Department of Rehabilitation, Toranomon Hospital, Minato-ku, Tokyo, Japan.
Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan.
Ann Surg Oncol. 2024 Nov;31(12):7722-7729. doi: 10.1245/s10434-024-16012-2. Epub 2024 Aug 17.
Identifying accurate prognostic factors is crucial for postoperative management of early gastric cancer (EGC) patients. Skeletal muscle quality (SMQ), defined by muscle density on computed tomography (CT) images, has been proposed as a novel prognostic factor. This study compared the prognostic significance of SMQ changes with the well-established factor of body weight (BW) loss in the postoperative EGC setting.
This single-center retrospective study included 297 postoperative EGC patients (median age 69 years, 68.4% male) who had preoperative and 1-year-postoperative gastrectomy CT images. SMQ was defined as the modified intramuscular adipose tissue content (mIMAC = skeletal muscle density-subcutaneous fat density on CT images) and the change as ΔmIMAC. Log-rank test, Kaplan-Meier survival, and Cox proportional hazards regression analyses were used to assess the associations between prognosis and either ΔmIMAC or BW change (ΔBW). Prognosis prediction by ΔmIMAC and ΔBW was compared by using the area under the curve (AUC) of the receiver operating characteristic curve.
ΔmIMAC was significantly associated with prognosis (log-rank test; P = 0.037), but ΔBW was not (P = 0.243). Prognosis was significantly poorer in the severely decreased mIMAC group than in the preserved group (multivariate Cox proportional hazards regression analysis; P = 0.030) but was unaffected by BW changes (P = 0.697). The AUC indicated a higher prognostic value for ΔmIMAC than ΔBW (ΔmIMAC: AUC = 0.697, ΔBW: AUC = 0.542).
One-year post-gastrectomy SMQ changes may be better prognostic EGC predictors than BW changes.
确定准确的预后因素对于早期胃癌（EGC）患者的术后管理至关重要。骨骼肌质量（SMQ）是通过 CT 图像上的肌肉密度定义的，已被提出作为一种新的预后因素。本研究比较了 SMQ 变化与术后 EGC 中已建立的体重（BW）损失因素的预后意义。
这是一项单中心回顾性研究，纳入了 297 例接受过术前和术后 1 年胃切除术 CT 图像的术后 EGC 患者（中位年龄 69 岁，男性占 68.4%）。SMQ 定义为改良的肌内脂肪组织含量（mIMAC = CT 图像上的骨骼肌密度-皮下脂肪密度），变化为ΔmIMAC。对数秩检验、Kaplan-Meier 生存分析和 Cox 比例风险回归分析用于评估预后与ΔmIMAC 或 BW 变化（ΔBW）之间的关系。通过受试者工作特征曲线（ROC）下面积（AUC）比较ΔmIMAC 和ΔBW 的预后预测能力。
ΔmIMAC 与预后显著相关（对数秩检验；P = 0.037），但ΔBW 则不然（P = 0.243）。与保留组相比，mIMAC 严重减少组的预后明显较差（多变量 Cox 比例风险回归分析；P = 0.030），而 BW 变化对预后没有影响（P = 0.697）。AUC 表明ΔmIMAC 的预后价值高于ΔBW（ΔmIMAC：AUC = 0.697，ΔBW：AUC = 0.542）。
与 BW 变化相比，胃切除术后 1 年的 SMQ 变化可能是更好的 EGC 预后预测因素。
