肌肉减少症对肝内胆管癌行肝切除术患者短期和长期结局的影响：一项多中心研究。

Impact of sarcopenia on the short-term and long-term outcomes of intrahepatic cholangiocarcinoma undergoing hepatectomy: A multi-center study.

机构信息

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China.

出版信息

Eur J Surg Oncol. 2024 Apr;50(4):108246. doi: 10.1016/j.ejso.2024.108246. Epub 2024 Mar 4.

DOI:10.1016/j.ejso.2024.108246

PMID:38484491

Abstract

BACKGROUND

Sarcopenia is associated with adverse prognosis of intrahepatic cholangiocarcinoma (iCCA) after surgery.

METHODS

321 patients with iCCA undergoing surgery were retrospectively recruited and assigned to training and validation cohort. Skeletal muscle index (SMI) was assessed to define sarcopenia. Logistic regression and cox regression analysis were used to identify risk factors. A novel sarcopenia-based nomogram was constructed and validated by ROC curves, calibration curves, and DCA curves.

RESULTS

260 patients were included for analysis. The median age was 63.0 years and 161 patients (61.9%) were diagnosed with sarcopenia. Patients with sarcopenia exhibited a higher rate of postoperative complications, a worse OS and RFS than patients without sarcopenia. Sarcopenia, low albumin and intraoperative blood transfusion were independent risk factors of postoperative complications, while sarcopenia and low albumin were risk factors of high CCI≥26.2. Sarcopenia, high PS score, low-undifferentiated differentiation, perineural invasion, TNM stage III-IV were risk factors of OS, and a novel nomogram based on these five factors was built to predict the 12-, 24-, and 36-months OS, with the mean AUC > 0.6.

CONCLUSION

Sarcopenia is negatively associated with both postoperative complications and survival prognosis of iCCA undergoing hepatectomy.

摘要

背景

肌少症与肝内胆管癌（iCCA）手术后的不良预后相关。

方法

回顾性招募了 321 名接受手术治疗的 iCCA 患者，并将其分配到训练和验证队列中。评估骨骼肌指数（SMI）以定义肌少症。使用逻辑回归和 Cox 回归分析来确定风险因素。通过 ROC 曲线、校准曲线和 DCA 曲线构建并验证了一种新的基于肌少症的列线图。

结果

对 260 名患者进行了分析。中位年龄为 63.0 岁，161 名患者（61.9%）被诊断为肌少症。与无肌少症的患者相比，肌少症患者术后并发症发生率更高，OS 和 RFS 更差。肌少症、低白蛋白血症和术中输血是术后并发症的独立危险因素，而肌少症和低白蛋白血症是 CCI≥26.2 的危险因素。肌少症、PS 评分高、低分化、神经周围侵犯、TNM 分期 III-IV 是 OS 的危险因素，基于这五个因素构建了一个新的列线图，用于预测 12、24 和 36 个月的 OS，平均 AUC＞0.6。