体成分与肝门部胆管癌术后并发症相关。

Body composition is associated with postoperative complications in perihilar cholangiocarcinoma.

机构信息

Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.

University of Applied Science Aachen, Aachen, Germany.

出版信息

Cancer Med. 2024 Jan;13(1):e6878. doi: 10.1002/cam4.6878. Epub 2024 Jan 1.

DOI:10.1002/cam4.6878

PMID:38164056

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10807576/

Abstract

BACKGROUND

Perihilar cholangiocarcinoma (pCCA) is a malignant tumor of the hepatobiliary system which is still associated with a challenging prognosis. Postoperative complications play a crucial role in determining the overall prognosis of patients with pCCA. Changes in body composition (BC) have been shown to impact the prognosis of various types of tumors. Therefore, our study aimed to investigate the correlation between BC, postoperative complications and oncological outcome in patients with pCCA.

METHODS

All patients with pCCA who underwent curative-intent surgery for pCCA between 2010 and 2022 were included in this analysis. BC was assessed using preoperative computed tomography and analyzed with the assistance of a 3D Slicer software. Univariate and multivariate binary logistic regression analyses were conducted to examine the relationship between BC and clinical characteristics including various measurements of postoperative complications and Cox regressions and Kaplan-Meier analysis to evaluate oncological risk factors in the study cohort.

RESULTS

BC was frequently altered in patients undergoing curative-intent liver resection for pCCA (n = 204) with 52.5% of the patients showing obesity, 55.9% sarcopenia, 21.6% sarcopenic obesity, 48.5% myosteatosis, and 69.1% visceral obesity. In multivariate analysis, severe postoperative complications (Clavien-Dindo ≥3b) were associated with body mass index (BMI) (Odds ratio (OR) = 2.001, p = 0.024), sarcopenia (OR = 2.145, p = 0.034), and myosteatosis (OR = 2.097, p = 0.017) as independent predictors. Furthermore, sarcopenia was associated with reduced overall survival (OS) in pCCA patients (sarcopenia vs. no-sarcopenia, 21 months vs. 32 months, p = 0.048 log rank).

CONCLUSIONS

BC is highly associated with severe postoperative complications in patients with pCCA and shows tendency to be associated impaired overall survival. Preoperative assessment of BC and interventions to improve BC might therefore be key to improve outcome in pCCA patients undergoing surgical therapy.

摘要

背景

肝门部胆管癌（pCCA）是一种肝胆系统恶性肿瘤，其预后仍然具有挑战性。术后并发症在确定 pCCA 患者的整体预后方面起着至关重要的作用。人体成分（BC）的变化已被证明会影响各种类型肿瘤的预后。因此，我们的研究旨在探讨 pCCA 患者 BC 与术后并发症和肿瘤学结果之间的相关性。

方法

本研究纳入了 2010 年至 2022 年间接受根治性手术治疗的所有 pCCA 患者。使用术前计算机断层扫描（CT）评估 BC，并借助 3D Slicer 软件进行分析。采用单变量和多变量二项逻辑回归分析，探讨 BC 与临床特征（包括各种术后并发症测量指标）之间的关系，采用 Cox 回归和 Kaplan-Meier 分析评估研究队列中的肿瘤学危险因素。

结果

在接受根治性肝切除术治疗 pCCA 的患者中（n=204），BC 经常发生改变，其中 52.5%的患者表现为肥胖，55.9%的患者存在肌肉减少症，21.6%的患者存在肌肉减少性肥胖症，48.5%的患者存在肌肉脂肪变性，69.1%的患者存在内脏肥胖症。多变量分析显示，严重的术后并发症（Clavien-Dindo ≥3b）与体重指数（BMI）（优势比（OR）=2.001，p=0.024）、肌肉减少症（OR=2.145，p=0.034）和肌肉脂肪变性（OR=2.097，p=0.017）相关，是独立的预测因素。此外，肌肉减少症与 pCCA 患者的总生存（OS）降低相关（肌肉减少症 vs. 非肌肉减少症，21 个月 vs. 32 个月，p=0.048 对数秩）。