Cancer Treatment Center, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka, 543-0035, Japan.
Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda-Cho, Ikoma, Nara, 630-0293, Japan.
Int J Clin Oncol. 2024 Mar;29(3):266-275. doi: 10.1007/s10147-023-02462-3. Epub 2024 Jan 16.
We previously showed that daily nutritional intervention with an oral elemental diet (ED) at 300 kcal/day for 6-8 weeks postoperatively decreased the percentage of body weight loss (%BWL), and that the effect was maintained for 1 year. This post hoc analysis aimed to determine whether this intervention decreased skeletal muscle mass loss 1-year post-gastrectomy.
Data from consecutive, untreated patients with histopathologically confirmed stage I-III gastric adenocarcinoma who planned to undergo total gastrectomy (TG) or distal gastrectomy (DG) and were enrolled in a previously published randomized trial were used. The primary endpoint was the percentage of skeletal muscle mass index (%SMI) loss from baseline at 1 year postoperatively, based on abdominal computed tomography images obtained preoperatively and at 1 year postoperatively.
The overall median %SMI loss was lower in the ED versus control group, but the difference was not significant. The difference in %SMI loss in the ED and control groups was greater in patients with TG (10.1 vs. 13.0; P = 0.12) than in those with DG (5.5 vs. 6.8; P = 0.69). A correlation was observed between %BWL and %SMI loss in both groups (ED group, coefficient 0.591; control group, coefficient 0.644; P < 0.001 for both). Type of gastrectomy (coefficient 7.38; P = 0.001) and disease stage (coefficient - 6.43; P = 0.04) were independent predictors of postoperative skeletal muscle mass loss.
ED administration for 6-8 weeks following gastrectomy had no inhibitory effect on skeletal muscle loss at 1 year postoperatively.
UMIN000023455.
我们之前的研究表明，术后每天接受 300 卡路里的口服要素饮食（ED）营养干预 6-8 周，可减少体重减轻百分比（%BWL），且该效果可维持 1 年。本事后分析旨在确定这种干预是否会减少胃癌术后 1 年的骨骼肌丢失。
使用了连续未经治疗的组织学证实为 I-III 期胃腺癌患者的数据，这些患者计划接受全胃切除术（TG）或胃远端切除术（DG），并参与了之前发表的一项随机试验。主要终点是基于术前和术后 1 年的腹部 CT 图像，术后 1 年骨骼肌质量指数（%SMI）的损失百分比。
ED 组的整体中位数 %SMI 损失低于对照组，但差异无统计学意义。在 TG 患者中，ED 组和对照组的 %SMI 损失差异较大（10.1%比 13.0%；P=0.12），而在 DG 患者中差异较小（5.5%比 6.8%；P=0.69）。两组之间均观察到 %BWL 与 %SMI 损失之间存在相关性（ED 组，系数 0.591；对照组，系数 0.644；均 P<0.001）。胃切除术类型（系数 7.38；P=0.001）和疾病分期（系数-6.43；P=0.04）是术后骨骼肌丢失的独立预测因素。
胃癌术后 6-8 周给予 ED 治疗对术后 1 年骨骼肌丢失无抑制作用。
UMIN000023455。
