肌肉减少症预测行肝切除术前行门静脉栓塞术的患者肝生长减少和切除率降低 - 306 例患者的 DRAGON 协作分析。
Sarcopenia predicts reduced liver growth and reduced resectability in patients undergoing portal vein embolization before liver resection - A DRAGON collaborative analysis of 306 patients.
机构信息
Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany.
Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland.
出版信息
HPB (Oxford). 2022 Mar;24(3):413-421. doi: 10.1016/j.hpb.2021.08.818. Epub 2021 Aug 16.
BACKGROUND
After portal vein embolization (PVE) 30% fail to achieve liver resection. Malnutrition is a modifiable risk factor and can be assessed by radiological indices. This study investigates, if sarcopenia affects resectability and kinetic growth rate (KGR) after PVE.
METHODS
A retrospective study was performed of the outcome of PVE at 8 centres of the DRAGON collaborative from 2010 to 2019. All malignant tumour types were included. Sarcopenia was defined using gender, body mass and skeletal muscle index. First imaging after PVE was used for liver volumetry. Primary and secondary endpoints were resectability and KGR. Risk factors impacting liver growth were assessed in a multivariable analysis.
RESULTS
Eight centres identified 368 patients undergoing PVE. 62 patients (17%) had to be excluded due to unavailability of data. Among the 306 included patients, 112 (37%) were non-sarcopenic and 194 (63%) were sarcopenic. Sarcopenic patients had a 21% lower resectability rate (87% vs. 66%, p < 0.001) and a 23% reduced KGR (p = 0.02) after PVE. In a multivariable model dichotomized for KGR ≥2.3% standardized FLR (sFLR)/week, only sarcopenia and sFLR before embolization correlated with KGR.
CONCLUSION
In this largest study of risk factors, sarcopenia was associated with reduced resectability and KGR in patients undergoing PVE.
背景
门静脉栓塞术（PVE）后有 30%的患者无法进行肝切除术。营养不良是可改变的危险因素，可以通过影像学指标进行评估。本研究调查了 PVE 后是否存在肌肉减少症会影响可切除性和动力学生长率（KGR）。
方法
对 2010 年至 2019 年期间 DRAGON 协作 8 个中心的 PVE 结果进行回顾性研究。所有恶性肿瘤类型均包括在内。肌肉减少症使用性别、体重和骨骼肌指数来定义。PVE 后的首次影像学检查用于肝脏体积测量。主要和次要终点是可切除性和 KGR。在多变量分析中评估了影响肝脏生长的风险因素。
结果
8 个中心确定了 368 例接受 PVE 的患者。由于数据不可用，62 例（17%）被排除在外。在 306 例纳入的患者中，112 例（37%）是非肌肉减少症患者，194 例（63%）是肌肉减少症患者。肌肉减少症患者的可切除性率降低了 21%（87%比 66%，p<0.001），KGR 降低了 23%（p=0.02）。在 KGR≥2.3%标准化功能性肝脏体积比（sFLR）/周的二分变量多变量模型中，只有肌肉减少症和栓塞前 sFLR 与 KGR 相关。
结论
在这项最大的危险因素研究中，肌肉减少症与接受 PVE 的患者的可切除性和 KGR 降低相关。
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