Higashizono Kazuya, Sato Shinsuke, Nakatani Eiji, Hawke Philip, Nagai Erina, Taki Yusuke, Nishida Masato, Watanabe Masaya, Oba Noriyuki
Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan.
Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.
Cancer Diagn Progn. 2023 Jan 3;3(1):67-74. doi: 10.21873/cdp.10181. eCollection 2023 Jan-Feb.
BACKGROUND/AIM: Malnutrition, immune deficiency, and skeletal muscle loss are associated with a risk of postoperative complications in patients with various types of cancer. This study evaluated whether malnutrition, immunological deficiencies, and skeletal muscle loss during neoadjuvant chemotherapy (NAC) predict postoperative complications in patients with esophageal cancer.
We retrospectively reviewed 123 patients with esophageal squamous cell carcinoma treated with NAC and esophagectomy at our hospital between 2014 and 2019. Patients were divided into two groups based on the presence or absence of postoperative infectious complications, such as pneumonia, anastomotic leakage, surgical site infections, pyothorax, acalculous cholecystitis, and peripheral phlebitis. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and Onodera prognostic nutritional index were used as indicators of systemic inflammation and nutritional status. Skeletal muscle mass was evaluated using the skeletal muscle index (SMI), calculated by evaluating the total cross-sectional area of muscle tissue at the third lumbar level in computed tomography imaging. Univariable and multivariable logistic regression analyses were used to identify predictors of postoperative infectious complications.
Postoperative infectious complications occurred in 41 patients (33.3%). A reduction in SMI was observed in 105 patients (87.8%) during NAC. Univariable and multivariable analyses indicated that the reduction in SMI during NAC was an independent predictor of postoperative complications (odds ratio=0.89; 95% confidence interval=0.79-0.99; p=0.048).
Skeletal muscle loss during NAC is a useful predictor of postoperative complications in patients with esophageal cancer undergoing esophagectomy.
背景/目的：营养不良、免疫缺陷和骨骼肌丢失与各类癌症患者术后并发症风险相关。本研究评估了新辅助化疗（NAC）期间的营养不良、免疫缺陷和骨骼肌丢失是否可预测食管癌患者的术后并发症。
我们回顾性分析了2014年至2019年间在我院接受NAC及食管切除术的123例食管鳞状细胞癌患者。根据是否发生术后感染性并发症（如肺炎、吻合口漏、手术部位感染、脓胸、无结石性胆囊炎和外周静脉炎）将患者分为两组。中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值和小野寺预后营养指数用作全身炎症和营养状况指标。使用骨骼肌指数（SMI）评估骨骼肌质量，SMI通过在计算机断层扫描成像中评估第三腰椎水平肌肉组织的总横截面积来计算。采用单因素和多因素逻辑回归分析确定术后感染性并发症的预测因素。
41例患者（33.3%）发生术后感染性并发症。105例患者（87.8%）在NAC期间观察到SMI降低。单因素和多因素分析表明，NAC期间SMI降低是术后并发症的独立预测因素（比值比=0.89；95%置信区间=0.79-0.99；p=0.048）。
NAC期间的骨骼肌丢失是接受食管切除术的食管癌患者术后并发症的有用预测指标。
