Department of Medical Oncology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, People's Republic of China.
Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen North Road 1017, Luohu District, Shenzhen, 518000, Guangdong, People's Republic of China.
BMC Cancer. 2023 Jul 10;23(1):640. doi: 10.1186/s12885-023-11073-0.
The impact of sarcopenia on the outcome of patients with left-sided colon and rectal cancer has not been exhaustively investigated. Thus, the present study was performed to evaluate the effect of sarcopenia on the outcome of patients with left-sided colon and rectal cancer.
Patients with pathologically diagnosed stage I, II and III left-sided colon or rectal cancer who had undergone curative surgery between January 2008 and December 2014 were retrospectively reviewed. The psoas muscle index (PMI) identified by 3D-image analysis of computed tomographic images was the criterion used to diagnose sarcopenia. The cut-off value recommended by Hamaguchi (PMI value < 6.36 cm/m for men and < 3.92 cm/m for women) was adopted to confirm the diagnosis of sarcopenia. According to the PMI, each patient was divided into the sarcopenia group (SG) or the nonsarcopenia group (NSG). Then, the SG was compared with the NSG in terms of postoperative outcomes.
Among the 939 patients included, 574 (61.1%) were confirmed to have preoperative sarcopenia. Initially, it was demonstrated that the SG was not significantly different from the NSG in terms of most baseline characteristics except for a lower body mass index (BMI) (P < 0.001), a larger tumour size (P < 0.001) and more weight loss (more than 3 kg in the last three months) (P = 0.033). The SG had a longer hospital stay after surgery (P = 0.040), more intraoperative blood transfusions (P = 0.035), and higher incidence of anastomotic fistula (P = 0.027), surgical site infection (SSI) (P = 0.037) and hypoalbuminemia (P = 0.022), 30-day mortality (P = 0.042) and 90-day mortality (P = 0.041). The SG had significantly worse overall survival (OS) (P = 0.016) and recurrence-free survival (RFS) (P = 0.036) than the NSG. Subsequently, Cox regression analysis revealed that preoperative sarcopenia was an independent predictive factor for worse OS (P = 0.0211, HR = 1.367, 95% CI: 1.049-1.782) and RFS (P = 0.045, HR = 1.299, 95% CI: 1.006-1.677).
Preoperative sarcopenia adversely affects the outcome of patients with left-sided colon and rectal cancer, and preoperative nutrition supplementation may help us improve their long-term and short-term outcomes.
目前尚未充分研究肌少症对左侧结肠癌和直肠癌患者结局的影响。因此，本研究旨在评估肌少症对左侧结肠癌和直肠癌患者结局的影响。
回顾性分析 2008 年 1 月至 2014 年 12 月期间接受根治性手术治疗的病理诊断为 I、II 和 III 期左侧结肠癌或直肠癌的患者。通过 CT 图像三维图像分析确定的竖脊肌指数（psoas muscle index，PMI）作为诊断肌少症的标准。采用 Hamaguchi 推荐的截断值（男性<6.36 cm/m，女性<3.92 cm/m）确诊肌少症。根据 PMI，将每位患者分为肌少症组（sarcopenia group，SG）或非肌少症组（nonsarcopenia group，NSG）。然后，比较 SG 与 NSG 的术后结局。
在纳入的 939 例患者中，574 例（61.1%）术前被确诊为肌少症。最初，结果表明，SG 与 NSG 在大多数基线特征方面无显著差异，仅体质量指数（body mass index，BMI）较低（P<0.001）、肿瘤较大（P<0.001）和体重减轻较多（过去 3 个月体重减轻超过 3kg）（P=0.033）。SG 的术后住院时间较长（P=0.040），术中输血较多（P=0.035），吻合口瘘（P=0.027）、手术部位感染（surgical site infection，SSI）（P=0.037）和低白蛋白血症（P=0.022）的发生率较高，30 天死亡率（P=0.042）和 90 天死亡率（P=0.041）较高。SG 的总生存（overall survival，OS）（P=0.016）和无复发生存（recurrence-free survival，RFS）（P=0.036）明显较差。随后，Cox 回归分析显示，术前肌少症是 OS（P=0.0211，HR=1.367，95%CI：1.049-1.782）和 RFS（P=0.045，HR=1.299，95%CI：1.006-1.677）较差的独立预测因素。
术前肌少症对左侧结肠癌和直肠癌患者的结局产生不利影响，术前营养补充可能有助于改善其长期和短期结局。
