Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
BMC Cancer. 2022 Dec 28;22(1):1358. doi: 10.1186/s12885-022-10453-2.
Preoperative sarcopenia is a predictor of poor survival in cancer patients. We hypothesized that sarcopenia could progress as occult metastasis arose, especially after highly invasive surgery for highly aggressive malignancy. This study aimed to evaluate the associations of postoperative changes in skeletal muscle mass volume with survival outcomes in patients who underwent surgery for perihilar cholangiocarcinoma.
Fifty-six patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar cholangiocarcinoma were studied. The skeletal muscle index (SMI) at the third lumbar vertebra was calculated from axial computed tomography images taken preoperatively and 3-6 months postoperatively (early postoperative period). The associations of clinicopathological variables, including changes of SMI after surgery, with overall survival and recurrence-free survival were evaluated. Moreover, the associations of decreased SMI and elevated serum carbohydrate antigen 19-9 level with early recurrence and poor survival was compared.
Among 56 patients, 26 (46%) had sarcopenia preoperatively and SMI decreased in 29 (52%) in the early postoperative period. During the median follow-up of 57.9 months, 35 patients (63%) developed recurrence and 29 (50%) died. Decreased SMI in the early postoperative period was independently associated with a shorter overall survival (hazard ratio, 2.39; 95% confidence interval, 1.00-6.18; P = 0.049) and a shorter recurrence-free survival (hazard ratio, 2.14; 95% confidence interval, 1.04-4.57; P = 0.039), whereas elevated carbohydrate antigen 19-9 level was not.
Decreased SMI in the early postoperative period may be used as a predictor for recurrence and poor survival in patients undergoing surgery for perihilar cholangiocarcinoma.
术前肌少症是癌症患者预后不良的预测因素。我们假设肌少症可能随着隐匿性转移的出现而进展，尤其是在高度侵袭性手术治疗高度侵袭性恶性肿瘤后。本研究旨在评估肝门部胆管癌患者接受手术治疗后骨骼肌质量体积的术后变化与生存结局的相关性。
对 56 例行肝切除术联合肝外胆管切除术的肝门部胆管癌患者进行研究。从术前和术后 3-6 个月（早期术后）的轴位 CT 图像计算第三腰椎的骨骼肌指数（SMI）。评估包括手术后 SMI 变化在内的临床病理变量与总生存和无复发生存的相关性。此外，还比较了 SMI 降低和血清糖类抗原 19-9 水平升高与早期复发和不良生存的关系。
56 例患者中，26 例（46%）术前存在肌少症，29 例（52%）在早期术后 SMI 下降。在中位随访 57.9 个月期间，35 例（63%）患者发生复发，29 例（50%）患者死亡。早期术后 SMI 下降与总生存时间较短（风险比，2.39；95%置信区间，1.00-6.18；P=0.049）和无复发生存时间较短（风险比，2.14；95%置信区间，1.04-4.57；P=0.039）独立相关，而糖类抗原 19-9 水平升高则无此相关性。
早期术后 SMI 下降可能可作为预测肝门部胆管癌患者手术治疗后复发和不良生存的指标。
