胃神经内分泌肿瘤患者根治性胃切除术后肌少症对近期和远期结局的影响：来自两大机构系列的大型研究结果。
Effect of sarcopenia on short- and long-term outcomes in patients with gastric neuroendocrine neoplasms after radical gastrectomy: results from a large, two-institution series.
机构信息
Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
出版信息
BMC Cancer. 2020 Oct 15;20(1):1002. doi: 10.1186/s12885-020-07506-9.
BACKGROUND
The relationship between sarcopenia and the prognoses of patients with gastric neuroendocrine neoplasms (g-NENs) is unclear. This study was designed to explore the effects of sarcopenia on short-term and long-term outcomes of patients with g-NENs after radical gastrectomy.
METHODS
This study retrospectively collected data from 138 patients with g-NENs after radical gastrectomy. The skeletal muscle index (SMI) diagnostic threshold for sarcopenia was determined using X-tile software. Cox regression analyses were performed to determine the independent risk factors for 3-year overall survival (OS) and 3-year recurrence-free survival (RFS).
RESULTS
In this study, 59 patients (42.8%) were diagnosed with sarcopenia. Among patients in the sarcopenia group and nonsarcopenia group, the incidences of total postoperative complications were 33.9 and 30.4%, incidences of serious postoperative complications were 0 and 3.7%, incidences of postoperative surgical complications were 13.6 and 15.2%, and incidences of postoperative systemic complications were 20.3 and 15.2%, respectively (all p > 0.05). The 3-year OS and RFS rates were significantly worse in the sarcopenia group than in the nonsarcopenia group (OS: 42.37% vs 65.82%, p = 0.004; RFS: 52.54% vs 68.35%, p = 0.036). The multivariate analysis revealed a relation between sarcopenia and the long-term prognoses of patients with g-NENs. A stratified analysis based on the pathological type revealed that the Kaplan-Meier curve was only significantly different in patients with gastric mixed adenoneuroendocrine carcinoma (gMANEC) (OS: 40.00% vs 71.79%, p = 0.007; RFS: 51.43% vs 74.36%, p = 0.026); furthermore, the multivariate analysis identified sarcopenia as an independent risk factor for patients with gMANEC (p < 0.05).
CONCLUSIONS
Sarcopenia is not related to the short-term prognoses of patients with g-NENs. Sarcopenia is an independent risk factor for patients with gMANEC after radical surgery.
背景
骨骼肌减少症与胃神经内分泌肿瘤（g-NENs）患者的预后之间的关系尚不清楚。本研究旨在探讨骨骼肌减少症对根治性胃切除术后 g-NENs 患者短期和长期结局的影响。
方法
本研究回顾性收集了 138 例根治性胃切除术后 g-NENs 患者的数据。使用 X-tile 软件确定骨骼肌减少症的骨骼肌指数（SMI）诊断阈值。采用 Cox 回归分析确定 3 年总生存率（OS）和 3 年无复发生存率（RFS）的独立危险因素。
结果
本研究中，59 例（42.8%）患者被诊断为骨骼肌减少症。在骨骼肌减少症组和非骨骼肌减少症组中，总术后并发症发生率分别为 33.9%和 30.4%，严重术后并发症发生率分别为 0 和 3.7%，术后手术并发症发生率分别为 13.6%和 15.2%，术后全身并发症发生率分别为 20.3%和 15.2%（均 p>0.05）。骨骼肌减少症组的 3 年 OS 和 RFS 率明显低于非骨骼肌减少症组（OS：42.37%比 65.82%，p=0.004；RFS：52.54%比 68.35%，p=0.036）。多因素分析显示，骨骼肌减少症与 g-NENs 患者的长期预后有关。基于病理类型的分层分析显示，仅在胃混合性腺神经内分泌癌（gMANEC）患者中，Kaplan-Meier 曲线有显著差异（OS：40.00%比 71.79%，p=0.007；RFS：51.43%比 74.36%，p=0.026）；此外，多因素分析显示，骨骼肌减少症是 gMANEC 患者的独立危险因素（p<0.05）。
结论
骨骼肌减少症与 g-NENs 患者的短期预后无关。骨骼肌减少症是根治性手术后 gMANEC 患者的独立危险因素。
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