Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
Eur J Surg Oncol. 2020 Dec;46(12):2262-2269. doi: 10.1016/j.ejso.2020.07.032. Epub 2020 Jul 29.
Sarcopenia and metabolic syndrome (MetS) are associated with the prognosis from malignant tumors. However, evidence of the relationship between sarcopenia and MetS among gastric cancer (GC) patients following radical gastrectomy is lacking. This study assessed the association between preoperative sarcopenia and MetS among GC patients and analyzed the prognosis of patients with different malnutrition statuses.
We prospectively assessed the preoperative statuses of sarcopenia and MetS among patients who underwent radical gastrectomy from July 2014 to December 2017. We combined sarcopenia and MetS to generate four groups: MetS-related sarcopenia group (MSS), sarcopenia group (S), MetS group (MS), and normal group (N).
A total of 749 patients with resectable GC were included in this study. Preoperative MetS was associated with sarcopenia (p < 0.001). Multivariate logistic regression presented that MetS-related sarcopenia (OR = 2.445; p = 0.010) and sarcopenia alone (OR = 2.117; p = 0.001) were independent predictors of grade Ⅱ and above complications, while MetS alone was not (p = 0.342). Cox regression analysis revealed that MetS-related sarcopenia led to the worst prognosis in the four groups (MSS vs MS: HR = 3.555, p < 0.001; MSS vs N: HR = 2.020, p = 0.003; MSS vs S: HR = 1.763, p = 0.021). However, the MetS group had better prognosis than the normal group (MS vs N: HR = 0.568, p = 0.048).
Preoperative MetS was associated with sarcopenia among GC patients. MetS-related sarcopenia resulted in a significantly worse prognosis. The long-term prognoses of patients with sarcopenia were impaired by preoperative MetS, while patients without sarcopenia benefited. Thus, patients with both sarcopenia and MetS require more medical interventions.
肌少症和代谢综合征（MetS）与恶性肿瘤的预后相关。然而，关于根治性胃切除术后胃癌（GC）患者肌少症与 MetS 之间的关系，目前尚无相关证据。本研究评估了术前肌少症与 GC 患者 MetS 之间的关系，并分析了不同营养不良状态患者的预后。
我们前瞻性评估了 2014 年 7 月至 2017 年 12 月接受根治性胃切除术的患者的术前肌少症和 MetS 状态。我们将肌少症和 MetS 相结合，生成了 4 个组：MetS 相关肌少症组（MSS）、肌少症组（S）、MetS 组（MS）和正常组（N）。
本研究共纳入 749 例可切除 GC 患者。术前 MetS 与肌少症相关（p<0.001）。多因素 logistic 回归显示，MetS 相关肌少症（OR=2.445；p=0.010）和单纯肌少症（OR=2.117；p=0.001）是 2 级及以上并发症的独立预测因素，而单纯 MetS 不是（p=0.342）。Cox 回归分析显示，在这 4 个组中，MetS 相关肌少症导致最差的预后（MSS 与 MS：HR=3.555，p<0.001；MSS 与 N：HR=2.020，p=0.003；MSS 与 S：HR=1.763，p=0.021）。然而，MetS 组的预后要好于正常组（MS 与 N：HR=0.568，p=0.048）。
GC 患者术前 MetS 与肌少症相关。MetS 相关肌少症导致预后显著恶化。术前 MetS 使肌少症患者的长期预后恶化，而无肌少症患者则受益。因此，同时患有肌少症和 MetS 的患者需要更多的医疗干预。
