Department of General Surgery, Faculty of Medicine, Dokuz Eylul University, Balcova, Izmir, Turkey.
Department of General Surgery, Faculty of Medicine, Medipol University, Istanbul, Turkey.
Tech Coloproctol. 2020 Apr;24(4):301-308. doi: 10.1007/s10151-020-02159-z. Epub 2020 Feb 21.
The aim of this study was to evaluate the prognostic value of preoperative sarcopenia with regard to postoperative morbidity and long-term survival in patients with peritoneal metastasis from colorectal cancer treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
A longitudinal cohort study was conducted on patients with peritoneal metastases of colorectal origin treated with CRS-HIPEC between 2008 and 2018. Data on patient demographics, body mass index, operative characteristics, perioperative morbidity and survivorship status and oncological follow-up were obtained from the hospital registry. Sarcopenia was assessed using preoperative computed tomography (CT) findings.
Sixty-five patients [mean (SD) age: 54.4 (13.4) years, 64.6% females] were included in the study. Sarcopenia was evident in 30.8% of patients, while mortality rate was 66.2% with median survival time of 33.6 months. Presence of sarcopenia was associated with older age (59.6 (9.2) vs. 52.1 (14.4) years, p = 0.038), higher likelihood of morbidity (70.0% vs. 35.6%, p = 0.015) and mortality (90.0% vs. 55.6%, p = 0.010) and shorter survival time (17.7 vs. 37.9 months, p = 0.005). Cox regression analysis revealed that the presence of sarcopenia (HR 2.245, 95% CI 0.996-5.067, p = 0.050) was a significant predictor of increased likelihood of mortality.
Preoperative sarcopenia is an independent prognostic factor of postoperative morbidity and shorter survival in CRC peritoneal metastasis patients treated with CRS-HIPEC. Our findings support the importance of preoperative screening for sarcopenia as part of preoperative risk assessment for better selection of CRS-HIPEC candidates or treatment modifications in CRC patients with peritoneal metastasis.
本研究旨在评估术前骨骼肌减少症对接受细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）治疗的结直肠癌腹膜转移患者术后发病率和长期生存的预后价值。
对 2008 年至 2018 年间接受 CRS-HIPEC 治疗的结直肠来源腹膜转移患者进行了一项纵向队列研究。从医院登记处获得患者人口统计学、体重指数、手术特征、围手术期发病率和生存状态以及肿瘤随访数据。使用术前计算机断层扫描（CT）结果评估骨骼肌减少症。
研究纳入 65 例患者[平均（标准差）年龄：54.4（13.4）岁，64.6%为女性]。30.8%的患者存在骨骼肌减少症，死亡率为 66.2%，中位生存时间为 33.6 个月。存在骨骼肌减少症与年龄较大（59.6（9.2）比 52.1（14.4）岁，p=0.038）、发病率较高（70.0%比 35.6%，p=0.015）和死亡率较高（90.0%比 55.6%，p=0.010）以及生存时间较短（17.7 比 37.9 个月，p=0.005）相关。Cox 回归分析显示，存在骨骼肌减少症（HR 2.245，95%CI 0.996-5.067，p=0.050）是死亡率增加的显著预测因素。
术前骨骼肌减少症是接受 CRS-HIPEC 治疗的结直肠癌腹膜转移患者术后发病率和生存时间较短的独立预后因素。我们的研究结果支持术前筛查骨骼肌减少症作为术前风险评估的一部分的重要性，以更好地选择 CRS-HIPEC 候选者或对腹膜转移的结直肠癌患者进行治疗修改。
