Takano Yasuhiro, Kodera Keita, Tsukihara Shu, Takahashi Sumika, Kobayashi Yasunobu, Koyama Muneyuki, Kanno Hironori, Ishiyama Satoshi, Hanyu Nobuyoshi, Eto Ken
Department of Surgery Tokyo Generel Hospital Tokyo Japan.
Department of Surgery Kasai Shoikai Hospital Tokyo Japan.
Ann Gastroenterol Surg. 2023 Feb 20;7(4):637-644. doi: 10.1002/ags3.12663. eCollection 2023 Jul.
Osteopenia and sarcopenia, features of the aging process, are recognized as major health problems in an aging society. This study investigated the prognostic impact of osteosarcopenia, the coexistence of osteopenia and sarcopenia, in older adults undergoing curative resection for colorectal cancer.
We retrospectively reviewed data of older adults aged 65-98 y who had undergone curative resection for colorectal cancer. Osteopenia was evaluated by bone mineral density measurement in the midvertebral core of the 11th thoracic vertebra on preoperative computed tomography images. Sarcopenia was evaluated by measuring the skeletal muscle cross-sectional area at the third lumbar vertebra level. Osteosarcopenia was defined as the coexistence of osteopenia and sarcopenia. We explored the relationship of preoperative osteosarcopenia with the disease-free and overall survival after curative resection.
Among the 325 patients included, those with osteosarcopenia had significantly lower overall survival rates than those with osteopenia or sarcopenia alone ( 0.01). In the multivariate analysis, male sex ( 0.045), C-reactive protein-to-albumin ratio ( 0.01), osteosarcopenia ( 0.01), pathological T4 stage ( 0.023), and pathological N1/N2 stage ( 0.01) were independent predictors of disease-free survival, while age ( 0.01), male sex ( 0.049), C-reactive protein-to-albumin ratio ( 0.01), osteosarcopenia ( 0.01), pathological T4 stage ( 0.036), pathological N1/N2 stage ( 0.01), and carbohydrate antigen 19-9 ( 0.041) were independent predictors of overall survival.
Osteosarcopenia was a strong predictor of poor outcomes in older adults undergoing curative resection for colorectal cancer, suggesting an important role of osteosarcopenia in an aging society.
骨质减少和肌肉减少症是衰老过程的特征，在老龄化社会中被视为主要的健康问题。本研究调查了骨质肌肉减少症（即骨质减少和肌肉减少症并存）对接受结直肠癌根治性切除的老年人的预后影响。
我们回顾性分析了65至98岁接受结直肠癌根治性切除的老年人的数据。通过术前计算机断层扫描图像测量第11胸椎椎体中部核心区域的骨密度来评估骨质减少情况。通过测量第三腰椎水平的骨骼肌横截面积来评估肌肉减少症。骨质肌肉减少症定义为骨质减少和肌肉减少症并存。我们探讨了术前骨质肌肉减少症与根治性切除术后无病生存期和总生存期的关系。
在纳入的325例患者中，患有骨质肌肉减少症的患者的总生存率显著低于仅患有骨质减少症或肌肉减少症的患者（P<0.01）。在多变量分析中，男性（P=0.045）、C反应蛋白与白蛋白比值（P=0.01）、骨质肌肉减少症（P=0.01）、病理T4期（P=0.023）和病理N1/N2期（P=0.01）是无病生存期的独立预测因素，而年龄（P=0.01）、男性（P=0.049）、C反应蛋白与白蛋白比值（P=0.01）、骨质肌肉减少症（P=0.01）、病理T4期（P=0.036）、病理N1/N2期（P=0.01）和糖类抗原19-9（P=0.041）是总生存期的独立预测因素。
骨质肌肉减少症是接受结直肠癌根治性切除的老年人预后不良的有力预测因素，表明骨质肌肉减少症在老龄化社会中具有重要作用。
