The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
The Swedish Cancer Institute, Seattle, WA, USA.
Integr Cancer Ther. 2021 Jan-Dec;20:15347354211000118. doi: 10.1177/15347354211000118.
Sarcopenia and suboptimal performance status are associated with postoperative complications and morbidity in cancer patients. Prehabilitation has emerged as an approach to improve fitness and muscle strength in patients preoperatively. We sought to describe the frequency of sarcopenia and sarcopenic obesity (SO) in a cohort of cancer patients referred for prehabilitation and the association between body composition and physical function.
In this retrospective review of 99 consecutive cancer patients referred for prehabilitation prior to intended oncologic surgery, prehabilitation included physical medicine and rehabilitation (PM&R) physician evaluation of function and physical therapy for individualized home-based exercise. Sarcopenic A was defined using sex-adjusted norms of skeletal muscle (SKM), measured using the sliceOmatic software (TomoVision, 2012) on computed tomography images at baseline. Sarcopenic B was defined by abnormal SKM and physical function. SO was defined as sarcopenia with BMI ≥ 25. Six-minute walk test (6MWT), 5 times sit-to-stand (5×STS), and grip strength were obtained at consultation (baseline) and at preoperative follow-up (if available).
Forty-nine patients (49%) were Sarcopenic A, 28 (28%) SO, and 38 (38%) Sarcopenic B. Age was negatively correlated with SKM ( = .0436). There were no significant associations between Sarcopenic A/B or SO with baseline or changes in physical function. Assessed by sex, Sarcopenic A females had low 5×STS ( = .04) and Sarcopenic B females had low GS ( = .037). Sarcopenic B males had low preoperative GS ( = .026). 6MWT and grip strength at baseline were lower than age- and sex-related norms (both < .001). Preoperatively, 6MWT distance and 5×STS time improved (both < .001). Functional improvement in the sarcopenic and nonsarcopenic patients did not differ according to sex.
In this cohort of prehabilitation surgical oncology patients, frequencies of sarcopenia and SO were high, and baseline physical function was abnormal but improved significantly regardless of body composition. These findings suggest that patients have considerable prehabilitation needs and are capable of improving with comprehensive care.
肌肉减少症和功能状态不佳与癌症患者的术后并发症和发病率有关。术前康复作为一种提高患者体能和肌肉力量的方法已经出现。我们旨在描述接受术前康复的癌症患者队列中肌肉减少症和肌肉减少性肥胖（SO）的频率，以及身体成分与身体功能之间的关系。
在这项对 99 例连续癌症患者的回顾性研究中，这些患者在接受肿瘤手术前被转诊接受术前康复，术前康复包括物理医学与康复（PM＆R）医师对功能的评估和个性化家庭锻炼的物理治疗。在基线时使用 TomoVision 切片 Omatic 软件（2012 年）测量计算机断层扫描图像上的骨骼肌（SKM），使用性别调整的 SKM 标准定义肌肉减少 A。通过异常的 SKM 和身体功能定义肌肉减少 B。SO 定义为肌肉减少症伴 BMI≥25。在咨询（基线）和术前随访（如果有）时获得 6 分钟步行测试（6MWT）、5 次坐立（5×STS）和握力。
49 例患者（49%）为肌肉减少 A，28 例（28%）为 SO，38 例（38%）为肌肉减少 B。年龄与 SKM 呈负相关（ = .0436）。肌肉减少 A/B 或 SO 与基线或身体功能变化之间无显著相关性。按性别评估，女性肌肉减少 A 的 5×STS 较低（ = .04），女性肌肉减少 B 的 GS 较低（ = .037）。男性肌肉减少 B 的术前 GS 较低（ = .026）。6MWT 和基线握力均低于年龄和性别相关的正常值（均 < .001）。术前 6MWT 距离和 5×STS 时间均改善（均 < .001）。肌肉减少和非肌肉减少患者的功能改善在性别方面没有差异。
在这个接受术前康复的肿瘤外科患者队列中，肌肉减少症和 SO 的频率较高，基线身体功能异常，但无论身体成分如何，都显著改善。这些发现表明患者有相当大的术前康复需求，并且能够通过综合护理来改善。
