Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
Nutrition. 2024 Jun;122:112391. doi: 10.1016/j.nut.2024.112391. Epub 2024 Feb 8.
Skeletal muscle index (SMI) is insufficient for evaluating muscle in obesity, and muscle attenuation (MA) may be a preferred indicator. This study aimed to investigate whether MA has greater prognostic value than SMI in gastric cancer patients with overweight and obesity.
Clinical parameters of 1312 patients with gastric cancer who underwent radical gastrectomy were prospectively collected between 2013 and 2019. MA and SMI were analyzed by computed tomography scan. Overweight/obesity was defined as body mass index (BMI) ≥24 kg/m. The hazard ratio (HR) for death was calculated using Cox regression analysis.
Among all patients, 405 were identified as overweight and obese, and 907 were identified as normal and underweight. MA was inversely associated with BMI and visceral fat area. Among the 405 patients with overweight and obesity, 212 patients (52%) were diagnosed with low MA. In the overweight/obese group, MA was an independent predictor for overall survival (HR, 1.610; P = 0.021) in multivariate Cox regression analyses, whereas SMI did not remain in the model. In the normal/underweight group, both low MA (HR, 1.283; P = 0.039) and low SMI (HR, 1.369; P = 0.008) were independent factors of overall survival. Additionally, 318 patients were identified as having visceral obesity in the overweight/obese group, and low MA was also an independent prognostic factor for survival in these patients (HR, 1.765; P = 0.013).
MA had a higher prognostic value than SMI in overweight and obese patients with gastric cancer after radical gastrectomy.
骨骼肌指数（SMI）在评估肥胖人群的肌肉方面存在不足，而肌肉衰减（MA）可能是一个更优的指标。本研究旨在探讨 MA 在超重和肥胖的胃癌患者中的预后价值是否优于 SMI。
前瞻性收集了 2013 年至 2019 年间 1312 例行根治性胃切除术的胃癌患者的临床参数，通过计算机断层扫描（CT）分析 MA 和 SMI。超重/肥胖定义为体质量指数（BMI）≥24kg/m。使用 Cox 回归分析计算死亡的危险比（HR）。
在所有患者中，有 405 例被诊断为超重和肥胖，907 例被诊断为正常和体重不足。MA 与 BMI 和内脏脂肪面积呈负相关。在 405 例超重和肥胖患者中，有 212 例（52%）被诊断为低 MA。在超重/肥胖组中，MA 是多变量 Cox 回归分析中总生存的独立预测因素（HR，1.610；P=0.021），而 SMI 则不在模型中。在正常/体重不足组中，低 MA（HR，1.283；P=0.039）和低 SMI（HR，1.369；P=0.008）均为总生存的独立因素。此外，在超重/肥胖组中有 318 例患者被诊断为内脏肥胖，低 MA 也是这些患者生存的独立预后因素（HR，1.765；P=0.013）。
在接受根治性胃切除术的超重和肥胖胃癌患者中，MA 的预后价值高于 SMI。
