Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan.
Division of Statistical Analysis in Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.
Langenbecks Arch Surg. 2021 Mar;406(2):463-471. doi: 10.1007/s00423-021-02092-1. Epub 2021 Jan 30.
Sarcopenia is a risk factor of severe surgical complications, short-term outcomes, and long-term outcomes for patients with gastric cancer. Several computed tomography (CT) measurements have been performed to diagnose sarcopenia. However, the optimal CT measurements for determining long-term outcomes have not been revealed.
A retrospective review of gastric cancer patients with clinical stage I, II, or III who underwent gastrectomy at age 75 years or more at Shizuoka General Hospital from 2007 to 2015 was performed. Using preoperative CT, skeletal muscle index (SMI), total psoas area, intramuscular adipose tissue content in multifidus muscle, morphologic change of psoas muscle, and visceral-to-subcutaneous adipose tissue area ratio (VSR) were measured in the third lumbar section. A Cox regression analysis was used to explore prognostic factors for overall survival.
A total of 257 patients were reviewed. There were 171, 53, and 33 patients with clinical stages I, II, and III, respectively. A multivariate analysis indicated that, in addition to age, performance status, clinical stage, and types of resection, which are known prognostic factors, SMI and VSR are prognostic factors (p = 0.016, 0.046, respectively). The prognostic score, which was the frequency of positive SMI and VSR values within the cutoff, also indicates overall survival. The five-year OS rates of patients with prognostic scores of 0, 1, and 2 were 90.9%, 62.3%, and 52%, respectively (p < 0.001).
Preoperative SMI and VSR were prognostic factors for the overall survival of elderly patients with gastric cancer after gastrectomy.
肌肉减少症是胃癌患者发生严重手术并发症、短期结局和长期结局的危险因素。已经进行了几种计算机断层扫描（CT）测量来诊断肌肉减少症。然而，尚未揭示确定长期结局的最佳 CT 测量方法。
对 2007 年至 2015 年在静冈综合医院接受年龄 75 岁或以上的胃癌患者进行了回顾性分析，这些患者的临床分期为 I、II 或 III 期，接受了胃切除术。使用术前 CT，在第三腰椎节段测量了骨骼肌指数（SMI）、总腰大肌面积、多裂肌内肌脂肪组织含量、腰大肌形态变化和内脏-皮下脂肪组织面积比（VSR）。使用 Cox 回归分析探讨了总生存的预测因素。
共回顾了 257 例患者。临床分期分别为 I 期 171 例、II 期 53 例和 III 期 33 例。多变量分析表明，除了年龄、体能状态、临床分期和切除类型等已知的预后因素外，SMI 和 VSR 也是预后因素（p=0.016、0.046）。预后评分，即截止值内阳性 SMI 和 VSR 值的频率，也预示着总生存。预后评分为 0、1 和 2 的患者的五年 OS 率分别为 90.9%、62.3%和 52%（p<0.001）。
术前 SMI 和 VSR 是老年胃癌患者胃切除术后总生存的预后因素。
