From the Department of Physical Therapy (Cameron, SM Judge, AR Judge), University of Florida, Gainesville, FL.
MD-PhD Training Program (Cameron), University of Florida, Gainesville, FL.
J Am Coll Surg. 2023 Apr 1;236(4):677-684. doi: 10.1097/XCS.0000000000000535. Epub 2023 Jan 5.
Sixty percent of patients with esophageal cancer display signs of cachexia at diagnosis. Changes in body composition are common, and muscle mass and quality are measurable through imaging studies. Cachexia leads to functional impairments that complicate treatments, including surgery. We hypothesize that low muscle mass and quality associate with pulmonary function testing parameters, highlighting ventilatory deficits, and postoperative complications in patients receiving esophagectomy.
We performed a retrospective review of patients receiving esophagectomy between 2012 and 2021 at our facility. PET/CT scans were used to quantify skeletal muscle at the L3 and T4 levels. Patient characteristics were recorded, including pulmonary function testing parameters. Regression models were created to characterize predictive associations.
One hundred eight patients were identified. All were included in the final analysis. In linear regression adjusted for sex, age, and COPD status, low L3 muscle mass independently associated with low forced vital capacity (p < 0.005, β 0.354) and forced expiratory volume in 1 second (p < 0.001, β 0.392). Similarly, T4 muscle mass independently predicted forced vital capacity (p < 0.005, β 0.524) and forced expiratory volume in 1 second (p < 0.01, β 0.480). L3 muscle quality correlated with total lung capacity ( R 0.2463, p < 0.05). Twenty-six patients had pleural effusions postoperatively, associated with low muscle quality on L3 images (p < 0.05). Similarly, patients with hospitalization more than 2 weeks presented with lower muscle quality (p < 0.005).
Cachexia and low muscle mass are common. Reduced muscle mass and quality independently associate with impaired forced vital capacity, forced expiratory volume in 1 second, and total lung capacity. We propose that respiratory muscle atrophy occurs with weight loss. Body composition analyses may aid in stratifying patients. Pulmonary function testing may also serve as a functional endpoint for clinical trials. These findings highlight the need to study mechanisms that lead to respiratory muscle pathology and dysfunction in tumor-bearing hosts.
60%的食管癌患者在诊断时表现出恶病质的迹象。身体成分的变化很常见，肌肉质量和数量可以通过影像学研究来衡量。恶病质导致功能障碍，使包括手术在内的治疗复杂化。我们假设低肌肉质量和质量与肺功能测试参数相关，突出显示接受食管切除术的患者的通气缺陷和术后并发症。
我们对 2012 年至 2021 年在我们机构接受食管切除术的患者进行了回顾性研究。PET/CT 扫描用于量化 L3 和 T4 水平的骨骼肌。记录了患者的特征，包括肺功能测试参数。创建回归模型以描述预测关联。
确定了 108 名患者。所有人都被纳入最终分析。在线性回归中，调整了性别、年龄和 COPD 状态，低 L3 肌肉质量与低用力肺活量独立相关（p<0.005，β0.354）和 1 秒用力呼气量（p<0.001，β0.392）。同样，T4 肌肉质量独立预测用力肺活量（p<0.005，β0.524）和 1 秒用力呼气量（p<0.01，β0.480）。L3 肌肉质量与总肺容量相关（R0.2463，p<0.05）。26 例患者术后出现胸腔积液，与 L3 图像上的低肌肉质量相关（p<0.05）。同样，住院时间超过 2 周的患者肌肉质量较低（p<0.005）。
恶病质和低肌肉质量很常见。肌肉质量和质量的降低与用力肺活量、1 秒用力呼气量和总肺容量受损独立相关。我们提出，体重减轻时会发生呼吸肌萎缩。身体成分分析可能有助于对患者进行分层。肺功能测试也可以作为临床试验的功能终点。这些发现强调了需要研究导致肿瘤宿主呼吸肌病理和功能障碍的机制。
