Wang Pei-Yu, Xu Li-Dong, Chen Xian-Kai, Xu Lei, Yu Yong-Kui, Zhang Rui-Xiang, Sun Hai-Bo, Wu Hui-Li, Li Yin
Department of Gastroenterology, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, Henan, China.
Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Surg Oncol. 2020 Aug;27(8):3041-3051. doi: 10.1245/s10434-020-08236-9. Epub 2020 Feb 10.
This meta-analysis aimed to investigate the value of preoperative sarcopenia in predicting complications after esophagectomy. Clinicopathologic characteristics of sarcopenia patients, which may support sarcopenia management, also were studied.
This study searched for articles describing an association between sarcopenia and short-term outcomes after esophagectomy using PubMed, EMBASE, and the Cochrane Library. Mantel-Haenszel and inverse variance models were used for the meta-analyses of end points.
The meta-analysis included 14 studies comprising a total of 2387 patients. Sarcopenia was significantly associated with advanced age (weighted mean difference [WMD], 3.48; 95% confidence interval [CI], 2.22-4.74), lower body mass index (WMD - 2.22; 95% CI - 2.65 to - 1.79), squamous cell carcinoma (odds ratio [OR], 2.78; 95% CI 1.72-4.47), advanced clinical tumor stage (OR 1.65; 95% CI 1.28-2.15), and neoadjuvant therapy (OR 1.87; 95% CI 1.38-2.53). The sarcopenia patients showed lower preoperative albumin levels (WMD - 0.11; 95% CI - 0.19 to - 0.04) than the nonsarcopenia patients. Sarcopenia was significantly predictive of pneumonia (OR 2.58; 95% CI 1.75-3.81) and overall complications (OR 1.52; 95% CI 1.07-2.15) after esophagectomy. The sarcopenia patients also showed nonsignificant increases in the risks of anastomotic leakage (OR 1.29; 95% CI 0.99-1.67), vocal cord palsy (OR 2.03; 95% CI 0.89-4.64), and major complications (≥ Clavien-Dindo grade III; OR 1.30; 95% CI 0.95-1.79) but not increased operation time, blood loss, or mortality.
Preoperative sarcopenia assessment showed considerable potential for predicting postoperative complications for esophageal cancer patients. To realize this potential, more effective diagnostic criteria and severity classifications for sarcopenia are warranted.
本荟萃分析旨在研究术前肌肉减少症在预测食管癌切除术后并发症方面的价值。还研究了可能有助于肌肉减少症管理的肌肉减少症患者的临床病理特征。
本研究使用PubMed、EMBASE和Cochrane图书馆检索描述肌肉减少症与食管癌切除术后短期结局之间关联的文章。采用Mantel-Haenszel和逆方差模型对终点进行荟萃分析。
该荟萃分析纳入了14项研究，共2387例患者。肌肉减少症与高龄显著相关（加权平均差[WMD]，3.48；95%置信区间[CI]，2.22 - 4.74）、较低的体重指数（WMD -2.22；95% CI -2.65至-1.79）、鳞状细胞癌（比值比[OR]，2.78；95% CI 1.72 - 4.47）、晚期临床肿瘤分期（OR 1.65；95% CI 1.28 - 2.15）和新辅助治疗（OR 1.87；95% CI 1.38 - 2.53）。肌肉减少症患者术前白蛋白水平低于非肌肉减少症患者（WMD -0.11；95% CI -0.19至-0.04）。肌肉减少症是食管癌切除术后肺炎（OR 2.58；95% CI 1.75 - 3.81）和总体并发症（OR 1.52；95% CI 1.07 - 2.15）的显著预测因素。肌肉减少症患者吻合口漏（OR 1.29；95% CI 0.99 - 1.67）、声带麻痹（OR 2.03；95% CI 0.89 - 4.64）和主要并发症（≥Clavien-Dindo III级；OR 1.30；95% CI 0.95 - 1.79）的风险也有非显著增加，但手术时间、失血量或死亡率未增加。
术前肌肉减少症评估在预测食管癌患者术后并发症方面显示出相当大的潜力。为了实现这一潜力，需要更有效的肌肉减少症诊断标准和严重程度分类。
