Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Ann Surg Oncol. 2022 Apr;29(4):2473-2479. doi: 10.1245/s10434-021-10881-7. Epub 2021 Oct 9.
We aimed to describe the effect of preoperative sarcopenia on oncologic outcomes of organ-confined renal cell carcinoma (RCC) after radical nephrectomy.
A total of 632 patients with pT1-2 RCC who underwent radical nephrectomy between 2004 and 2014 were retrospectively analyzed. From preoperative computerized tomography (CT) scans, skeletal muscle index (SMI) was measured and gender-specific cutoff values at third lumbar vertebra of 52.4 cm/m for men and 38.5 cm/m for women were used to define sarcopenia. Survivals were compared and associations with sarcopenia were analyzed using Kaplan-Meier log rank tests and Cox proportional hazard regression models. Median follow-up was 83 months.
Of 632 patients, 268 (42.4%) were classified as sarcopenic. The sarcopenic group was more advanced in age (57 versus 53 years) and more predominantly male (71.3% versus 59.9%). Sarcopenic patients had lower body mass index (BMI, 23.0 versus 25.9 kg/m), but there was no difference in tumor size, stage, or nuclear grade. Sarcopenia was associated with poorer overall survival (OS) and cancer-specific survival (CSS; OS 94.0% versus 82.1%; p < 0.001 and CSS 97.5% versus 91.8%; p < 0.001). On multivariate analysis, sarcopenia was an independent risk factor for all-cause mortality [hazard ratio (HR) 2.58; 95% CI 1.02-6.54] and cancer-specific mortality (HR 3.07; 95% CI 1.38-6.83).
Sarcopenia at diagnosis was an independent risk factor for all-cause and cancer-specific mortality after radical nephrectomy for pT1-2 RCC. These findings underscore the importance of assessing presence of sarcopenia for risk stratification even among surgical candidates.
我们旨在描述术前肌少症对接受根治性肾切除术的局限性肾细胞癌（RCC）患者的肿瘤学结果的影响。
回顾性分析了 2004 年至 2014 年间接受根治性肾切除术的 632 名 pT1-2RCC 患者。从术前计算机断层扫描（CT）扫描中测量骨骼肌指数（SMI），并使用性别特异性第 3 腰椎截断值，男性为 52.4cm/m，女性为 38.5cm/m 来定义肌少症。使用 Kaplan-Meier 对数秩检验和 Cox 比例风险回归模型比较生存率，并分析与肌少症的相关性。中位随访时间为 83 个月。
632 例患者中，268 例（42.4%）被归类为肌少症。肌少症组年龄较大（57 岁比 53 岁），男性比例更高（71.3%比 59.9%）。肌少症患者的体重指数（BMI）较低（23.0kg/m 比 25.9kg/m），但肿瘤大小、分期或核分级无差异。肌少症与总体生存率（OS）和癌症特异性生存率（CSS；OS 94.0%比 82.1%；p<0.001 和 CSS 97.5%比 91.8%；p<0.001）较差相关。多因素分析显示，肌少症是全因死亡率（HR 2.58；95%CI 1.02-6.54）和癌症特异性死亡率（HR 3.07；95%CI 1.38-6.83）的独立危险因素。
诊断时的肌少症是接受 pT1-2RCC 根治性肾切除术患者全因和癌症特异性死亡的独立危险因素。这些发现强调了即使在手术候选者中，评估肌少症的存在对风险分层的重要性。
