Shuto Kiyohiko, Nabeya Yoshihiro, Mori Mikito, Yamazaki Masato, Kosugi Chihiro, Narushima Kazuo, Usui Akihiro, Nojima Hiroyuki, Shimizu Hiroaki, Koda Keiji
Department of Surgery, Teikyo Chiba Medical Center, 3426-3 Anesaki, Ichihara-shi, Chiba 299-0111, Japan.
Division of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, Nitona-cho, Chiba 260-8717, Japan.
Cancers (Basel). 2025 Feb 21;17(5):738. doi: 10.3390/cancers17050738.
Postoperative changes in body composition (BC) have not been clearly defined. The aim of this study was to clarify the impact of postoperative comprehensive changes in BC on long-term prognosis in gastric cancer (GC) patients.
A total of 366 GC patients who underwent radical gastrectomy were included. Postoperative changes in skeletal muscle volume, body fat volume, and skeletal muscle density were investigated at six months postoperatively using computed tomography and evaluated their association with long-term survival.
Patients with decreased muscle volume, decreased fat volume, and increased muscle density had a poor prognosis, respectively. When the risk scores based on these three BC parameters were applied, patients were classified from score 0 to 4, with survival rate declining as the scores improved: score 0, interim 5-year overall survival 94%; score 1, 82%; score 2, 73%; score 3, 56%; and score 4, 20%. BC change (score > 2) was an independent poor prognosticator (HR, 3.086; < 0.001). Preoperative myosteatosis, high Charlson comorbidity, and total gastrectomy were identified as significant independent risk factors for BC change.
Each of postoperative skeletal muscle loss, body fat loss, and muscle hyperdensity negatively affected prognosis of GC patients after surgery, and the BC risk scoring assessment well predicted the prognosis of postoperative patients with GC.
术后身体成分（BC）的变化尚未明确界定。本研究的目的是阐明BC术后综合变化对胃癌（GC）患者长期预后的影响。
共纳入366例行根治性胃切除术的GC患者。术后6个月采用计算机断层扫描研究骨骼肌体积、体脂体积和骨骼肌密度的术后变化，并评估它们与长期生存的关系。
肌肉体积减少、脂肪体积减少和肌肉密度增加的患者预后分别较差。当应用基于这三个BC参数的风险评分时，患者从0分到4分进行分类，生存率随着评分升高而下降：0分，中期5年总生存率94%；1分，82%；2分，73%；3分，56%；4分，20%。BC变化（评分>2）是一个独立的不良预后因素（HR，3.086；<0.001）。术前肌少脂性、高Charlson合并症和全胃切除术被确定为BC变化的显著独立危险因素。
术后骨骼肌丢失、体脂丢失和肌肉高密度均对GC患者术后预后产生负面影响，BC风险评分评估能很好地预测GC术后患者的预后。
