Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland OH, USA.
Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland OH, USA.
Am Surg. 2023 Dec;89(12):5631-5637. doi: 10.1177/00031348231160849. Epub 2023 Mar 10.
Sarcopenia, defined as low skeletal muscle mass, affects up to 60% of rectal adenocarcinoma patients receiving neoadjuvant chemoradiation (NACRT), with negative impact on patient outcomes. Identifying modifiable risk factors may decrease morbidity and mortality.
A retrospective review of rectal cancer patients from a single academic center from 2006 to 2020 was performed. Sixty-nine patients with pre- and post-NACRT CT imaging were included. Skeletal muscle index (SMI) was calculated as total L3 skeletal muscle divided by height squared. Sarcopenia thresholds were 52.4 cm/m for men and 38.5 cm/m for women. Student T-test, chi-square test, multivariable regression, and multivariable Cox hazard analysis were performed.
62.3% of patients lost SMI from pre- to post-NACRT imaging, with a mean change of -7.8% (±19.9%). Eleven (15.9%) patients were sarcopenic at presentation, increasing to 20 (29.0%) following NACRT. Mean SMI decreased from 49.0 cm/m (95% CI: 42.0 cm/m-56.0 cm/m) to 38.2 cm/m (95% CI: 33.6 cm/m-42.9 cm/m) (P = .003). Pre-NACRT sarcopenia correlated with post-NACRT sarcopenia (OR 20.6, P = .002). Percent decrease in SMI was associated with a 5% increased mortality risk.
The presence of sarcopenia at diagnosis and its association with post-NACRT sarcopenia suggests an opportunity for a high-impact intervention.
骨骼肌减少症定义为低骨骼肌量，影响多达 60%接受新辅助放化疗（NACRT）的直肠腺癌患者，对患者预后产生负面影响。确定可改变的危险因素可能会降低发病率和死亡率。
对 2006 年至 2020 年来自单一学术中心的直肠癌患者进行回顾性研究。共纳入 69 例接受 NACRT 前后 CT 影像学检查的患者。通过 L3 总骨骼肌除以身高的平方计算骨骼肌指数（SMI）。男性的骨骼肌减少症阈值为 52.4cm/m，女性为 38.5cm/m。采用学生 t 检验、卡方检验、多变量回归和多变量 Cox 风险分析。
62.3%的患者在 NACRT 前后的影像学检查中失去了 SMI，平均变化为-7.8%（±19.9%）。11 名（15.9%）患者在就诊时存在骨骼肌减少症，NACRT 后增加至 20 名（29.0%）。SMI 从 49.0cm/m（95%CI：42.0cm/m-56.0cm/m）降至 38.2cm/m（95%CI：33.6cm/m-42.9cm/m）（P=0.003）。NACRT 前的骨骼肌减少症与 NACRT 后的骨骼肌减少症相关（OR 20.6，P=0.002）。SMI 减少百分比与死亡率增加 5%相关。
诊断时存在骨骼肌减少症及其与 NACRT 后骨骼肌减少症的关联表明存在高影响干预的机会。
