Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria.
Department of Radio-Oncology, Academic Teaching Hospital, 6800 Feldkirch, Austria.
Nutrients. 2023 Jun 5;15(11):2632. doi: 10.3390/nu15112632.
Malnutrition and skeletal muscle waste (sarcopenia) are known as predictive factors for a poor postoperative outcome. Paradoxically, obesity seems to be associated with a survival advantage in wasting diseases such as cancer. Thus, the interpretation of body composition indices and their impact on rectal cancer therapy has become more and more complex. The aim of this study was to evaluate body composition indices in locally advanced rectal cancer patients prior to therapy and their impact on short- and long-term outcomes.
Between 2008 and 2018, 96 patients were included in this study. Pre-therapeutic CT scans were used to evaluate visceral and subcutaneous fat mass, as well as muscle mass. Body composition indices were compared to body mass index, morbidity, anastomotic leakage rate, local recurrency rate, and oncological long-term outcomes.
Increased visceral fat ( < 0.01), subcutaneous fat ( < 0.01), and total fat mass ( = 0.001) were associated with overweight. Skeletal muscle waste (sarcopenia) ( = 0.045), age ( = 0.004), comorbidities ( < 0.01), and sarcopenic obesity ( = 0.02) were significantly associated with increased overall morbidity. The anastomotic leakage rate was significantly influenced when comorbidities were present ( = 0.006). Patients with sarcopenic obesity showed significantly worse disease-free ( = 0.04) and overall survival ( = 0.0019). The local recurrency rate was not influenced by body composition indices.
Muscle waste, older age, and comorbidities were demonstrated as strong risk factors for increased overall morbidity. Sarcopenic obesity was associated with worse DFS and OS. This study underlines the role of nutrition and appropriate physical activity prior to therapy.
营养不良和骨骼肌减少症（肌少症）是预测术后不良结局的已知因素。具有讽刺意味的是，肥胖似乎与癌症等消耗性疾病的生存优势有关。因此，身体成分指数的解释及其对直肠癌治疗的影响变得越来越复杂。本研究旨在评估治疗前局部晚期直肠癌患者的身体成分指数及其对短期和长期结局的影响。
在 2008 年至 2018 年期间，共纳入 96 名患者。使用治疗前 CT 扫描评估内脏和皮下脂肪量以及肌肉量。将身体成分指数与体重指数、发病率、吻合口漏发生率、局部复发率和肿瘤学长期结果进行比较。
内脏脂肪增加（<0.01）、皮下脂肪增加（<0.01）和总脂肪量增加（=0.001）与超重有关。骨骼肌减少症（肌少症）（=0.045）、年龄（=0.004）、合并症（<0.01）和肌少性肥胖（=0.02）与总发病率显著相关。当存在合并症时，吻合口漏发生率显著受到影响（=0.006）。肌少性肥胖患者的无病生存率（=0.04）和总生存率（=0.0019）明显较差。局部复发率不受身体成分指数的影响。
肌肉减少、年龄较大和合并症是总发病率增加的强烈危险因素。肌少性肥胖与较差的无病生存率和总生存率相关。本研究强调了治疗前营养和适当身体活动的作用。
