Department of Gastrointestinal Surgery, Kosuyolu Research and Education Hospital, University of Health Sciences, 34865, Istanbul, Turkey.
Department of Surgery, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Langenbecks Arch Surg. 2020 Dec;405(8):1131-1138. doi: 10.1007/s00423-020-01983-z. Epub 2020 Sep 9.
The role of sarcopenia in pathologic complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in non-metastatic locally advanced rectal cancer is currently unknown. The present study investigates the association between sarcopenia and post-nCRT pCR.
The data of patients operated on following nCRT between January 2013 and January 2020 were collected retrospectively. Sarcopenia was diagnosed based on the calculation of the skeletal muscle index (SMI) from computed tomography carried out at the time of the initial diagnosis. A statistical analysis was then conducted for predictors of pCR.
The study included 61 patients with an average age of 57.3 years, 28 of whom formed the non-sarcopenic group (NSG) and 33 the sarcopenic group (SG). Of the patients, 32.7% were at clinical stage 2, and 67.3% were at clinical stage 3. Pathologic data following a mesorectal excision revealed a pCR rate of 21.4% in the NSG compared with 3% in the SG, which was a statistically significant difference (p = 0.025). The TNM downstaging rate was higher in the NSG than in the SG, although the difference was not statistically significant (50% vs. 33.3%, p = 0.28). A univariate analysis revealed the factors affecting pCR to be non-sarcopenia (p = 0.025), age < 61 years (p = 0.004), interval to surgery ≥ 8 weeks (p = 0.029), and serum CEA < 2.5 ng/ml (p = 0.035).
Sarcopenia was found to be a negative marker of pCR following nCRT in non-metastatic locally advanced rectal cancer.
新辅助放化疗（nCRT）后非转移性局部晚期直肠癌病理完全缓解（pCR）中，肌肉减少症的作用尚不清楚。本研究探讨了肌肉减少症与 post-nCRT pCR 之间的关系。
回顾性收集了 2013 年 1 月至 2020 年 1 月间 nCRT 后手术患者的数据。在初始诊断时通过计算计算机断层扫描（CT）得出的骨骼肌指数（SMI）来诊断肌肉减少症。然后对 pCR 的预测因素进行了统计学分析。
研究纳入了 61 例平均年龄为 57.3 岁的患者，其中 28 例为非肌肉减少症组（NSG），33 例为肌肉减少症组（SG）。患者中，2型占 32.7%，3 型占 67.3%。直肠系膜切除术后的病理数据显示，NSG 的 pCR 率为 21.4%，而 SG 为 3%，差异有统计学意义（p = 0.025）。NSG 的 TNM 降级率高于 SG，但差异无统计学意义（50% vs. 33.3%，p = 0.28）。单因素分析显示，影响 pCR 的因素是非肌肉减少症（p = 0.025）、年龄<61 岁（p = 0.004）、手术间隔时间≥8 周（p = 0.029）和血清 CEA<2.5ng/ml（p = 0.035）。
肌肉减少症是 nCRT 后非转移性局部晚期直肠癌 pCR 的阴性标志物。
