Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Nutr Health Aging. 2024 Jul;28(7):100243. doi: 10.1016/j.jnha.2024.100243. Epub 2024 Apr 20.
The present retrospective study reviewed the association among sarcopenia, myosteatosis, and overall survival (OS) in patients with postoperative colorectal cancer (CRC) with regard to age.
A retrospective study was conducted with a five-year follow-up.
Data from all patients with CRC, who underwent surgery between February 2005 and April 2014, were reviewed.
Data from 1053 patients (622 male [59.1%], 431 female [40.9%]; mean [± SD] age, 62.8 ± 11.8 years) were analyzed.
Patients were divided into three groups according to age: ≤50, 51-74, and ≥75 years. Data, including perioperative parameters, and the presence of sarcopenia and myosteatosis according to skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD), respectively, were collected. Sarcopenia was evaluated using CT by calculating the SMI at the L3 level by dividing the area of the skeletal muscle by height squared (cm/m). SMD was also calculated using CT at the L3 level, but by evaluating fat attenuation according to Hounsfield units (HU).
Patient allocation according to age group was as follows: ≤50 years, n = 147 (14.0%); 51-74 years, n = 742 (70.5%); and ≥75 years, n = 164 (15.5%). The presence of sarcopenia and myosteatosis were statistically significant with increasing age (P = 0.004 and P < 0.001, respectively). The 51-74 years age group exhibited a significant association in OS for myosteatosis (P < 0.001) while the ≥75 years group was significantly associated with sarcopenia (P = 0.04) with regard to OS. Multivariable analysis also revealed a statistically significant association between myosteatosis in the 51-74 years age group (P = 0.033) and sarcopenia in the ≥75 years age group (P = 0.005) even when adjusted for recurrence status.
Different age groups exhibited significantly variable skeletal muscle indices. Although an abundance of irrefutable results demonstrated a correlation between CT-defined sarcopenia, myosteatosis, and clinical prognosis, data regarding age-dependent correlations are scarce. Results of this study demonstrated that sarcopenia and myosteatosis did not influence the prognosis of young patients with postoperative CRC (≤50 years of age), inferring the existence of significantly different skeletal muscle-related parameters according to age. Patients over 75 years of age showed significant association with sarcopenia while those in the 51-74 age group displayed significant link to myosteatosis. Clinicians should consider the impact of sarcopenia and myosteatosis on patient prognosis and should also be aware that the effect may differ according to patient age.
本回顾性研究旨在探讨年龄对术后结直肠癌（CRC）患者 sarcopenia、myosteatosis 和总生存期（OS）之间关联的影响。
进行了一项回顾性研究，随访时间为 5 年。
回顾了 2005 年 2 月至 2014 年 4 月期间接受手术的所有 CRC 患者的数据。
分析了 1053 名患者的数据（622 名男性[59.1%]，431 名女性[40.9%]；平均[±标准差]年龄为 62.8±11.8 岁）。
根据年龄将患者分为三组：≤50 岁、51-74 岁和≥75 岁。收集了围手术期参数以及根据骨骼肌指数（SMI）和骨骼肌放射性密度（SMD）分别存在的 sarcopenia 和 myosteatosis 的数据。使用 CT 通过在 L3 水平处计算骨骼肌面积除以身高平方（cm/m）来评估 sarcopenia。还通过在 L3 水平处使用 CT 评估 SMD，但通过根据亨氏单位（HU）评估脂肪衰减来评估。
根据年龄组的患者分配情况如下：≤50 岁，n=147（14.0%）；51-74 岁，n=742（70.5%）；≥75 岁，n=164（15.5%）。随着年龄的增长，sarcopenia 和 myosteatosis 的存在具有统计学意义（P=0.004 和 P<0.001）。51-74 岁年龄组的 myosteatosis 与 OS 显著相关（P<0.001），而≥75 岁年龄组的 sarcopenia 与 OS 显著相关（P=0.04）。多变量分析还显示，51-74 岁年龄组的 myosteatosis（P=0.033）和≥75 岁年龄组的 sarcopenia（P=0.005）之间存在统计学显著关联，即使在调整了复发状态后也是如此。
不同的年龄组表现出明显不同的骨骼肌指数。尽管大量确凿的结果表明 CT 定义的 sarcopenia、myosteatosis 与临床预后之间存在相关性，但关于年龄依赖性相关性的数据却很少。本研究的结果表明，sarcopenia 和 myosteatosis 并不影响年轻（≤50 岁）术后 CRC 患者的预后，这表明根据年龄存在明显不同的骨骼肌相关参数。75 岁以上的患者与 sarcopenia 有显著关联，而 51-74 岁年龄组的患者与 myosteatosis 有显著关联。临床医生应考虑 sarcopenia 和 myosteatosis 对患者预后的影响，并且还应意识到这种影响可能因患者年龄而异。
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