National Cancer Center Hospital East, Department of Urology, Chiba, Japan.
Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
Clin Nutr. 2023 Sep;42(9):1537-1544. doi: 10.1016/j.clnu.2023.07.005. Epub 2023 Jul 12.
BACKGROUND & AIMS: Recently, the strength, assistance with walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire has been developed to screen patients with signs of sarcopenia. However, its clinical benefit remains uncertain in elderly patients undergoing elective major surgeries. This study aimed to explore the role of the SARC-F questionnaire as a screening tool for patients who plan to undergo elective major surgery for urologic cancer and to also evaluate correlations of SARC-F scores with established indicators of sarcopenia.
This retrospective observational study enrolled 815 patients over 40 years of age undergoing elective major surgery for urologic cancer and who were screened with the SARC-F questionnaire, preoperatively. The primary endpoint was an association between SARC-F scores and postoperative ambulation failure. Here we define postoperative ambulation failure as a condition where a patient is unable to walk independently within 2 days after surgery and required physical rehabilitation or was transferred to other hospitals in a bedridden state. The secondary endpoint was an association between SARC-F scores and overall survival (OS). Psoas muscle density (PMD) and psoas muscle index (PMI) were calculated from abdominal computed tomography images, and their correlations with SARC-F scores grouped by sex.
Of the 815 patients, 738 (91%) were male and the median age was 72 years. Although SARC-F scores weakly correlated with PMD in males and moderately correlated in females (ρ = -0.222 and ρ = -0.474, respectively), their correlation with PMI was negligible (ρ = -0.179 and ρ = -0.084, respectively). SARC-F scores successfully discriminate postoperative ambulation failure in both males and females with the respective area under the receiver operating characteristic curve of 0.856 and 0.813. Multivariate analysis also showed that SARC-F scores greater than 4 are an independent risk factor of postoperative ambulation failure along with older age, lower PMD, and poor performance status. SARC-F scores greater than 4 were significantly associated with a shorter OS in the whole cohort (P < 0.001) and a subgroup of patients undergoing radical cystectomy (P = 0.03; median follow-up of 515 days).
The SARC-F questionnaire might be applicable to identify elderly patients at a higher risk of unfavourable outcomes after major urologic cancer surgery. A randomised controlled trial is necessary to confirm this finding.
最近，力量、助行能力、从椅子上起身能力、爬楼梯能力和跌倒能力（SARC-F）问卷已被开发出来，用于筛查有肌少症迹象的患者。然而，其在接受择期大手术的老年患者中的临床获益仍不确定。本研究旨在探讨 SARC-F 问卷作为筛查计划接受择期大手术治疗泌尿系统癌症的患者的工具的作用，并评估 SARC-F 评分与既定肌少症指标的相关性。
本回顾性观察性研究纳入了 815 名年龄在 40 岁以上、接受择期大手术治疗泌尿系统癌症并接受 SARC-F 问卷筛查的患者。主要终点是 SARC-F 评分与术后活动失败之间的关联。我们将术后活动失败定义为患者在手术后 2 天内无法独立行走，需要进行物理康复或卧床状态下转至其他医院的情况。次要终点是 SARC-F 评分与总生存期（OS）之间的关联。从腹部 CT 图像计算腰大肌密度（PMD）和腰大肌指数（PMI），并按性别分组分析其与 SARC-F 评分的相关性。
在 815 名患者中，738 名（91%）为男性，中位年龄为 72 岁。尽管 SARC-F 评分与男性的 PMD 呈弱相关，与女性的 PMD 呈中度相关（ρ=-0.222 和 ρ=-0.474），但与 PMI 的相关性可忽略不计（ρ=-0.179 和 ρ=-0.084）。SARC-F 评分可成功区分男性和女性的术后活动失败，其受试者工作特征曲线下面积分别为 0.856 和 0.813。多变量分析还表明，SARC-F 评分大于 4 是术后活动失败的独立危险因素，同时还与年龄较大、较低的 PMD 和较差的表现状态相关。SARC-F 评分大于 4 与全队列（P<0.001）和接受根治性膀胱切除术的亚组患者（P=0.03；中位随访 515 天）的较短总生存期显著相关。
SARC-F 问卷可能适用于识别接受大泌尿系统癌症手术后预后不良风险较高的老年患者。需要进行随机对照试验来证实这一发现。
