0.021）。对于EWGSOP1和EWGSOP2而言，肌少症都是总生存期（OS）和无病生存期（DFS）的独立危险因素，但EWGSOP2定义的肌少症似乎具有更高的风险比（OS，1.667对1.449；DFS，1.603对1.563）。此外，EWGSOP2或EWGSOP1所定义的重度肌少症对术后并发症具有较强的预测能力（OR 4.909对3.827）。在Cox分析中，两种版本的重度肌少症均对OS和DFS具有显著预测作用。
统一诊断标准下的肌少症是接受胃癌根治性胃切除术患者生存的独立危险因素。在胃癌胃切除术后患者中，EWGSOP2标准定义的肌少症比EWGSOP1标准定义的肌少症能更好地预测临床结局。
