Fehrenbach Uli, Wuensch Tilo, Gabriel Pia, Segger Laura, Yamaguchi Takeru, Auer Timo Alexander, Beetz Nick Lasse, Denecke Christian, Kröll Dino, Raakow Jonas, Knitter Sebastian, Chopra Sascha, Thuss-Patience Peter, Pratschke Johann, Hamm Bernd, Biebl Matthias, Geisel Dominik
Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
Cancers (Basel). 2021 Jun 11;13(12):2921. doi: 10.3390/cancers13122921.
To assess the impact of body composition imaging biomarkers in computed tomography (CT) on the perioperative morbidity and survival after surgery of patients with esophageal cancer (EC).
Eighty-five patients who underwent esophagectomy for locally advanced EC after neoadjuvant therapy between 2014 and 2019 were retrospectively enrolled. Pre- and postoperative CT scans were used to assess the body composition imaging biomarkers (visceral (VAT) and subcutaneous adipose tissue (SAT) areas, psoas muscle area (PMA) and volume (PMV), total abdominal muscle area (TAMA)). Sarcopenia was defined as lumbar skeletal muscle index (LSMI) ≤38.5 cm/m in women and ≤52.4 cm/m in men. Patients with a body mass index (BMI) of ≥30 were considered obese. These imaging biomarkers were correlated with major complications, anastomotic leakage, postoperative pneumonia, duration of postoperative hospitalization, disease-free survival (DFS), and overall survival (OS).
Preoperatively, sarcopenia was identified in 58 patients (68.2%), and sarcopenic obesity was present in 7 patients (8.2%). Sarcopenic patients were found to have an elevated risk for the occurrence of major complications (OR: 2.587, = 0.048) and prolonged hospitalization (32 d vs. 19 d, = 0.040). Patients with sarcopenic obesity had a significantly higher risk for postoperative pneumonia (OR: 6.364 = 0.018) and a longer postoperative hospital stay (71 d vs. 24 d, = 0.021). Neither sarcopenia nor sarcopenic obesity was an independent risk factor for the occurrence of anastomotic leakage ( > 0.05). Low preoperative muscle biomarkers (PMA and PMV) and their decrease (ΔPMV and ΔTAMA) during the follow-up period significantly correlated with shorter DFS and OS ( = 0.005 to 0.048).
CT body composition imaging biomarkers can identify high-risk patients with locally advanced esophageal cancer undergoing surgery. Sarcopenic patients have a higher risk of major complications, and patients with sarcopenic obesity are more prone to postoperative pneumonia. Sarcopenia and sarcopenic obesity are both subsequently associated with a prolonged hospitalization. Low preoperative muscle mass and its decrease during the postoperative follow-up are associated with lower DFS and OS.
评估计算机断层扫描（CT）中的身体成分成像生物标志物对食管癌（EC）患者围手术期发病率和术后生存率的影响。
回顾性纳入2014年至2019年间85例接受新辅助治疗后因局部晚期EC行食管切除术的患者。术前和术后CT扫描用于评估身体成分成像生物标志物（内脏脂肪组织（VAT）和皮下脂肪组织（SAT）面积、腰大肌面积（PMA）和体积（PMV）、腹部总肌肉面积（TAMA））。肌肉减少症定义为女性腰椎骨骼肌指数（LSMI）≤38.5 cm/m²，男性≤52.4 cm/m²。体重指数（BMI）≥30的患者被视为肥胖。这些成像生物标志物与主要并发症、吻合口漏、术后肺炎、术后住院时间、无病生存期（DFS）和总生存期（OS）相关。
术前，58例患者（68.2%）被诊断为肌肉减少症，7例患者（8.2%）存在肌肉减少性肥胖。发现肌肉减少症患者发生主要并发症的风险升高（OR：2.587，P = 0.048）且住院时间延长（32天对19天，P = 0.040）；肌肉减少性肥胖患者术后肺炎风险显著更高（OR：6.364，P = 0.018）且术后住院时间更长（71天对24天，P = 0.021）。肌肉减少症和肌肉减少性肥胖均不是吻合口漏发生的独立危险因素（P>0.05）。术前低肌肉生物标志物（PMA和PMV）及其在随访期间的下降（ΔPMV和ΔTAMA）与较短的DFS和OS显著相关（P = 0.005至0.048）。
CT身体成分成像生物标志物可识别接受手术的局部晚期食管癌高危患者。肌肉减少症患者发生主要并发症的风险更高，肌肉减少性肥胖患者更容易发生术后肺炎。肌肉减少症和肌肉减少性肥胖均与住院时间延长相关。术前低肌肉量及其在术后随访期间的下降与较低的DFS和OS相关。
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