Martin David, Billy Mathilde, Becce Fabio, Maier Damien, Schneider Michael, Dromain Clarisse, Hahnloser Dieter, Hübner Martin, Grass Fabian
Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland.
Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland.
Diagnostics (Basel). 2025 Mar 5;15(5):629. doi: 10.3390/diagnostics15050629.
Patients with rectal cancer may be exposed to a loss of muscle strength and quality. This study aimed to assess the role of preoperative CT-based sarcopenia on postoperative clinical, pathological, and oncological outcomes after rectal cancer surgery. This retrospective monocentric study included patients who underwent elective oncologic resection for rectal adenocarcinoma between 01/2014 and 03/2022. The skeletal muscle index (SMI) was measured using CT at the third lumbar vertebral level, and sarcopenia was defined based on pre-established sex-specific cut-offs. Patients with sarcopenia were compared to those without sarcopenia in terms of outcomes. A Cox proportional hazard regression analysis was used to determine the independent prognostic factors of disease-free survival (DFS) and overall survival (OS). A total of 208 patients were included, and 123 (59%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (66 vs. 61 years, = 0.003), had lower BMI (24 vs. 28 kg/m, < 0.001), and were mainly men (76 vs. 48%, < 0.001). There was no difference in overall and major complication rates between the sarcopenia and non-sarcopenia group (43 vs. 37%, = 0.389, and 17 vs. 17%, = 1.000, respectively). Preoperative and postoperative features related to rectal surgery were comparable. The only predictive factor impacting OS was R1/R2 resection (HR 4.915, 95% CI, 1.141-11.282, < 0.001), while sarcopenia (HR 2.013, 95% CI 0.972-4.173, = 0.050) and T3/T4 status (HR 2.108, 95% CI 1.058-4.203, = 0.034) were independently associated with DFS. A majority of patients undergoing rectal cancer surgery had preoperative CT-based sarcopenia. In this cohort, sarcopenia had no impact on postoperative morbidity and OS but was independently associated with DFS.
直肠癌患者可能会出现肌肉力量和质量的丧失。本研究旨在评估术前基于CT的肌肉减少症对直肠癌手术后临床、病理和肿瘤学结局的作用。这项回顾性单中心研究纳入了2014年1月至2022年3月期间接受择期直肠癌根治术的患者。使用CT在第三腰椎水平测量骨骼肌指数（SMI），并根据预先设定的性别特异性临界值定义肌肉减少症。将肌肉减少症患者与无肌肉减少症患者的结局进行比较。采用Cox比例风险回归分析确定无病生存期（DFS）和总生存期（OS）的独立预后因素。共纳入208例患者，其中123例（59%）术前存在肌肉减少症。肌肉减少症患者年龄显著更大（66岁 vs. 61岁，P = 0.003），BMI更低（24 vs. 28 kg/m²，P < 0.001），且主要为男性（76% vs. 48%，P < 0.001）。肌肉减少症组与非肌肉减少症组的总体并发症和主要并发症发生率无差异（分别为43% vs. 37%，P = 0.389，以及17% vs. 17%，P = 1.000）。与直肠手术相关的术前和术后特征具有可比性。影响OS的唯一预测因素是R1/R2切除（HR 4.915，95%CI，1.141 - 11.282，P < 0.001），而肌肉减少症（HR 2.013，95%CI 0.972 - 4.173，P = 0.050）和T3/T4分期（HR 2.108，95%CI 1.058 - 4.203，P = 0.034）与DFS独立相关。大多数接受直肠癌手术的患者术前存在基于CT的肌肉减少症。在该队列中，肌肉减少症对术后发病率和OS无影响，但与DFS独立相关。
