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肌少症预测行根治性手术的结直肠癌患者的术后并发症和生存情况。

Sarcopenia Predicts Postoperative Complications and Survival of Colorectal Cancer Patients Undergoing Radical Surgery.

机构信息

Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.

Day Chemotherapy Ward, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.

出版信息

Br J Hosp Med (Lond). 2024 Sep 30;85(9):1-17. doi: 10.12968/hmed.2024.0297. Epub 2024 Sep 12.

Abstract

Previous literature has indicated that sarcopenia is related to poor outcomes after radical resection for colorectal cancer (CRC). However, its effect on the postoperative clinical outcomes of CRC remains controversial. This study aimed to elucidate the predictive value of sarcopenia for postoperative complications and survival in CRC patients. This investigation retrospectively assessed the clinical data of 226 CRC patients who underwent radical resection at the Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University from January 2018 to December 2020. Sarcopenia was diagnosed according to the recommendations of the Asian Working Group for Sarcopenia in 2019, and patients were categorized into sarcopenia and non-sarcopenia groups. Multivariate and univariate analyses were employed to assess the risk factors for postoperative complications. The Kaplan-Meier method and survival curve were used to analyze postoperative survival time. Cox proportional hazards regression models were used to evaluate risk factors affecting the prognosis of CRC patients. This investigation included 226 patients, of which 68 were diagnosed with sarcopenia. Furthermore, it was revealed that sarcopenia was linked with older age ( < 0.001), low body mass index ( < 0.001), high prevalence of diabetes ( = 0.002), high cystatin level ( = 0.017), and low 3rd lumbar spine (L3) planar skeletal muscle index ( < 0.001), but was not related to the tumour stage or the gender. Moreover, sarcopenia was also correlated with increased occurrence of all postoperative complications ( = 0.050). The results of the multivariate analysis indicated that sarcopenia was an independent risk factor for postoperative complications (odds ratio (OR): 7.154; 95% confidence interval (CI): 2.261-22.633; = 0.017). The Kaplan-Meier analysis revealed that sarcopenia patients had significantly lower 5-year disease-free survival (DFS) (48.5% vs 59.5%; log-rank = 0.033) and 5-year overall survival (OS) (57.4% vs 77.2%; log-rank < 0.001) rates. Sarcopenia was an independent risk factor for poor DFS (hazard ratio (HR) = 1.404; = 0.016) and OS (HR = 1.290; = 0.021). In CRC patients undergoing radical surgery, sarcopenia is an independent risk factor for postoperative complications. Sarcopenia may be a predictive factor for the prognosis and survival of CRC patients undergoing radical resection.

摘要

先前的文献表明,肌少症与结直肠癌(CRC)根治术后的不良结局有关。然而,其对 CRC 术后临床结局的影响仍存在争议。本研究旨在阐明肌少症对 CRC 患者术后并发症和生存的预测价值。

本研究回顾性评估了 2018 年 1 月至 2020 年 12 月遵义医科大学附属医院胃肠外科 226 例接受根治性切除术的 CRC 患者的临床资料。根据 2019 年亚洲肌少症工作组的建议诊断肌少症,并将患者分为肌少症组和非肌少症组。采用多因素和单因素分析评估术后并发症的危险因素。采用 Kaplan-Meier 法和生存曲线分析术后生存时间。采用 Cox 比例风险回归模型评估影响 CRC 患者预后的危险因素。

本研究共纳入 226 例患者,其中 68 例诊断为肌少症。此外,研究结果表明,肌少症与年龄较大(<0.001)、低体重指数(<0.001)、糖尿病患病率高(=0.002)、胱抑素水平高(=0.017)和第 3 腰椎(L3)平面骨骼肌指数低(<0.001)有关,但与肿瘤分期或性别无关。此外,肌少症与所有术后并发症的发生率增加也有关(=0.050)。多因素分析结果表明,肌少症是术后并发症的独立危险因素(比值比(OR):7.154;95%置信区间(CI):2.261-22.633;=0.017)。Kaplan-Meier 分析显示,肌少症患者 5 年无病生存率(DFS)(48.5%比 59.5%;log-rank=0.033)和 5 年总生存率(OS)(57.4%比 77.2%;log-rank<0.001)显著降低。肌少症是 DFS 不良的独立危险因素(风险比(HR)=1.404;=0.016)和 OS(HR=1.290;=0.021)。

在接受根治性手术的 CRC 患者中,肌少症是术后并发症的独立危险因素。肌少症可能是预测 CRC 患者根治性切除术后预后和生存的因素。

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