Sato Ryuichiro, Oikawa Masaya, Kakita Tetsuya, Okada Takaho, Abe Tomoya, Yazawa Takashi, Tsuchiya Haruyuki, Akazawa Naoya, Yoshimachi Shingo, Okano Haruka, Ito Kei, Tsuchiya Takashi
Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, Sendai, Japan.
Department of Surgery, Japanese Red Cross Sendai Hospital, Sendai, Japan.
J Anus Rectum Colon. 2022 Jan 28;6(1):40-51. doi: 10.23922/jarc.2021-057. eCollection 2022.
Understanding the relationship between sarcopenia and malignancy is increasingly important since they inevitably affect the aging population. We investigated the clinical significance of sarcopenia in nonmetastatic obstructive colorectal cancer (OCRC) patients who were inserted self-expandable metallic stent and underwent curative surgery.
Plain cross-sectional CT images obtained before stenting were retrospectively analyzed in 92 patients. Muscle volume loss (myopenia) and decreased muscle quality (myosteatosis) were evaluated as skeletal muscle index (SMI) and intramuscular adipose tissue content (IMAC), respectively.
This study included 54 men and 38 women, with a median age of 70.5 years. The median interval between SEMS placement and the surgery was 17 days (range, 5-47). There were 35 postoperative complications. The median postoperative hospital stay was 15.5 days (range, 8-77). Twenty-eight patients (41.3%) were classified as SMI-low, and 31 (34.1%) patients were classified as IMAC-high. In multivariate analysis, IMAC-high [hazard ratio (HR) = 7.68, 95% confidence interval (CI) 2.22-26.5, = 0.001] and right-sided tumor (HR = 5.79, 95% CI 1.36-24.7, = 0.018) were independent predictors of postoperative complications. IMAC-high (HR = 23.2, 95% CI 4.11-131, < 0.001) and elevated modified Glasgow prognostic score (mGPS) (HR = 5.85, 95% CI 1.22-28.1, = 0.027) were independent predictors of infectious complications. Relapse-free survival and overall survival were not significantly different regardless of the SMI or IMAC status.
IMAC was associated with postoperative complications and infectious complications. Myosteatosis might be a stronger predictor of postoperative complications than myopenia.
鉴于肌肉减少症和恶性肿瘤对老年人群产生不可避免的影响，了解二者之间的关系愈发重要。我们调查了接受自膨式金属支架置入并进行根治性手术的非转移性梗阻性结直肠癌（OCRC）患者中肌肉减少症的临床意义。
对92例患者支架置入前的平扫CT图像进行回顾性分析。肌肉体积减少（肌减少症）和肌肉质量下降（肌脂肪变性）分别通过骨骼肌指数（SMI）和肌肉内脂肪组织含量（IMAC）进行评估。
本研究纳入54例男性和38例女性，中位年龄为70.5岁。自膨式金属支架置入与手术之间的中位间隔时间为17天（范围5 - 47天）。术后有35例并发症。术后中位住院时间为15.5天（范围8 - 77天）。28例患者（41.3%）被归类为SMI低，31例患者（34.1%）被归类为IMAC高。多因素分析中，IMAC高[风险比（HR）= 7.68，95%置信区间（CI）2.22 - 26.5，P = 0.001]和右侧肿瘤（HR = 5.79，95% CI 1.36 - 24.7，P = 0.018）是术后并发症的独立预测因素。IMAC高（HR = 23.2，95% CI 4.11 - 131，P < 0.001）和改良格拉斯哥预后评分（mGPS）升高（HR = 5.85，95% CI 1.22 - 28.1，P = 0.027）是感染性并发症的独立预测因素。无论SMI或IMAC状态如何，无复发生存率和总生存率均无显著差异。
IMAC与术后并发症和感染性并发症相关。肌脂肪变性可能比肌减少症是更强的术后并发症预测因素。
