Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Surg Endosc. 2024 Mar;38(3):1151-1162. doi: 10.1007/s00464-023-10638-1. Epub 2023 Dec 11.
To assess the effect of preoperative sarcopenia on the short-term and long-term outcomes in older patients with locally advanced gastric cancer (LAGC).
Clinicopathological data of older patients with LAGC who underwent radical surgery were retrospectively analyzed. Sarcopenia was defined as a skeletal muscle index of less than 36.4 cm/m for men and less than 28.4 cm/m for women. Comparing the postoperative complications and survival between sarcopenia and non-sarcopenia groups using multicenter data.
A total of 406 older patients with LAGC were included in the analysis, including 145 (35.7%) with sarcopenia and 261 (64.3%) with non-sarcopenia. Multivariate logistic regression analysis showed that sarcopenia was an independent risk factor for postoperative complications with CD grade ≥ II (OR 1.616; P < 0.05). Kaplan-Meier survival curve analysis showed that the 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) in the sarcopenia group were lower than those in the non-sarcopenia group (P both < 0.05). Multivariate Cox regression analyses showed that sarcopenia was an independent prognostic factor for 5-year OS and RFS (P both < 0.05). The 5-year recurrence rate in the sarcopenia group was 57.2%, which was significantly higher than that in the non-sarcopenia group (46.4%; P = 0.036). Recurrence pattern analysis showed that the incidence of distant metastases in patients with sarcopenia (42.8%) was significantly higher than non-sarcopenia (31.4%; P = 0.022).
Sarcopenia serves as a valuable predictor of both short-term and long-term outcomes in older patients with LAGC. Therefore, the significance of assessing preoperative nutritional status and implementing thorough postoperative follow-up for older LAGC patients with sarcopenia should be emphasized.
评估术前肌少症对老年局部进展期胃癌（LAGC）患者短期和长期结局的影响。
回顾性分析接受根治性手术的老年 LAGC 患者的临床病理资料。肌少症定义为男性骨骼肌指数<36.4 cm/m，女性<28.4 cm/m。使用多中心数据比较肌少症组和非肌少症组的术后并发症和生存情况。
共纳入 406 例老年 LAGC 患者，其中 145 例（35.7%）存在肌少症，261 例（64.3%）无肌少症。多因素 logistic 回归分析显示，肌少症是术后并发症（CD 分级≥Ⅱ级）的独立危险因素（OR=1.616，P<0.05）。Kaplan-Meier 生存曲线分析显示，肌少症组的 5 年总生存（OS）和 5 年无复发生存（RFS）均低于非肌少症组（P 均<0.05）。多因素 Cox 回归分析显示，肌少症是 5 年 OS 和 RFS 的独立预后因素（P 均<0.05）。肌少症组的 5 年复发率为 57.2%，明显高于非肌少症组（46.4%，P=0.036）。复发模式分析显示，肌少症患者远处转移的发生率（42.8%）明显高于非肌少症患者（31.4%，P=0.022）。
肌少症是老年 LAGC 患者短期和长期结局的有价值预测指标。因此，应重视评估老年 LAGC 合并肌少症患者的术前营养状况并进行彻底的术后随访。
