Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan.
Microsurgery. 2020 Nov;40(8):859-867. doi: 10.1002/micr.30668. Epub 2020 Oct 21.
Sarcopenia is characterized by depletion of skeletal muscle mass (SMM) and can cause increased postoperative complication in free flap procedure. One of the most important considerations while deciding the indication of the procedure is patients' survival. This study aimed to verify the relationship between low SMM and survival in patients who undergo oral cancer resection using free flap.
SMM was evaluated using the skeletal muscle index (SMI cm /m ), which was defined using cross-sectional areas of skeletal muscles on computed tomography at the level of the third lumbar vertebrae normalized for height. Overall, 111 patients who underwent primary oral cancer resection and free flaps were included. Multivariate Cox regression analyses were used to evaluate the prognostic factors for survival.
A total of 25 patients (22.5%) were diagnosed with low SMM. The mean SMI was 42.2 cm /m . Multivariable analyses showed that increased age (hazard ratio [HR]; 4.98, p = .004), infiltrative growth pattern INF-c (HR; 3.83, p = .037), and low SMM (HR; 2.59, p = .034) were significant negative prognostic factors for overall survival. Increased age (HR; 3.18, p = .005), extra-nodal extension (HR; 3.30, p = .001), and low SMM (HR; 2.42, p = .017) were significant negative prognostic factors for disease-free survival.
Low SMM is a significant negative prognostic factor for overall and disease-free survival in oral cancer patients undergoing free flap. Future prospective studies are warranted to identify effective preoperative exercise and nutrition programs to improve low skeletal muscle and survival rate in patients undergoing free flap procedures.
肌少症的特征是骨骼肌质量（SMM）减少，可能导致游离皮瓣手术术后并发症增加。在决定手术适应证时，最重要的考虑因素之一是患者的生存情况。本研究旨在验证在接受游离皮瓣的口腔癌切除患者中，低 SMM 与生存之间的关系。
使用骨骼肌指数（SMI cm /m ）评估 SMM，该指数通过在第三腰椎水平的 CT 上测量骨骼肌的横截面积并除以身高来定义。共纳入 111 例接受原发性口腔癌切除和游离皮瓣的患者。使用多变量 Cox 回归分析评估生存的预后因素。
共有 25 例（22.5%）患者被诊断为低 SMM。SMI 的平均值为 42.2 cm /m 。多变量分析显示，年龄增加（危险比 [HR]；4.98，p =.004）、浸润性生长模式 INF-c（HR；3.83，p =.037）和低 SMM（HR；2.59，p =.034）是总生存的显著负预后因素。年龄增加（HR；3.18，p =.005）、结外扩展（HR；3.30，p =.001）和低 SMM（HR；2.42，p =.017）是无病生存的显著负预后因素。
在接受游离皮瓣的口腔癌患者中，低 SMM 是总生存和无病生存的显著负预后因素。需要进一步的前瞻性研究来确定有效的术前运动和营养计划，以改善接受游离皮瓣手术的患者的低骨骼肌和生存率。
