Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Endocrinol Metab (Seoul). 2024 Aug;39(4):632-640. doi: 10.3803/EnM.2024.1956. Epub 2024 Jul 17.
Osteoporosis and fragility fractures are crucial musculoskeletal complications in long-term survivors of gastric cancer. However, the relationship between changes in body composition after gastrectomy and bone loss has not been investigated. Therefore, this study aimed to explore whether computed tomography (CT)-derived body composition parameters are associated with bone loss after gastrectomy in patients with gastric cancer.
We retrospectively reviewed medical records and abdomen CT scans of patients who underwent gastrectomy at Yonsei University Severance Hospital between 2009 and 2018. Patients with non-metastatic gastric adenocarcinoma and preoperative and postoperative non-contrast CT scans were analyzed. Section area of skeletal muscle (SMA), visceral fat (VFA), and subcutaneous fat (SFA) were assessed using semi-automatic segmentation software. Changes in trabecular bone attenuation of L1 mid-vertebra level (L1 Hounsfield units [HU]) were measured.
Fifty-seven patients (mean age, 65.5±10.6; 70.2% males) were analyzed, and the median duration was 31 months. Fortyseven patients (82.5%) lost weight after gastrectomy. Baseline SMA and VFA did not differ between the bone loss and preserved groups; however, baseline SFA was significantly higher in the bone preserved group than in the bone loss group (P=0.020). In a multivariable linear regression model adjusted for confounding factors, one standard deviation higher VFA at baseline was associated with greater annualized L1 HU loss (%) (P=0.034). However, higher preoperative SFA was associated with protection against bone loss after gastrectomy (P=0.025).
Higher preoperative SFA exhibited a protective effect against bone loss after gastrectomy in patients with non-metastatic gastric cancer, whereas VFA exhibited a negative effect.
骨质疏松症和脆性骨折是胃癌长期幸存者的重要骨骼肌肉并发症。然而，胃切除术后身体成分的变化与骨丢失之间的关系尚未得到研究。因此，本研究旨在探讨胃癌患者胃切除术后 CT 衍生的身体成分参数是否与骨丢失有关。
我们回顾性分析了 2009 年至 2018 年在延世大学Severance 医院接受胃切除术的患者的病历和腹部 CT 扫描。分析了患有非转移性胃腺癌且术前和术后均未进行对比 CT 扫描的患者。使用半自动分割软件评估骨骼肌（SMA）、内脏脂肪（VFA）和皮下脂肪（SFA）的截面积。测量 L1 中脊椎水平（L1 亨氏单位[HU]）的小梁骨衰减变化。
对 57 名患者（平均年龄 65.5±10.6；70.2%为男性）进行了分析，中位时间为 31 个月。47 名患者（82.5%）在胃切除术后体重减轻。基线 SMA 和 VFA 在骨丢失和保留组之间无差异；然而，基线 SFA 在骨保留组明显高于骨丢失组（P=0.020）。在调整混杂因素的多变量线性回归模型中，基线时 VFA 每增加一个标准差，与 L1 HU 每年损失的百分比（%）增加呈正相关（P=0.034）。然而，较高的术前 SFA 与胃切除术后防止骨丢失相关（P=0.025）。
在患有非转移性胃癌的患者中，较高的术前 SFA 对胃切除术后的骨丢失表现出保护作用，而 VFA 则表现出负作用。
