Tang Jiabao, Xu Jingwen, Li Xiaohua, Cao Chun
Department of General Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Thyroid and Breast Surgery, Suzhou Wuzhong People's Hospital, Suzhou, China.
Ann Surg Treat Res. 2024 Aug;107(2):68-80. doi: 10.4174/astr.2024.107.2.68. Epub 2024 Jul 30.
This study was performed to investigate influencing factors of preoperative muscle mass-to-fat ratio (MMFR) and its impact on overall survival and postoperative complications of colon cancer.
Patients who underwent colectomy for stage I-III colon cancer at the Second Affiliated Hospital of Soochow University between January 2016 and December 2022 were included. The skeletal muscle and fat area at the third lumbar vertebra were measured with preoperative CT measurement. MMFR was defined as the ratio of skeletal muscle area to total fat area, and low MMFR was defined as the 2 lowest tertiles (≤0.585). Univariate and multivariable analyses were conducted to assess the impact of MMFR on overall complications and survival outcomes. Kaplan-Meier survival curves and log-rank test were used to compare the overall survival between high MMFR and low MMFR groups.
A total of 885 patients were analyzed. Female sex, older age, high body mass index, sarcopenia, and high cancer stage were more likely to result in low MMFR. Complications, including intestinal fistula, chylous fistula and organ space surgical site infection were significantly higher in the low MMFR group. Low MMFR was an independent factor associated with overall complications (odds ratio, 1.940; 95% confidence interval [CI], 1.252-3.007; P < 0.01) and long-term survival (hazard ratio, 2.222; 95% CI, 1.443-3.425; P < 0.01). Furthermore, patients with high MMFR had a higher survival rate than patients with low MMFR (P < 0.01).
Low MMFR is an independent factor that predicts worse overall survival and complications in patients with colon cancer.
本研究旨在探讨术前肌肉质量与脂肪比率（MMFR）的影响因素及其对结肠癌患者总生存期和术后并发症的影响。
纳入2016年1月至2022年12月在苏州大学附属第二医院接受I-III期结肠癌结肠切除术的患者。术前通过CT测量第三腰椎水平的骨骼肌和脂肪面积。MMFR定义为骨骼肌面积与总脂肪面积之比，低MMFR定义为最低的两个三分位数（≤0.585）。进行单因素和多因素分析以评估MMFR对总体并发症和生存结局的影响。采用Kaplan-Meier生存曲线和对数秩检验比较高MMFR组和低MMFR组的总生存期。
共分析了885例患者。女性、年龄较大、高体重指数、肌肉减少症和癌症分期较高更易导致低MMFR。低MMFR组的并发症，包括肠瘘、乳糜瘘和器官腔隙手术部位感染明显更多。低MMFR是与总体并发症（比值比，1.940；95%置信区间[CI]，1.252-3.007；P<0.01）和长期生存（风险比，2.222；95%CI，1.443-3.425；P<0.01）相关的独立因素。此外，高MMFR患者的生存率高于低MMFR患者（P<0.01）。
低MMFR是预测结肠癌患者总生存期和并发症较差的独立因素。
