Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Surg Today. 2024 May;54(5):407-418. doi: 10.1007/s00595-023-02747-0. Epub 2023 Sep 12.
This study examined the impact of osteosarcopenia on recurrence and the prognosis after resection for extrahepatic biliary tract cancer (EBTC).
We retrospectively analyzed 138 patients after resection for perihilar cholangiocarcinoma (11), distal cholangiocarcinoma (54), gallbladder carcinoma (30), or ampullary carcinoma (43). Osteosarcopenia is defined as the concomitant occurrence of osteopenia and sarcopenia. We investigated the relationship between osteosarcopenia and the overall survival (OS) and disease-free survival (DFS) in univariate and multivariate analyses.
Osteosarcopenia was identified in 38 patients (27.5%) before propensity score (PS) matching. In the multivariate analysis, the independent recurrence factors were the prognostic nutrition index (p = 0.015), osteosarcopenia (p < 0.001), poorly differentiated adenocarcinoma (p = 0.004), perineural invasion (p = 0.002), and non-curability (p = 0.008), whereas the independent prognostic factors were prognostic nutrition index (p = 0.030), osteosarcopenia (p < 0.001), poorly differentiated adenocarcinoma (p = 0.007), lymphatic invasion (p = 0.018), and non-curability (p = 0.004). After PS matching, there was no significant difference in the variables between the patients with and without osteosarcopenia (n = 34 each). The 5-year DFS and OS after PS matching in patients with osteosarcopenia were significantly worse than in patients without osteosarcopenia (17.6% vs. 38.8%, p = 0.013 and 20.6% vs. 57.4%, p = 0.0005, respectively).
Preoperative osteosarcopenia could predict the DFS and OS of patients after resection for EBTC.
本研究探讨了骨肌减少症对肝外胆管癌（E BTC）切除后复发和预后的影响。
我们回顾性分析了 138 例接受肝门部胆管癌（11 例）、远端胆管癌（54 例）、胆囊癌（30 例）或壶腹癌（43 例）切除的患者。骨肌减少症定义为骨质疏松症和肌肉减少症同时发生。我们在单因素和多因素分析中研究了骨肌减少症与总生存期（OS）和无病生存期（DFS）之间的关系。
在倾向评分（PS）匹配前，38 例（27.5%）患者存在骨肌减少症。多因素分析中，独立的复发因素包括预后营养指数（p=0.015）、骨肌减少症（p<0.001）、低分化腺癌（p=0.004）、神经周围侵犯（p=0.002）和不可治愈性（p=0.008），而独立的预后因素包括预后营养指数（p=0.030）、骨肌减少症（p<0.001）、低分化腺癌（p=0.007）、淋巴血管侵犯（p=0.018）和不可治愈性（p=0.004）。PS 匹配后，骨肌减少症患者与无骨肌减少症患者之间的变量无显著差异（每组 34 例）。PS 匹配后，骨肌减少症患者的 5 年 DFS 和 OS 明显低于无骨肌减少症患者（17.6%比 38.8%，p=0.013 和 20.6%比 57.4%，p=0.0005）。
术前骨肌减少症可预测 E BTC 切除后患者的 DFS 和 OS。
