Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Ann Thorac Surg. 2020 Aug;110(2):374-382. doi: 10.1016/j.athoracsur.2020.03.013. Epub 2020 Apr 9.
Although both sarcopenia and systemic inflammation reportedly affect long-term outcomes of esophageal carcinoma (EC) patients, their reciprocal associations with survival outcomes have yet to be investigated. This study aimed to evaluate the survival impact of sarcopenia combined with the neutrophil-to-lymphocyte ratio (NLR) in EC patients undergoing esophagectomy.
In total, 378 EC patients were retrospectively reviewed. The cutoff value for NLR was set at the NLR median of the cohort. Sarcopenia was determined based on decreased skeletal muscle index calculated from computed tomography obtained before surgery. Univariate and multivariate Cox hazards models were applied to determine independent predictors of poor overall survival and cancer-specific survival.
Sarcopenia was more common in the high-NLR group (2.57 or greater) than in the low-NLR group (less than 2.57; P = .01). In the high-NLR group, patients with sarcopenia had significantly poorer overall and cancer-specific survival than those without sarcopenia (P < .001). In contrast, there was no survival impact of sarcopenia in the low-NLR group. Patients with both high NLR and sarcopenia exhibited poor overall and cancer-specific survival (5-year overall survival = 44.4%, 5-year cancer-specific survival = 57.0%). Sarcopenia was independently associated with poor overall survival (hazard ratio = 1.95; P = .007) and poor cancer-specific survival (hazard ratio = 2.66; P = .002) as well as pathological stage III disease and noncurative resection in the high-NLR group.
The survival and oncological impact of sarcopenia was noteworthy only when present with elevated NLR. The combination of 2 factors is rational for identifying EC patients likely to have poor survival outcomes.
据报道，肌少症和全身炎症均会影响食管癌（EC）患者的长期预后，但两者与生存结局的相互关系尚未得到研究。本研究旨在评估接受食管癌切除术的 EC 患者中肌少症与中性粒细胞与淋巴细胞比值（NLR）联合对生存的影响。
共回顾性分析了 378 例 EC 患者。NLR 的截断值设定为队列的 NLR 中位数。肌少症根据术前 CT 计算得出的骨骼肌指数降低来确定。采用单因素和多因素 Cox 风险模型确定总生存和癌症特异性生存的独立预测因素。
在高 NLR 组（2.57 或更高）中，肌少症更为常见，而在低 NLR 组（小于 2.57）中则少见（P =.01）。在高 NLR 组中，有肌少症的患者总生存和癌症特异性生存明显差于无肌少症的患者（P <.001）。相反，在低 NLR 组中，肌少症对生存没有影响。同时存在高 NLR 和肌少症的患者总生存和癌症特异性生存较差（5 年总生存率为 44.4%，5 年癌症特异性生存率为 57.0%）。在高 NLR 组中，肌少症与总生存不良（风险比=1.95；P =.007）和癌症特异性生存不良（风险比=2.66；P =.002）以及病理分期 III 期疾病和非治愈性切除独立相关。
仅当存在 NLR 升高时，肌少症的生存和肿瘤学影响才值得关注。这两个因素的结合合理地识别出可能生存结局较差的 EC 患者。
