Lu Jun, Xue Zhen, Xie Jian-Gao, Xu Bin-Bin, Yang Hai-Bo, Wu Dong, Zheng Hua-Long, Xie Jian-Wei, Wang Jia-Bin, Lin Jian-Xian, Chen Qi-Yue, Li Ping, Huang Chang-Ming, Zheng Chao-Hui
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Ann Surg Oncol. 2022 Mar 16. doi: 10.1245/s10434-022-11509-0.
Studies have shown that traditional nutrition indicators and body composition indicators are closely related to prognosis after radical gastric cancer (GC) surgery. However, the effect of the combined muscle and adipose composite on the prognosis of GC has not been reported.
The clinicopathological data of 514 patients with GC were retrospectively analyzed. The skeletal muscle adipose tissue were measured by preoperative CT images to obtain the muscle index and adipose index. X-tile software was used to determine the diagnostic threshold of muscle-adipose imbalance.
The 5-year OS and RFS of the muscle-adipose imbalanced group were significantly worse than those of the balanced group. Multivariate analysis showed that muscle-adipose imbalance and the CONUT score were independent prognostic factors of OS and RFS (p < 0.05). The nuclear density curve showed that the recurrence risk of the muscle-adipose imbalanced group was higher than that of the balanced group, whereas the nuclear density curve of the CONUT score was confounded. Incorporating the muscle-adipose index into cTNM has the same prognostic performance as the pTNM staging system. Chemotherapy-benefit analysis showed that stage II/III patients in the muscle-adipose balanced group could benefit from adjuvant chemotherapy.
The preoperative muscle-adipose index discovered for the first time is a new independent prognostic factor that affects the prognosis with GC. In addition, the preoperative muscle-adipose index is better than traditional nutrition and body composition indicators in terms of the prognostic evaluation of GC patients and the predictive value of recurrence risk.
研究表明，传统营养指标和身体成分指标与胃癌（GC）根治术后的预后密切相关。然而，肌肉与脂肪复合指标对GC预后的影响尚未见报道。
回顾性分析514例GC患者的临床病理资料。通过术前CT图像测量骨骼肌脂肪组织，以获得肌肉指数和脂肪指数。使用X-tile软件确定肌肉-脂肪失衡的诊断阈值。
肌肉-脂肪失衡组的5年总生存期（OS）和无复发生存期（RFS）明显差于平衡组。多因素分析显示，肌肉-脂肪失衡和CONUT评分是OS和RFS的独立预后因素（p<0.05）。核密度曲线显示，肌肉-脂肪失衡组的复发风险高于平衡组，而CONUT评分的核密度曲线存在混淆。将肌肉-脂肪指数纳入cTNM与pTNM分期系统具有相同的预后性能。化疗获益分析显示，肌肉-脂肪平衡组的II/III期患者可从辅助化疗中获益。
首次发现的术前肌肉-脂肪指数是影响GC预后的一个新的独立预后因素。此外，术前肌肉-脂肪指数在GC患者的预后评估和复发风险预测价值方面优于传统营养和身体成分指标。
