Cai Zhi-Wei, Li Jia-Lin, Liu Meng, Wang Hong-Wei, Jiang Chong-Yi
Department of General Surgery, Hepato-Biliary-Pancreatic Center, Huadong Hospital, Shanghai 200040, China.
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
World J Gastrointest Surg. 2022 Dec 27;14(12):1350-1362. doi: 10.4240/wjgs.v14.i12.1350.
The only potential curative treatment for patients with pancreatic cancer is surgery; however, the prognosis remains poor. Measures of body composition based on computed tomography (CT) have been established as a reliable predictor of the prognosis of cancer patients after surgery.
To elucidate the associations of body composition measures derived from preoperative CT scans with the prognosis of patients with pancreatic cancer.
One hundred fifteen patients undergoing pancreatic resection with curative intent for pancreatic cancer were retrospectively enrolled. A preoperative CT scan at the third lumbar vertebral level was performed to measure the skeletal muscle index (SMI), mean skeletal muscle radiodensity, subcutaneous adipose tissue index, and visceral to subcutaneous adipose tissue area ratio. The clinical and pathological data were collected. The effects of these factors on long-term survival were evaluated.
Among the five body composition measures, only low SMI independently predicted overall survival (OS) [hazard ratio (HR): 2.307; 95% confidence interval (CI): 1.210-4.402] and recurrence-free survival (HR: 1.907; 95%CI: 1.147-3.171). Furthermore, patients with low SMI ( high SMI) were older (68.8 ± 9.3 years 63.3 ± 8.4 years); low SMI was present in 27 of 56 patients (48.2%) aged 65 years and older and in 11 of 59 younger patients (18.6%). In addition, subgroup analyses revealed that the correlation between low SMI and OS was observed only in patients aged 65 years and older.
Low preoperative SMI was more prevalent in elderly patients and was associated with a poor prognosis among pancreatic cancer patients, especially elderly patients.
胰腺癌患者唯一可能的治愈性治疗方法是手术；然而，其预后仍然很差。基于计算机断层扫描（CT）的身体成分测量已被确立为癌症患者术后预后的可靠预测指标。
阐明术前CT扫描得出的身体成分测量指标与胰腺癌患者预后之间的关联。
回顾性纳入115例接受胰腺癌根治性切除的患者。在第三腰椎水平进行术前CT扫描，以测量骨骼肌指数（SMI）、平均骨骼肌放射密度、皮下脂肪组织指数以及内脏与皮下脂肪组织面积比。收集临床和病理数据。评估这些因素对长期生存的影响。
在五项身体成分测量指标中，只有低SMI独立预测总生存期（OS）[风险比（HR）：2.307；95%置信区间（CI）：1.210 - 4.402]和无复发生存期（HR：1.907；95%CI：1.147 - 3.171）。此外，低SMI（高SMI）患者年龄更大（68.8±9.3岁 63.3±8.4岁）；56例65岁及以上患者中有27例（48.2%）存在低SMI，59例年轻患者中有11例（18.6%）存在低SMI。此外，亚组分析显示，仅在65岁及以上患者中观察到低SMI与OS之间的相关性。
术前低SMI在老年患者中更为普遍，并且与胰腺癌患者，尤其是老年患者的不良预后相关。
