Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China.
School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang, China.
BMC Cancer. 2023 Mar 6;23(1):212. doi: 10.1186/s12885-023-10643-6.
Literature review have shown that sarcopenia substantially alters the postoperative outcomes after liver resection for malignant tumors. However, these retrospective studies do not distinguish cirrhotic and non-cirrhotic liver cancer patients, nor combine the assessment of muscle strength in addition to muscle mass. The purpose of this study is to study the relationship between sarcopenia and short-term outcomes after hepatectomy in patients with non-cirrhotic liver cancer.
From December 2020 to October 2021, 431 consecutive inpatients were prospectively enrolled in this study. Muscle strength and mass were assessed by handgrip strength and the skeletal muscle index (SMI) on preoperative computed tomographic scans, respectively. Based on the SMI and the handgrip strength, patients were divided into four groups: group A (low muscle mass and strength), group B (low muscle mass and normal muscle strength), group C (low muscle strength and normal muscle mass), and group D (normal muscle mass and strength). The main outcome was major complications and the secondary outcome was 90-d Readmission rate.
After strictly exclusion, 171 non-cirrhosis patients (median age, 59.00 [IQR, 50.00-67.00] years; 72 females [42.1%]) were selected in the final analysis. Patients in group A had a statistically significantly higher incidence of major postoperative complications (Clavien-Dindo classification ≥ III) (26.1%, p = 0.032), blood transfusion rate (65.2%, p < 0.001), 90-day readmission rate (21.7%, p = 0.037) and hospitalization expenses (60,842.00 [IQR, 35,563.10-87,575.30], p < 0.001) than other groups. Sarcopenia (hazard ratio, 4.21; 95% CI, 1.44-9.48; p = 0.025) and open approach (hazard ratio, 2.56; 95% CI, 1.01-6.49; p = 0.004) were independent risk factors associated with major postoperative complications.
Sarcopenia is closely related to poor short-term postoperative outcomes in non-cirrhosis liver cancer patients and the assessment that combines muscle strength and muscle mass can simply and comprehensively identify it.
ClinicalTrials.gov identifiers NCT04637048 . (19/11/2020).
文献回顾表明，肌肉减少症在恶性肿瘤肝切除术后的术后结局中起重要作用。然而，这些回顾性研究并未区分肝硬化和非肝硬化肝癌患者，也未结合肌肉力量和肌肉质量评估。本研究旨在研究非肝硬化肝癌患者肝切除术后肌肉减少症与短期预后的关系。
从 2020 年 12 月至 2021 年 10 月，前瞻性纳入了 431 例连续住院患者。肌肉力量和质量分别通过术前 CT 扫描的握力和骨骼肌指数（SMI）评估。根据 SMI 和握力，将患者分为 4 组：A 组（肌肉量低且力量弱）、B 组（肌肉量低但肌肉力量正常）、C 组（肌肉力量低但肌肉量正常）和 D 组（肌肉量和力量正常）。主要结局是主要并发症，次要结局是 90 天再入院率。
经过严格排除，最终有 171 例非肝硬化患者（中位年龄 59.00[IQR，50.00-67.00]岁；72 例女性[42.1%]）被纳入最终分析。A 组患者的术后主要并发症（Clavien-Dindo 分级≥III 级）发生率（26.1%，p=0.032）、输血率（65.2%，p<0.001）、90 天再入院率（21.7%，p=0.037）和住院费用（60842.00[IQR，35563.10-87575.30]，p<0.001）均显著高于其他组。肌肉减少症（风险比，4.21；95%CI，1.44-9.48；p=0.025）和开放手术入路（风险比，2.56；95%CI，1.01-6.49；p=0.004）是与主要术后并发症相关的独立危险因素。
肌肉减少症与非肝硬化肝癌患者术后短期预后不良密切相关，结合肌肉力量和肌肉质量的评估可以简单、全面地识别肌肉减少症。
ClinicalTrials.gov 标识符 NCT04637048。（2020 年 11 月 19 日）
