Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
J Cachexia Sarcopenia Muscle. 2021 Dec;12(6):1897-1907. doi: 10.1002/jcsm.12793. Epub 2021 Sep 17.
Preoperative sarcopenia is associated with a poor long-term prognosis in patients with gastric cancer (GC). Most GC patients rapidly lose muscle mass after gastrectomy. This retrospective cohort study analysed the effect of postoperative muscle loss and surgery-induced sarcopenia on the long-term outcomes of patients with GC.
Preoperative and postoperative 1 year abdominal computed tomography scans were available for 1801 GC patients who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. The patients were categorized into normal, presarcopenia, and sarcopenia groups according to the skeletal muscle index (SMI) measured on computed tomography scans. Patients who were not sarcopenic prior to gastrectomy but became sarcopenic after surgery were defined as the surgery-induced sarcopenia group.
There were 1227 men and 574 women included in the study. The mean age of the patients was 59.5 ± 12.3 years. Multivariable Cox-regression analyses showed that preoperative SMI was not associated with overall survival (OS). However, postoperative sarcopenia was associated with significantly worse OS only in men [hazard ratio (HR), 1.75; 95% confidence interval (CI), 1.08-2.85]. SMI loss was an independent risk factor for OS in the entire cohort and in men (HR, 1.01; 95% CI, 1.00-1.02, for the entire cohort; HR, 1.02; 95% CI, 1.01-1.04, for men). The surgery-induced sarcopenia group was associated with significantly higher mortality (HR, 1.84; 95% CI, 1.16-2.90, for the cohort; HR, 2.73; 95% CI, 1.54-4.82, for men), although SMI loss and surgery-induced sarcopenia were not risk factors in women. Similar results were obtained for relapse-free survival.
Postoperative muscle mass loss and surgery-induced sarcopenia are prognostic factors for survival in patients with GC. Impact of postoperative muscle mass loss and surgery-induced sarcopenia on survival outcomes is dependent on the sex.
术前肌少症与胃癌（GC）患者的长期预后不良相关。大多数 GC 患者在胃切除术后会迅速失去肌肉量。这项回顾性队列研究分析了术后肌肉丢失和手术引起的肌肉减少症对 GC 患者长期结局的影响。
2009 年 1 月至 2013 年 12 月，在首尔国立大学盆唐医院接受根治性胃切除术的 1801 例 GC 患者中，有 1801 例患者可获得术前和术后 1 年的腹部计算机断层扫描（CT）扫描。根据 CT 扫描测量的骨骼肌指数（SMI），将患者分为正常、预肌少症和肌少症组。术前无肌少症但术后发生肌少症的患者定义为手术诱导性肌少症组。
本研究共纳入 1227 名男性和 574 名女性患者。患者的平均年龄为 59.5±12.3 岁。多变量 Cox 回归分析显示，术前 SMI 与总生存期（OS）无关。然而，仅在男性中，术后肌少症与明显较差的 OS 相关[风险比（HR），1.75；95%置信区间（CI），1.08-2.85]。SMI 丢失是整个队列和男性 OS 的独立危险因素（HR，1.01；95%CI，1.00-1.02，整个队列；HR，1.02；95%CI，1.01-1.04，男性）。手术诱导性肌少症组与死亡率显著升高相关（HR，1.84；95%CI，1.16-2.90，整个队列；HR，2.73；95%CI，1.54-4.82，男性），尽管 SMI 丢失和手术诱导性肌少症在女性中不是危险因素。无复发生存率也得到了类似的结果。
术后肌肉量丢失和手术引起的肌肉减少症是 GC 患者生存的预后因素。术后肌肉量丢失和手术诱导性肌肉减少症对生存结果的影响取决于性别。
