National Cancer Center Hospital East, Department of Urology, Chiba, Japan.
National Cancer Center Hospital East, Department of Urology, Chiba, Japan.
Clin Genitourin Cancer. 2024 Jun;22(3):102051. doi: 10.1016/j.clgc.2024.02.002. Epub 2024 Feb 9.
Sarcopenia is a condition of low muscle strength and quantity, severe if low physical performances. The sarcopenia index (SI), calculated by blood levels of creatinine and cystatin C, had been reported to be correlated with skeletal muscle mass and is a potential simple screening tool for sarcopenia. We hypothesized that patients with a low SI, meaning low muscle mass, would have an inflated estimated glomerular filtration rate (eGFR) value based on serum creatinine levels. We also tested the prognostic value of the SI in a cohort of patients who had surgery for renal malignancies.
We conducted a retrospective, observational study of 322 patients that had surgery for renal tumors in National Cancer Center Hospital East (Kashiwa, Chiba) between April 2017 and June 2023. We assessed sarcopenia measuring psoas muscle index (PMI), psoas muscle density (PMD), and skeletal muscle area (SMA) by computed tomography. We assessed the association between SI and eGFR before and after surgery. We also assessed the association between SI and postoperative outcome, including overall survival.
Of the 322 patients, 211 (66%) were males, with a median age of 69 years. SI had a weak correlation with both PMI and PMD in males (PMI: ρ = 0.25; PMD: ρ = 0.21). In females, SI and PMD exhibited a low correlation (ρ = 0.26), while SI and PMI displayed an insignificant correlation (ρ = 0.19). The correlation between SMA and SI was moderate for both males and females (males: ρ = 0.51; females: ρ = 0.46). After radical nephrectomy, eGFR decreased in 98% of patients with high SI, compared to 69% of patients with low SI. We also demonstrated that low SI predicted poor prognosis.
Clinicians can recognize the possibility of overestimated eGFR in the low SI group by measuring SI around the surgery. Low SI may also help predict poor prognosis.
肌少症是一种肌肉力量和数量低下的状况，如果身体机能严重下降则称为重症肌少症。肌少症指数（SI）通过血肌酐和胱抑素 C 水平计算得出，与骨骼肌量相关，是肌少症的一种潜在简单筛查工具。我们假设低 SI （即肌肉量低）的患者基于血清肌酐水平的估算肾小球滤过率（eGFR）值会偏高。我们还在一组接受肾恶性肿瘤手术的患者中测试了 SI 的预后价值。
我们对 2017 年 4 月至 2023 年 6 月在国立癌症中心医院东（千叶县柏市）接受肾肿瘤手术的 322 例患者进行了回顾性观察性研究。我们通过计算机断层扫描评估了竖脊肌指数（PMI）、竖脊肌密度（PMD）和骨骼肌面积（SMA）来评估肌少症。我们评估了 SI 与手术前后 eGFR 的相关性。我们还评估了 SI 与术后结果（包括总生存率）之间的相关性。
322 例患者中，211 例（66%）为男性，中位年龄为 69 岁。SI 与男性的 PMI 和 PMD 均有弱相关性（PMI：ρ=0.25；PMD：ρ=0.21）。在女性中，SI 与 PMD 呈低度相关（ρ=0.26），而 SI 与 PMI 呈不显著相关（ρ=0.19）。男性和女性的 SMA 与 SI 的相关性均为中度（男性：ρ=0.51；女性：ρ=0.46）。行根治性肾切除术的患者中，高 SI 组 98%的患者 eGFR 下降，而低 SI 组 69%的患者 eGFR 下降。我们还表明，低 SI 可预测预后不良。
通过测量手术前后的 SI，临床医生可以识别低 SI 组中 eGFR 可能被高估的情况。低 SI 可能还有助于预测不良预后。
