可切除胰腺导管腺癌患者肌肉减少症和肌内脂肪变性的预后价值。
Prognostic Value of Sarcopenia and Myosteatosis in Patients with Resectable Pancreatic Ductal Adenocarcinoma.
机构信息
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
出版信息
Korean J Radiol. 2022 Nov;23(11):1055-1066. doi: 10.3348/kjr.2022.0277. Epub 2022 Aug 31.
OBJECTIVE
The clinical relevance of myosteatosis has not been well evaluated in patients with pancreatic ductal adenocarcinoma (PDAC), although sarcopenia has been extensively researched. Therefore, we evaluated the prognostic value of muscle quality, including myosteatosis, in patients with resectable PDAC treated surgically.
MATERIALS AND METHODS
We retrospectively evaluated 347 patients with resectable PDAC who underwent curative surgery (mean age ± standard deviation, 63.6 ± 9.6 years; 202 male). Automatic muscle segmentation was performed on preoperative computed tomography (CT) images using an artificial intelligence program. A single axial image of the portal phase at the inferior endplate level of the L3 vertebra was used for analysis in each patient. Sarcopenia was evaluated using the skeletal muscle index, calculated as the skeletal muscle area (SMA) divided by the height squared. The mean SMA attenuation was used to evaluate myosteatosis. Diagnostic cutoff values for sarcopenia and myosteatosis were devised using the Contal and O'Quigley methods, and patients were classified according to normal (nMT), sarcopenic (sMT), myosteatotic (mMT), or combined (cMT) muscle quality types. Multivariable Cox regression analyses were conducted to assess the effects of muscle type on the overall survival (OS) and recurrence-free survival (RFS) after surgery.
RESULTS
Eighty-four (24.2%), 73 (21.0%), 75 (21.6%), and 115 (33.1%) patients were classified as having nMT, sMT, mMT, and cMT, respectively. Compared to nMT, mMT and cMT were significantly associated with poorer OS, with hazard ratios (HRs) of 1.49 (95% confidence interval, 1.00-2.22) and 1.68 (1.16-2.43), respectively, while sMT was not (HR of 1.40 [0.94-2.10]). Only mMT was significantly associated with poorer RFS, with an HR of 1.59 (1.07-2.35), while sMT and cMT were not.
CONCLUSION
Myosteatosis was associated with poor OS and RFS in patients with resectable PDAC who underwent curative surgery.
目的
尽管肌肉减少症在胰腺导管腺癌（PDAC）患者中已经得到了广泛研究，但脂肪肌在 PDAC 患者中的临床相关性尚未得到很好的评估。因此，我们评估了可切除 PDAC 患者接受手术治疗后的肌肉质量（包括脂肪肌）的预后价值。
材料和方法
我们回顾性评估了 347 名接受根治性手术的可切除 PDAC 患者（平均年龄±标准差，63.6±9.6 岁；202 名男性）。使用人工智能程序在术前 CT 图像上进行自动肌肉分割。每位患者均在 L3 椎下终板水平的门静脉期进行单次轴位图像分析。使用骨骼肌指数评估肌肉减少症，其计算方法为骨骼肌面积（SMA）除以身高的平方。使用平均 SMA 衰减值来评估脂肪肌。使用 Contal 和 O'Quigley 方法设计了肌肉减少症和脂肪肌的诊断截断值，并根据正常（nMT）、肌肉减少症（sMT）、脂肪肌（mMT）或合并（cMT）肌肉质量类型对患者进行分类。进行多变量 Cox 回归分析以评估肌肉类型对手术后总体生存（OS）和无复发生存（RFS）的影响。
结果
84 例（24.2%）、73 例（21.0%）、75 例（21.6%）和 115 例（33.1%）患者分别被归类为 nMT、sMT、mMT 和 cMT。与 nMT 相比，mMT 和 cMT 与较差的 OS 显著相关，风险比（HRs）分别为 1.49（95%置信区间，1.00-2.22）和 1.68（1.16-2.43），而 sMT 则没有（HR 为 1.40[0.94-2.10]）。只有 mMT 与较差的 RFS 显著相关，HR 为 1.59（1.07-2.35），而 sMT 和 cMT 则没有。
结论
脂肪肌与接受根治性手术的可切除 PDAC 患者的 OS 和 RFS 较差相关。
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