Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Japan.
Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Japan; Department of Genomic Medicine, Mie University Hospital, Japan.
Clin Nutr. 2021 May;40(5):2640-2653. doi: 10.1016/j.clnu.2021.03.036. Epub 2021 Apr 17.
BACKGROUND & AIMS: Myosteatosis is gathering attention as a feasible indicator for sarcopenia and increased risk of morbidity. However, the prognostic value of intramuscular adipose tissue content (IMAC) as an assessment method for myosteatosis remains controversial. The objectives of this study are to compare the prognostic value of intramuscular adipose tissue content (IMAC) with our newly-developed modified IMAC (mIMAC), and to assess the clinical significance of mIMAC in colorectal cancer (CRC) and gastric cancer (GC).
We evaluated 892 patients with CRC or GC, and assessed preoperative IMAC and mIMAC to compare their prognostic and predictive values for postoperative infectious complications in both cohorts.
Both preoperative IMAC and mIMAC were sex- and disease-dependent, and positively or negatively correlated with age in CRC and GC patients (IMAC: CRC: r = 0.33, P < 0.0001; GC: r = 0.304, P < 0.0001; mIMAC: CRC: r = -0.364, P < 0.0001; GC: r = -0.263, P < 0.0001). In contrast to IMAC, lower preoperative mIMAC was significantly associated with disease-development factors, and was an independent prognostic factor for both overall survival (OS) and disease-free survival (DFS) in both CRC (OS: hazard ratio (HR): 1.95, 95% confidence interval (CI): 1.25-3.03, p = 0.003; DFS: HR: 1.93, 95% CI: 1.22-3.04, p = 0.005) and GC patients (OS: HR: 2.11, 95% CI: 1.22-3.68, P = 0.008; DFS: HR: 2.03, 95% CI: 1.18-3.5, P = 0.011). Patients with postoperative remote infections had a poorer prognosis compared with those without in both cohorts (CRC: HR: 2.67, 95% CI: 1.46-4.89, P = 0.002; GC: HR: 3.01, 95% CI: 1.47-6.19, P = 0.003), and low mIMAC was an independent risk factor for postoperative remote infection in both cancers (CRC: odds ratio (OR): 2.56, 95% CI: 1.06-6.23, P = 0.038; GC: OR: 2.8, 95% CI: 1.03-7.58, P = 0.043). Finally, we assessed the correlation between IMAC or mIMAC and the representative frailty markers body mass index (BMI), serum albumin, and prognostic nutritional index (PNI). We found a positive correlation between preoperative mIMAC and all of these markers in both cohorts (CRC: BMI: r = 0.193, P < 0.0001; serum albumin: r = 0.42, P < 0.0001; PNI: r = 0.39, P < 0.0001; GC: BMI: r = 0.22, P < 0.0001; serum albumin: r = 0.212, P < 0.0001; PNI: r = 0.287, P < 0.0001).
Preoperative mIMAC could be useful for perioperative and postoperative management in CRC and GC.
肌内脂肪堆积作为肌肉减少症和发病率增加的一个可行指标正受到关注。然而，作为肌内脂肪堆积评估方法的肌肉内脂肪组织含量（IMAC）的预后价值仍存在争议。本研究的目的是比较 IMAC 和我们新开发的改良 IMAC（mIMAC）的预后价值，并评估 mIMAC 在结直肠癌（CRC）和胃癌（GC）中的临床意义。
我们评估了 892 例 CRC 或 GC 患者，评估了术前 IMAC 和 mIMAC，以比较两者在两个队列中对术后感染性并发症的预后和预测价值。
术前 IMAC 和 mIMAC 均受性别和疾病的影响，与 CRC 和 GC 患者的年龄呈正相关或负相关（IMAC：CRC：r=0.33，P<0.0001；GC：r=0.304，P<0.0001；mIMAC：CRC：r=-0.364，P<0.0001；GC：r=-0.263，P<0.0001）。与 IMAC 相反，术前较低的 mIMAC 与疾病发展因素显著相关，是 CRC（OS：HR：1.95，95%置信区间（CI）：1.25-3.03，p=0.003；DFS：HR：1.93，95%CI：1.22-3.04，p=0.005）和 GC 患者（OS：HR：2.11，95%CI：1.22-3.68，P=0.008；DFS：HR：2.03，95%CI：1.18-3.5，P=0.011）的独立预后因素。与无术后远处感染的患者相比，两组患者中发生术后远处感染的患者预后较差（CRC：HR：2.67，95%CI：1.46-4.89，P=0.002；GC：HR：3.01，95%CI：1.47-6.19，P=0.003），低 mIMAC 是两种癌症术后远处感染的独立危险因素（CRC：OR：2.56，95%CI：1.06-6.23，P=0.038；GC：OR：2.8，95%CI：1.03-7.58，P=0.043）。最后，我们评估了 IMAC 或 mIMAC 与代表脆弱性标志物的体重指数（BMI）、血清白蛋白和预后营养指数（PNI）之间的相关性。我们发现，在两个队列中，术前 mIMAC 与所有这些标志物均呈正相关（CRC：BMI：r=0.193，P<0.0001；血清白蛋白：r=0.42，P<0.0001；PNI：r=0.39，P<0.0001；GC：BMI：r=0.22，P<0.0001；血清白蛋白：r=0.212，P<0.0001；PNI：r=0.287，P<0.0001）。
术前 mIMAC 可用于 CRC 和 GC 的围手术期和术后管理。
