Third Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Endoscopy, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Hepatobiliary Pancreat Sci. 2021 Jul;28(7):572-580. doi: 10.1002/jhbp.970. Epub 2021 May 12.
BACKGROUND/PURPOSE: Recurrent biliary obstruction (RBO) after self-expandable metallic stent (SEMS) insertion is a big problem in patients with unresectable malignant biliary obstruction (MBO). Sarcopenia is associated with poor prognosis in patients with malignancies. The purpose of this study is to clarify the relationship between RBO and sarcopenia.
Forty-six patients with normal psoas muscle mass index (PMI) and 55 with low PMI were enrolled, based on PMI cut-off values. We analyzed the cumulative incidences and predictors of RBO, considering death without RBO to be a competing risk.
In the Kaplan-Meier analysis, the 60-, 180-, and 360-day cumulative incidence rates of RBO were 0.0%, 12.2%, and 22.0% in the normal PMI group, as compared to 4.0%, 31.1%, and 55.0% in the low PMI group, respectively (log-rank P = .003). In competing risk analysis, the incidences were 2.9%, 2.9%, and 7.1% in the normal PMI group, as compared to 13.7%, 34.8%, and 51.7% in the low PMI group, respectively (P < .001). In multivariate Cox regression and Fine-Gray's analyses, hazard ratios of low PMI for RBO were 4.593 (95% confidence interval 1.673-12.61, P = .003) and 4.980 (2.045-12.13, P < .001), respectively.
Sarcopenia in MBO was an independent risk factor for RBO.
背景/目的：不可切除恶性胆道梗阻（MBO）患者自膨式金属支架（SEMS）置入后出现复发性胆道梗阻（RBO）是一个大问题。肌肉减少症与恶性肿瘤患者的预后不良有关。本研究旨在阐明 RBO 与肌肉减少症之间的关系。
根据肌肉减少症指数（PMI）截断值，纳入 46 例 PMI 正常和 55 例 PMI 降低的患者。我们分析了 RBO 的累积发生率和预测因素，考虑到无 RBO 死亡是一个竞争风险。
在 Kaplan-Meier 分析中，正常 PMI 组的 60、180 和 360 天 RBO 累积发生率分别为 0.0%、12.2%和 22.0%，而低 PMI 组分别为 4.0%、31.1%和 55.0%（对数秩 P = 0.003）。在竞争风险分析中，正常 PMI 组的发生率分别为 2.9%、2.9%和 7.1%，低 PMI 组分别为 13.7%、34.8%和 51.7%（P < 0.001）。在多变量 Cox 回归和 Fine-Gray 分析中，低 PMI 发生 RBO 的风险比分别为 4.593（95%置信区间 1.673-12.61，P = 0.003）和 4.980（2.045-12.13，P < 0.001）。
MBO 中的肌肉减少症是 RBO 的独立危险因素。
