肌肉减少症对结直肠癌复发的预后影响。

Prognostic effect of sarcopenia in colorectal cancer recurrence.

机构信息

First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.

出版信息

Nutrition. 2021 Nov-Dec;91-92:111362. doi: 10.1016/j.nut.2021.111362. Epub 2021 Jun 2.

DOI:10.1016/j.nut.2021.111362

PMID:34274653

Abstract

OBJECTIVES

Nutritional status significantly influences postoperative prognosis in gastrointestinal cancers. It has been evaluated using sarcopenia before treatments such as surgery and chemotherapy, despite constant changes in nutritional status. We consider that nutritional status at cancer recurrence is one of the important factors that affect treatment choice and intensity. This study evaluated the prognostic effects of improved postoperative nutritional status for people with colorectal cancer recurrence.

METHODS

We enrolled 209 participants with pathologically confirmed stage II or III colorectal cancer who underwent radical resection. Sarcopenia was diagnosed using the psoas muscle index obtained from analysis of three-dimensional computed tomographic images. We adopted the cutoff value that was proposed by Hamaguchi et al. (psoas muscle index < 6.36 cm/m for men and < 3.92 cm/m for women). Evaluation was performed before surgery and at the time of recurrence. Participants with preoperative sarcopenia who relapsed were divided into two groups at the time of recurrence: sarcopenia continuation and sarcopenia improvement. We compared the prognosis of the two groups and examined the effect of postoperative nutritional improvement.

RESULTS

Among the 209 participants, 81 (38.8%) had preoperative sarcopenia; this group had significantly lower overall survival than those without sarcopenia (P = 0.028). Colorectal cancer recurred in 48 participants. Of those 46, sarcopenia was evaluated at the time of recurrence; 19 of those 46 had preoperative sarcopenia. Preoperative sarcopenia did not affect the cancer recurrence ratio (sarcopenia, 23.5%; non-sarcopenia, 21.3%; P = 0.893). The sarcopenia-improvement group had higher overall survival than the sarcopenia-continuation group (P = 0.042).

CONCLUSIONS

Among participants with preoperative sarcopenia, the prognosis at the time of recurrence improved for the sarcopenia-improvement group compared to the sarcopenia-continuation group. In people with colorectal cancer and sarcopenia, nutritional management is important not only before but also after surgery.

摘要

目的

营养状况显著影响胃肠道癌症的术后预后。尽管在手术和化疗等治疗前已经通过肌肉减少症进行了评估，但营养状况仍在不断变化。我们认为癌症复发时的营养状况是影响治疗选择和强度的重要因素之一。本研究评估了改善结直肠癌复发患者术后营养状况的预后效果。

方法

我们纳入了 209 名经病理证实为 II 期或 III 期结直肠癌患者，这些患者接受了根治性切除术。使用三维计算机断层扫描图像分析获得的腰大肌指数诊断肌肉减少症。我们采用了 Hamaguchi 等人提出的截断值（男性腰大肌指数＜6.36cm/m，女性＜3.92cm/m）。评估在术前和复发时进行。术前存在肌肉减少症且复发的患者在复发时分为两组：肌肉减少症持续和肌肉减少症改善。我们比较了两组的预后，并检查了术后营养改善的效果。

结果

在 209 名参与者中，81 名（38.8%）存在术前肌肉减少症；与无肌肉减少症的患者相比，这组患者的总生存率明显较低（P=0.028）。48 名参与者中出现结直肠癌复发。在这 46 名患者中，有 46 名评估了复发时的肌肉减少症；其中 19 名患者术前存在肌肉减少症。术前肌肉减少症并不影响癌症复发率（肌肉减少症，23.5%；非肌肉减少症，21.3%；P=0.893）。与肌肉减少症持续组相比，肌肉减少症改善组的总生存率更高（P=0.042）。