Ikuta Shinichi, Aihara Tsukasa, Nakajima Takayoshi, Kasai Meidai, Yamanaka Naoki
Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan.
Ann Transl Med. 2021 Jan;9(1):21. doi: 10.21037/atm-20-3751.
Osteopenia/osteoporosis, characterized by low bone mineral density (BMD), is a potential prognostic factor in cancer patients. We conducted a retrospective single-institution study to evaluate the prognostic impact of preoperative low BMD on colorectal liver metastases (CRLM) in patients undergoing liver resection.
BMD was assessed in 281 patients undergoing initial liver resection for CRLM by analyzing the preoperative computed tomography (CT) images at the level of the eleventh thoracic vertebra as the region of interest. Survival outcomes were compared between the two groups divided by the median BMD value and prognostic factors after surgery were assessed. Propensity score-based inverse probability weighting (IPW) was applied to adjust for between-group differences in baseline characteristics.
The low BMD group had significantly more older patients (≥75 years) (P=0.01) and a higher incidence of bilobar metastases (P=0.005) than the normal BMD group. After IPW adjustment, overall survival (OS) was significantly poorer (P=0.02) and recurrence-free survival was slightly poorer (P=0.05) in the low BMD group than in the normal BMD group. IPW-adjusted regression analysis revealed that low BMD was independently associated with an adverse OS (hazard ratio, 1.42; 95% CI, 1.04-1.93; P=0.03), in addition to other factors such as tumor number, extrahepatic disease, preoperative carcinoembryonic antigen level (≥5 ng/mL), and right-sided primary tumor location.
Preoperative CT-measured low BMD can serve as a surrogate marker of adverse OS in CRLM patients undergoing liver resection. Prevention and early intervention for osteopenia/osteoporosis may be suggested for these patients.
骨量减少/骨质疏松以低骨密度（BMD）为特征，是癌症患者潜在的预后因素。我们进行了一项单机构回顾性研究，以评估术前低骨密度对接受肝切除的结直肠癌肝转移（CRLM）患者的预后影响。
通过分析第11胸椎水平的术前计算机断层扫描（CT）图像作为感兴趣区域，对281例首次接受CRLM肝切除的患者进行骨密度评估。比较以骨密度中位数划分的两组患者的生存结局，并评估术后的预后因素。应用基于倾向评分的逆概率加权（IPW）来调整组间基线特征差异。
与正常骨密度组相比，低骨密度组老年患者（≥75岁）明显更多（P = 0.01），双叶转移发生率更高（P = 0.005）。经过IPW调整后，低骨密度组的总生存期（OS）明显较差（P = 0.02），无复发生存期略差（P = 0.05）。IPW调整后的回归分析显示，除肿瘤数量、肝外疾病、术前癌胚抗原水平（≥5 ng/mL）和右侧原发性肿瘤位置等其他因素外，低骨密度与不良OS独立相关（风险比，1.42；95% CI，1.04 - 1.93；P = 0.03）。
术前CT测量的低骨密度可作为接受肝切除的CRLM患者不良OS的替代标志物。对于这些患者，可能建议对骨量减少/骨质疏松进行预防和早期干预。
