Yasunobe Yukiko, Akasaka Hiroshi, Yamamoto Koichi, Sugimoto Ken, Maekawa Yoshihiro, Onishi Yuri, Isaka Masaaki, Tanaka Minoru, Fujimoto Taku, Minami Tomohiro, Yoshida Shino, Yamasaki Makoto, Yamashita Kotaro, Noda Takehiro, Takahashi Hidekazu, Eguchi Hidetoshi, Doki Yuichiro, Rakugi Hiromi
Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
J Am Med Dir Assoc. 2024 Jan;25(1):98-103. doi: 10.1016/j.jamda.2023.05.020. Epub 2023 Jun 20.
Muscle weakness, assessed by grip strength, has been shown to predict postoperative mortality in older patients with cancer. Because lower extremity muscle strength well reflects physical performance, we examined whether lower knee extension muscle strength predicts postoperative mortality better than grip strength in older patients with gastrointestinal cancer.
Prospective, observational study in a single institution.
A total of 813 patients (79.0 ± 4.2 years, 66.5% male) aged 65 years or older with gastrointestinal cancer who underwent preoperative evaluation of grip strength and isometric knee extension muscle strength between April 2012 and April 2019 were included.
The study participants were prospectively followed up for postoperative mortality. Muscle weakness was defined as the lowest quartile of grip strength or knee extension strength (GS-muscle weakness and KS-muscle weakness, respectively).
Among the study participants, 176 patients died during a median follow-up of 716 days. In the Kaplan-Meier analysis, we found that patients with both GS-muscle weakness and KS-muscle weakness had a lower survival rate than those without muscle weakness. As expected, higher clinical stages and abdominal and thoracic surgeries compared with endoscopic surgery were associated with increased all-cause mortality. In addition, we found that KS-muscle weakness, but not GS-muscle weakness, was an independent prognostic factor after adjusting for sex, body mass index, cancer stage, surgical technique, and surgical site in the Cox proportional hazard model.
In older patients with gastrointestinal cancer, muscle weakness based on knee extension muscle strength can be a better predictor of postoperative prognosis than muscle weakness based on grip strength.
通过握力评估的肌肉无力已被证明可预测老年癌症患者的术后死亡率。由于下肢肌肉力量能很好地反映身体机能，我们研究了在老年胃肠癌患者中，屈膝伸肌力量是否比握力更能预测术后死亡率。
在单一机构进行的前瞻性观察性研究。
纳入了2012年4月至2019年4月期间接受了握力和等长屈膝伸肌力量术前评估的813例65岁及以上的胃肠癌患者（年龄79.0±4.2岁，男性占66.5%）。
对研究参与者进行术后死亡率的前瞻性随访。肌肉无力定义为握力或屈膝伸肌力量的最低四分位数（分别为握力肌肉无力和屈膝伸肌力量肌肉无力）。
在研究参与者中，176例患者在中位随访716天期间死亡。在Kaplan-Meier分析中，我们发现握力肌肉无力和屈膝伸肌力量肌肉无力的患者生存率低于无肌肉无力的患者。正如预期的那样，与内镜手术相比，更高的临床分期以及腹部和胸部手术与全因死亡率增加相关。此外，在Cox比例风险模型中，调整性别、体重指数、癌症分期、手术技术和手术部位后，我们发现屈膝伸肌力量肌肉无力而非握力肌肉无力是一个独立的预后因素。
在老年胃肠癌患者中，基于屈膝伸肌力量的肌肉无力比基于握力的肌肉无力更能预测术后预后。
