Zheng Hua-Long, Wei Ling-Hua, Xu Bin-Bin, Zheng Hong-Hong, Xue Zhen, Chen Qi-Yue, Xie Jian-Wei, Zheng Chao-Hui, Huang Chang-Ming, Lin Jian-Xian, Li Ping
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350001, China.
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350001, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350001, China.
Eur J Surg Oncol. 2024 Mar;50(3):108004. doi: 10.1016/j.ejso.2024.108004. Epub 2024 Feb 3.
Preoperative sarcopenia is associated with prognosis in patients with gastric cancer (GC); however, studies with 10-year survival follow-up are lacking.
Consecutive patients with GC who underwent radical gastrectomy between December 2009-2012 were included retrospectively. Preoperative sarcopenia was diagnosed using computed tomography skeletal muscle index. The Kaplan-Meier method estimated overall survival (OS) and relapse-free survival (RFS). Cox proportional hazard regression analysis determined the prognostic factors for OS and RFS.
In total, 781 patients with GC were included; among these, 207 (26.5%) had preoperative sarcopenia. Patients with sarcopenia had significantly lower 10-year OS and RFS than patients without sarcopenia (39.61% vs. 58.71% and 39.61% vs. 57.84%, respectively). Further, preoperative sarcopenia was an independent risk factor for 10-year OS (HR = 1.467; 95% confidence interval [CI]: 1.169-1.839) and RFS (HR = 1.450; 95% CI: 1.157-1.819). Patients with sarcopenia had a higher risk of death and recurrence in the first 10 years postoperatively than patients without sarcopenia. Additionally, the risk of death (HR = 2.62; 95% CI:1.581-4.332) and recurrence (HR = 2.34; 95% CI:1.516-3.606) was the highest in the 1st postoperative year and remained relatively stable thereafter. Further, postoperative adjuvant chemotherapy significantly improved 10-year OS (p = 0.006; HR = 0.558) and RFS (p = 0.008; HR = 0.573) in patients with TNM stage II-III GC that presented with sarcopenia.
Preoperative sarcopenia remained an independent risk factor for postoperative very long-term prognosis of GC. Postoperative adjuvant chemotherapy improved the long-term outcomes of stage II-III patients with sarcopenia.
术前肌肉减少症与胃癌（GC）患者的预后相关；然而，缺乏10年生存随访的研究。
回顾性纳入2009年12月至2012年期间接受根治性胃切除术的连续性GC患者。使用计算机断层扫描骨骼肌指数诊断术前肌肉减少症。采用Kaplan-Meier法估计总生存期（OS）和无复发生存期（RFS）。Cox比例风险回归分析确定OS和RFS的预后因素。
共纳入781例GC患者；其中，207例（26.5%）有术前肌肉减少症。肌肉减少症患者的10年OS和RFS显著低于无肌肉减少症的患者（分别为39.61%对58.71%和39.61%对57.84%）。此外，术前肌肉减少症是10年OS（HR = 1.467；95%置信区间[CI]：1.169 - 1.839）和RFS（HR = 1.450；95% CI：1.157 - 1.819）的独立危险因素。与无肌肉减少症的患者相比，肌肉减少症患者术后前10年的死亡和复发风险更高。此外，死亡风险（HR = 2.62；95% CI：1.581 - 4.332）和复发风险（HR = 2.34；95% CI：1.516 - 3.606）在术后第1年最高，此后保持相对稳定。此外，术后辅助化疗显著改善了TNM分期为II - III期且伴有肌肉减少症的GC患者的10年OS（p = 0.006；HR = 0.558）和RFS（p = 0.008；HR = 0.573）。
术前肌肉减少症仍然是GC术后长期预后的独立危险因素。术后辅助化疗改善了II - III期肌肉减少症患者的长期结局。
