Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, 2278501, Japan.
Clin Nutr. 2022 Jul;41(7):1467-1474. doi: 10.1016/j.clnu.2022.05.002. Epub 2022 May 6.
BACKGROUND & AIMS: Preoperative low skeletal muscle mass and obesity have been identified as poor prognostic factors after gastrectomy for cancer, but the predictive value of combined quantitation of skeletal muscle mass and obesity remains unclear. This study examined the impact of combined body compositions on outcomes after gastrectomy for cancer.
518 patients who had undergone gastric resection for cancer between 2004 and 2017 were analyzed retrospectively. Skeletal muscle mass (skeletal muscle mass index (SMI)) and visceral obesity (visceral fat area) were measured in preoperative computed tomographic images to categorize patients as outlined below. Impacts of these body compositions on outcomes after gastrectomy were investigated.
Body composition was classified as high SMI without obesity in 231 patients (45%), high SMI with obesity in 202 (39%), low SMI without obesity in 55 (11%), and low SMI with obesity in 30 (6%). Postoperative complications developed in 128 patients (25%). Multivariate analysis identified low SMI with obesity as an independent risk factor for postoperative complications (odds ratio, 3.27; P = 0.010). Moreover, patients with low SMI without obesity had lower 5-year overall survival rates than patients with high SMI without obesity (64.4% vs. 88.0%; P < 0.001) and worse 5-year relapse-free survival rates (61.3% vs. 81.3%; P = 0.002). Multivariate analysis identified low SMI without obesity as a significant risk factor for overall survival (hazard ratio, 3.033; P < 0.001) and relapse-free survival (hazard ratio, 2.144; P = 0.008) after gastrectomy.
Preoperative low SMI with obesity was an independent risk factor for postoperative complications, while low SMI without obesity was an independent risk factor for overall and relapse-free survival following gastrectomy for cancer.
术前低骨骼肌量和肥胖已被确定为胃癌根治术后不良预后的因素，但骨骼肌量和肥胖的综合定量预测价值仍不清楚。本研究旨在探讨胃癌根治术后综合身体成分对预后的影响。
回顾性分析 2004 年至 2017 年间接受胃癌胃切除术的 518 例患者。术前 CT 图像测量骨骼肌量（骨骼肌指数（SMI））和内脏肥胖（内脏脂肪面积），将患者分类如下。研究这些身体成分对胃癌胃切除术后结局的影响。
身体成分分类为：高 SMI 无肥胖 231 例（45%），高 SMI 合并肥胖 202 例（39%），低 SMI 无肥胖 55 例（11%），低 SMI 合并肥胖 30 例（6%）。128 例（25%）患者发生术后并发症。多因素分析发现，低 SMI 合并肥胖是术后并发症的独立危险因素（比值比，3.27；P=0.010）。此外，与高 SMI 无肥胖患者相比，低 SMI 无肥胖患者的 5 年总生存率较低（64.4% vs. 88.0%；P<0.001），5 年无复发生存率较差（61.3% vs. 81.3%；P=0.002）。多因素分析发现，低 SMI 无肥胖是总生存（危险比，3.033；P<0.001）和无复发生存（危险比，2.144；P=0.008）的独立危险因素。
术前低 SMI 合并肥胖是术后并发症的独立危险因素，而低 SMI 无肥胖是胃癌根治术后总生存和无复发生存的独立危险因素。
