Department of Gastrointestinal Surgery, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
World J Surg. 2023 Jun;47(6):1503-1511. doi: 10.1007/s00268-023-06942-5. Epub 2023 Feb 21.
The optimal method for evaluating frailty grade in patients with cancer has not been established in patients undergoing esophagectomy for esophageal cancer. This study aimed to clarify the impact of cachexia index (CXI) and osteopenia on survival in esophagectomized patients for esophageal cancer to develop frailty grade for risk stratification of the prognosis.
A total of 239 patients who underwent esophagectomy were analyzed. CXI was calculated as follows: skeletal muscle index × serum albumin/neutrophil-to-lymphocyte ratio. Meanwhile, osteopenia was defined as below the cutoff value of bone mineral density (BMD) calculated by the receiver operating characteristic curve. We evaluated the average Hounsfield unit within a circle in the lower midvertebral core of the 11th thoracic vertebra on preoperative computed tomography as BMD.
Multivariate analysis revealed that low CXI (Hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.25-3.04) and osteopenia (HR, 1.86; 95% CI, 1.19-2.93) were independent prognostic factors for overall survival. Meanwhile, low CXI (HR, 1.58; 95% CI, 1.06-2.34) and osteopenia (HR, 1.57; 95% CI, 1.05-2.36) were also significant prognostic factors for relapse-free survival. A frailty grade combined with CXI and osteopenia stratified into four groups by their prognosis.
Low CXI and osteopenia predict poor survival in patients undergoing esophagectomy for esophageal cancer. Furthermore, a novel frailty grade combined with CXI and osteopenia stratified the patients into four groups according to their prognosis.
在接受食管癌切除术的癌症患者中，尚未确定评估虚弱程度的最佳方法。本研究旨在阐明恶病质指数（CXI）和骨质疏松症对食管癌切除术患者生存的影响，以制定虚弱分级，对预后进行风险分层。
共分析了 239 例接受食管癌切除术的患者。CXI 的计算方法如下：骨骼肌指数×血清白蛋白/中性粒细胞与淋巴细胞比值。同时，骨质疏松症定义为骨密度（BMD）低于通过受试者工作特征曲线计算的截值。我们在术前计算机断层扫描的第 11 胸椎中下中轴的圆圈内评估下中轴的平均 Hounsfield 单位。
多变量分析显示，低 CXI（危险比 [HR]，1.95；95%置信区间 [CI]，1.25-3.04）和骨质疏松症（HR，1.86；95% CI，1.19-2.93）是总生存的独立预后因素。同时，低 CXI（HR，1.58；95% CI，1.06-2.34）和骨质疏松症（HR，1.57；95% CI，1.05-2.36）也是无复发生存的显著预后因素。一个虚弱分级结合 CXI 和骨质疏松症，根据预后分为四组。
低 CXI 和骨质疏松症预示着接受食管癌切除术的癌症患者生存不良。此外，一种新的虚弱分级结合 CXI 和骨质疏松症，根据预后将患者分为四组。
