Rai Jason, Pring Edward T, Knight Katrina, Tilney Henry, Gudgeon Judy, Gudgeon Mark, Taylor Fiona, Gould Laura E, Wong Joel, Andreani Stefano, Mai Dinh V C, Drami Ioanna, Lung Phillip, Athanasiou Thanos, Roxburgh Campbell, Jenkins John T
BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
J Cachexia Sarcopenia Muscle. 2024 Oct;15(5):1850-1857. doi: 10.1002/jcsm.13536. Epub 2024 Jun 26.
Accurate preoperative risk assessment for major colorectal cancer (CRC) surgery remains challenging. Body composition (BC) and cardiopulmonary exercise testing (CPET) can be used to evaluate risk. The relationship between BC and CPET in patients undergoing curative CRC surgery is unclear.
Consecutive patients undergoing CPET prior to CRC surgery between 2010 and 2020 were identified between two different UK hospitals. Body composition phenotypes such as sarcopenia, myosteatosis, and visceral obesity were defined using widely accepted thresholds using preoperative single axial slice CT image at L3 vertebrae. Relationships between clinicopathological, BC, and CPET variables were investigated using linear regression analysis.
Two hundred eighteen patients with stage I-III CRC were included. The prevalence of sarcopenia, myosteatosis, and visceral obesity was 62%, 33%, and 64%, respectively. The median oxygen uptake at anaerobic threshold (VO2 at AT) was 12.2 mL/kg/min (IQR 10.6-14.2), and oxygen uptake at peak exercise (VO2 peak) was 18.8 mL/kg/min (IQR 15.4-23). On univariate linear regression analysis, male sex (P < 0.001) was positively associated with VO2 at AT. While ASA grade (P < 0.001) and BMI (P = 0.007) were negatively associated with VO2 at AT, on multivariate linear regression analysis, these variables remained significant (P < 0.05). On univariate linear regression analysis, male sex (P < 0.001) was positively associated with VO2 peak, whereas age (P < 0.001), ASA grade (P < 0.001), BMI (P = 0.003), sarcopenia (P = 0.015), and myosteatosis (P < 0.001) were negatively associated with VO2 peak. On multivariate linear regression analysis age (P < 0.001), ASA grade (P < 0.001), BMI (P < 0.001), and sarcopenia (P = 0.006) were independently and negatively associated with VO2 peak.
The novel finding that sarcopenia is independently associated with reduced VO2 peak performance in CPET supports the supposition that reduced muscle mass relates to poor physical function in CRC patients. Further work should be undertaken to assess whether sarcopenia diagnosed on CT can act as suitable surrogate for CPET to further enhance personalized risk stratification.
对主要的结直肠癌（CRC）手术进行准确的术前风险评估仍然具有挑战性。身体成分（BC）和心肺运动试验（CPET）可用于评估风险。接受根治性CRC手术患者的BC与CPET之间的关系尚不清楚。
在英国两家不同医院确定了2010年至2020年间在CRC手术前接受CPET的连续患者。使用L3椎体术前单轴切片CT图像，采用广泛接受的阈值定义肌肉减少症、肌少脂性肥胖和内脏肥胖等身体成分表型。使用线性回归分析研究临床病理、BC和CPET变量之间的关系。
纳入了218例I-III期CRC患者。肌肉减少症、肌少脂性肥胖和内脏肥胖的患病率分别为62%、33%和64%。无氧阈时的氧摄取量（AT时的VO2）中位数为12.2 mL/kg/min（IQR 10.6-14.2），运动峰值时的氧摄取量（VO2峰值）为18.8 mL/kg/min（IQR 15.4-23）。单变量线性回归分析显示，男性（P < 0.001）与AT时的VO2呈正相关。而美国麻醉医师协会（ASA）分级（P < 0.001）和体重指数（BMI）（P = 0.007）与AT时的VO2呈负相关，多变量线性回归分析显示，这些变量仍然具有显著性（P < 0.05）。单变量线性回归分析显示，男性（P < 0.001）与VO2峰值呈正相关，而年龄（P < 0.001）、ASA分级（P < 0.001）、BMI（P = 0.003）、肌肉减少症（P = 0.015）和肌少脂性肥胖（P < 0.001）与VO2峰值呈负相关。多变量线性回归分析显示，年龄（P < 0.001）、ASA分级（P < 0.001）、BMI（P < 0.001）和肌肉减少症（P = 0.006）与VO2峰值独立且呈负相关。
肌肉减少症与CPET中VO2峰值表现降低独立相关这一新颖发现支持了肌肉量减少与CRC患者身体功能不佳相关的假设。应进一步开展工作，以评估CT诊断的肌肉减少症是否可作为CPET的合适替代指标，以进一步加强个性化风险分层。
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