Department of Colorectal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Department of Surgery, The Jikei University School of Medicine, Chuo-ku, Tokyo, Japan.
World J Surg. 2024 Sep;48(9):2098-2108. doi: 10.1002/wjs.12302. Epub 2024 Aug 2.
Sarcopenia affects the postoperative prognosis of patients with colorectal cancer (CRC). Recently, it has become possible to measure psoas volume from computed tomography images, and an index called psoas volume index (PVI) has been reported. However, it is unclear whether the dynamics of PVI before and after surgery is associated with clinical outcomes after CRC surgery. This study aimed to evaluate the association between pre- and postoperative PVI dynamics and clinical outcomes after CRC surgery.
This study analyzed 1115 patients diagnosed with primary CRC and operated on for treatment between January 2014 and December 2017. Sarcopenia was defined as PVI below the lowest tertile in the preoperative assessment for each sex. The overall population was divided into four groups according to the dynamics of sarcopenia from preoperative to postoperative: group 1 (pre-to postoperative sarcopenia), group 2 (preoperative nonsarcopenia to postoperative sarcopenia), group 3 (pre-to postoperative nonsarcopenia), and group 4 (pre-to postoperative nonsarcopenia).
Based on pre- and postoperative sarcopenia dynamics, 343 patients (29.7%) were classified into group 1, 105 patients (9.1%) into group 2, 42 patients (3.6%) into group 3, and 665 patients (57.6%) into group 4. Comparison of overall survival (OS) by the Kaplan-Meier method showed that Group 2 tended to have the worst prognosis (p = 0.007). Multivariate analysis showed an increased OS risk in Group 2 in sarcopenia dynamics (Hazard ratio: 2.103, 95% CI: 1.202-3.681, p = 0.009).
Sarcopenia dynamics using PVI is an independent prognostic predictor of OS in patients with CRC.
肌肉减少症影响结直肠癌（CRC）患者的术后预后。最近，从 CT 图像中测量腰大肌体积成为可能，并且已经报道了一种称为腰大肌体积指数（PVI）的指数。但是，手术前后 PVI 的变化是否与 CRC 手术后的临床结果相关尚不清楚。本研究旨在评估 CRC 手术后手术前后 PVI 变化与临床结果之间的关系。
本研究分析了 2014 年 1 月至 2017 年 12 月期间因原发性 CRC 而接受手术治疗的 1115 例患者。肌肉减少症的定义为术前评估中男女每性别最低三分位数以下的 PVI。根据从术前到术后的肌肉减少症的动态，将总体人群分为四组：组 1（术前至术后肌肉减少症），组 2（术前非肌肉减少症至术后肌肉减少症），组 3（术前至术后非肌肉减少症），和组 4（术前至术后非肌肉减少症）。
基于术前和术后肌肉减少症的动态，343 例患者（29.7％）被分为组 1，105 例患者（9.1％）分为组 2，42 例患者（3.6％）分为组 3，和 665 例患者（57.6％）分为组 4。通过 Kaplan-Meier 方法比较总生存率（OS）表明，组 2的预后最差（p=0.007）。多变量分析显示，肌肉减少症动态中的组 2 的 OS 风险增加（风险比：2.103，95％CI：1.202-3.681，p=0.009）。
使用 PVI 的肌肉减少症动态是 CRC 患者 OS 的独立预后预测因子。
