Chen Shuqiu, He Ting, Sun Si, Wu Jianping, Xu Bin, Mao Weipu, Chen Ming
Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
Front Surg. 2022 Apr 21;9:871731. doi: 10.3389/fsurg.2022.871731. eCollection 2022.
The aim of this study was to investigate the prognostic role of the dynamics of sarcopenia in the pre- to postoperative for patients with renal cell carcinoma (RCC) undergoing laparoscopic nephrectomy.
This study included 261 patients who underwent laparoscopic nephrectomy between 2014 and 2019. The skeletal muscle index (SMI) of the L3 lumbar region was used to assess sarcopenia. The overall population was divided into four groups according to the dynamics of sarcopenia from pre- to postoperative: group 1 (both pre- and postoperative sarcopenia), group 2 (preoperative non-sarcopenia to postoperative sarcopenia), group 3 (preoperative sarcopenia to postoperative non-sarcopenia), and group 4 (both pre- and postoperative non-sarcopenia). The endpoints of the study were overall survival (OS) and cancer-specific survival (CSS).
Of the 261 patients who underwent laparoscopic nephrectomy, 103 (39.5%) had preoperative sarcopenia and 183 (70.1%) had postoperative sarcopenia. Patients with pre- or postoperative sarcopenia had poor survival outcomes. Sarcopenia dynamic was a better predictor of OS (AUC = 0.737) and CSS (AUC = 0.696) in patients with RCC than pre- and postoperative sarcopenia, and patients in group 4 of sarcopenia dynamic had the best OS and CSS. In addition, sarcopenia dynamics was an independent risk factor for OS and CSS, with a 94.5% reduction in OS risk (HR = 0.055, 95% CI 0.007-0.407, = 0.003) and a 91.9% reduction in CSS risk (HR = 0.081, 95% CI 0.011-0.616, = 0.015) in the group 4 compared with the group 1.
Our study is the first to assess the prognostic value of pre- and postoperative sarcopenia dynamics in patients with RCC.
本研究旨在探讨肾细胞癌（RCC）患者行腹腔镜肾切除术前至术后肌肉减少症动态变化的预后作用。
本研究纳入了2014年至2019年间接受腹腔镜肾切除术的261例患者。采用L3腰椎区域的骨骼肌指数（SMI）评估肌肉减少症。根据术前至术后肌肉减少症的动态变化，将总体人群分为四组：第1组（术前和术后均有肌肉减少症）、第2组（术前无肌肉减少症至术后出现肌肉减少症）、第3组（术前有肌肉减少症至术后无肌肉减少症）和第4组（术前和术后均无肌肉减少症）。研究的终点为总生存期（OS）和癌症特异性生存期（CSS）。
在接受腹腔镜肾切除术的261例患者中，103例（39.5%）术前有肌肉减少症，183例（70.1%）术后有肌肉减少症。术前或术后有肌肉减少症的患者生存结局较差。与术前和术后肌肉减少症相比，肌肉减少症动态变化对RCC患者的OS（AUC = 0.737）和CSS（AUC = 0.696）是更好的预测指标，且肌肉减少症动态变化第4组患者的OS和CSS最佳。此外，肌肉减少症动态变化是OS和CSS的独立危险因素，与第1组相比，第4组的OS风险降低94.5%（HR = 0.055，95%CI 0.007 - 0.407，P = 0.003），CSS风险降低91.9%（HR = 0.081，95%CI 0.011 - 0.616，P = 0.015）。
我们的研究首次评估了RCC患者术前和术后肌肉减少症动态变化的预后价值。
