Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Cachexia Sarcopenia Muscle. 2023 Apr;14(2):860-868. doi: 10.1002/jcsm.13183. Epub 2023 Jan 25.
Myosteatosis and systemic inflammation are well-known prognostic factors in patients with colorectal cancer (CRC). The serum albumin level is a reflection of malnutrition and systemic inflammation, which in turn plays a key role in the development of myosteatosis. However, few studies have been conducted on these synergistic effects. This study aimed to examine the individual and synergistic effects of different prognostic markers related to skeletal muscle quality and serum albumin levels in patients with CRC.
This study enrolled patients with stage I-III CRC who underwent surgical resection between July 2006 and February 2014. Skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) were calculated using computed tomography at the L3 level obtained within 2 months prior to surgery. The albumin-myosteatosis gauge (AMG) was defined as SMD × albumin. Patients were divided into sex-specific quartiles (G1 to G4) according to the AMG, and analysis of variance for continuous variables and chi-square test for categorical variables were used to compare variables among quartiles. Cox proportional hazard models were constructed and integrated receiver operating characteristic curve (iAUC) analysis was used to compare the prognostic performance of SMD, albumin and AMG.
Among the 906 participants, the median (interquartile) age was 64 (55-72) years, and 365 (40.3%) were female. AMG was significantly correlated with the occurrence of complications, albumin level, SMI and SMD (all P < 0.001). Overall survival (OS) differed significantly according to the AMG group, with 5-year OS for G1-G4 being 73.4%, 86.2%, 91.1% and 95.5%, respectively (P < 0.0001). Although SMI, SMD, albumin and AMG were all significant individual prognostic markers of OS in the univariable analysis, AMG remained the only independent prognostic factor in the multivariable analysis (G1 vs. G2, P = 0.045, G1 vs. G3, P = 0.005, G1 vs. G4, P < 0.001, respectively). The iAUC value of AMG [0.681, 95% confidence interval (CI) = 0.638-0.723] was superior to that of SMD (0.610, 95% CI = 0.566-0.654) (bootstrap iAUC mean difference = 0.071, 95% CI = 0.034-0.106), SMI (0.551, 95% CI = 0.511-0.594) (bootstrap iAUC mean difference = 0.129, 95% CI = 0.076-0.181) and albumin (0.627, 95% CI = 0.585-0.668) (bootstrap iAUC mean difference = 0.053, 95% CI = 0.010-0.098).
In patients with stage I-III CRC, AMG is a meaningful predictor of survival, with superior prognostic value compared to SMI, SMD or albumin alone. Further studies are needed to determine their significance in different ethnic groups.
肌内脂肪增多和全身炎症是结直肠癌（CRC）患者预后的已知因素。血清白蛋白水平反映了营养不良和全身炎症，而这反过来又在肌内脂肪增多的发展中起着关键作用。然而，很少有研究关注这些协同作用。本研究旨在研究与骨骼肌质量和血清白蛋白水平相关的不同预后标志物的个体和协同作用，以评估 CRC 患者的预后。
本研究纳入了 2006 年 7 月至 2014 年 2 月期间接受手术切除的 I-III 期 CRC 患者。在手术前 2 个月内使用 CT 计算 L3 水平的骨骼肌指数（SMI）和骨骼肌密度（SMD）。白蛋白-肌内脂肪量表（AMG）定义为 SMD×白蛋白。根据 AMG 将患者分为性别特异性四分位数（G1 至 G4），并使用方差分析比较四分位数之间的连续变量，使用卡方检验比较分类变量。构建 Cox 比例风险模型，并使用整合接受者操作特征曲线（iAUC）分析比较 SMD、白蛋白和 AMG 的预后性能。
在 906 名参与者中，中位（四分位间距）年龄为 64（55-72）岁，365 名（40.3%）为女性。AMG 与并发症的发生、白蛋白水平、SMI 和 SMD 显著相关（均 P<0.001）。根据 AMG 组，总生存率（OS）差异显著，G1-G4 的 5 年 OS 分别为 73.4%、86.2%、91.1%和 95.5%（P<0.0001）。虽然 SMI、SMD、白蛋白和 AMG 在单变量分析中均为 OS 的显著个体预后标志物，但 AMG 是多变量分析中唯一的独立预后因素（G1 与 G2，P=0.045；G1 与 G3，P=0.005；G1 与 G4，P<0.001）。AMG 的 iAUC 值[0.681，95%置信区间（CI）=0.638-0.723]优于 SMD 的 iAUC 值[0.610，95%CI=0.566-0.654]（bootstrap iAUC 均值差异=0.071，95%CI=0.034-0.106）、SMI 的 iAUC 值[0.551，95%CI=0.511-0.594]（bootstrap iAUC 均值差异=0.129，95%CI=0.076-0.181）和白蛋白的 iAUC 值[0.627，95%CI=0.585-0.668]（bootstrap iAUC 均值差异=0.053，95%CI=0.010-0.098）。
在 I-III 期 CRC 患者中，AMG 是生存的有意义的预测指标，其预后价值优于 SMI、SMD 或白蛋白单独使用。需要进一步的研究来确定它们在不同种族群体中的意义。
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