Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, Osaka, Japan.
Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan.
Medicine (Baltimore). 2023 Oct 13;102(41):e35547. doi: 10.1097/MD.0000000000035547.
The low attenuation area percentage (LAA%) is gaining popularity. LAA% is an index of quantitative emphysema on computed tomography (CT) imaging of the chest. This study aims to retrospectively investigate whether preoperative LAA% is associated with postoperative prognosis in patients with esophageal cancer who were scheduled for esophagectomy. From January 2016 to March 2020, 105 patients with esophageal cancer underwent esophagectomy via right thoracotomy and neoadjuvant chemotherapy. A Synapse Vincent volume analyzer (Fujifilm Medical, Tokyo, Japan) was used for measurement. The software automatically quantified LAA% using a threshold of less than - 950 Hounsfield units on CT images of lung regions. Cox proportional hazard analyses were performed in univariable and multivariable forms. Estimates of the receiver operating curve are used to determine the cutoff value for death of LAA%, and the binary value is then inserted into Cox proportional hazard analyses. The preoperative LAA% cutoff value was ≥ 6.3%. Patients with a preoperative LAA% ≥6.3% had a significantly worse prognosis than those with a preoperative LAA% of < 6.3%. LAA% ≥6.3% (hazard ratio: 6.76; 95% confidence interval: 2.56-17.90, P < .001) was the most influential preoperative factor for overall survival after esophagectomy in multivariate Cox proportional hazard analyses. LAA% is one of the preoperative risk factors for survival after esophagectomy and an indicator of lung condition using routinely performed preoperative CT images. We quantified the extent of preoperative emphysema in patients with esophageal cancer, who were scheduled for surgery, and for the first time, reported LAA% as one of the preoperative risk factors for survival after esophagectomy.
低衰减区百分比（LAA%）越来越受欢迎。LAA%是胸部 CT 成像定量肺气肿的指标。本研究旨在回顾性调查接受食管癌切除术的患者术前 LAA%是否与术后预后相关。2016 年 1 月至 2020 年 3 月，105 例食管癌患者通过右开胸和新辅助化疗行食管癌切除术。使用 Synapse Vincent 体积分析仪（富士胶片医疗，东京，日本）进行测量。软件自动使用肺部 CT 图像上小于-950 豪斯菲尔德单位的阈值量化 LAA%。进行单变量和多变量 Cox 比例风险分析。使用接收者操作曲线的估计值确定 LAA%死亡的截止值，然后将二进制值插入 Cox 比例风险分析。术前 LAA%的截止值为≥6.3%。术前 LAA%≥6.3%的患者预后明显差于术前 LAA%＜6.3%的患者。LAA%≥6.3%（风险比：6.76；95%置信区间：2.56-17.90，P＜0.001）是多变量 Cox 比例风险分析中影响食管癌术后总生存的最主要术前因素。LAA%是食管癌患者术后生存的术前危险因素之一，也是使用常规术前 CT 图像评估肺状况的指标。我们量化了计划手术的食管癌患者术前肺气肿的程度，并首次报道 LAA%是食管癌术后生存的术前危险因素之一。
