Li Ling, Xing Mengchen, Wang Rong, Ding Xiaoyue, Wan Xia, Yu Xin
Department of Thyroid, Breast, and Gastrointestinal Surgery, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China.
Department of Geriatric Medicine, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China.
BMC Geriatr. 2025 Mar 28;25(1):206. doi: 10.1186/s12877-025-05806-y.
Sarcopenia predicts worse postoperative outcomes and lower survival rates in patients with colorectal cancer (CRC). There is a scarcity of studies on the most effective assessment tools for detecting sarcopenia in preoperative elderly patients with CRC. Our objective was to compare the diagnostic accuracy of various tools such as calf circumference (CC), strength, need for assistance with walking, rising from a sitting position, climbing stairs, and the incidence of falls (SARC-F), SARC-F plus CC (SARC-CalF), the short version of mini sarcopenia risk assessment (MSRA-5), the full version of mini sarcopenia risk assessment (MSRA-7), and Ishii score chart in screening sarcopenia in preoperative elderly patients with CRC.
During the period of April 2021 to September 2023, we conducted a cross-sectional study involving consecutive elderly patients who were undergoing colorectal surgery. Sarcopenia was defined using the diagnostic criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) and the 2019 Asian Working Group for Sarcopenia (AWGS2019). The screening tools' performances were evaluated through receiver operating characteristic (ROC) curves, area under the ROC curves (AUC), and sensitivity/specificity analyses, based on the criteria proposed by EWGSOP2 and AWGS2019.
We enrolled 482 patients with an average age of 71.86 ± 5.60 years. According to the EWGSOP2 and AWGS2019 diagnostic standards, the incidence of sarcopenia was 19.5% and 21.6% respectively. The sensitivity of SARC-F, SARC-CalF, MSRA-5, MSRA-7, and Ishii score chart ranged from 51.92 to 56.38%, 84.62-85.11%, 86.54-88.30%, 65.96-67.31%, and 73.08-74.47% respectively, while the specificity ranged from 84.92 to 85.05%, 70.36-71.69%, 36.86-37.04%, 60.57-61.64%, and 77.32-78.31% respectively. Regardless of the sarcopenia diagnostic criteria used, the AUCs of Ishii score chart (0.87 to 0.88) and SARC-CalF (0.89 to 0.90) were significantly larger than those of other tools (P<0.05). There was no significant difference in AUCs among SARC-F, SARC-CalF, and Ishii score chart in females.
Among the five sarcopenia screening tools, Ishii score chart and SARC-CalF had the largest overall diagnostic accuracy for sarcopenia in preoperative elderly patients with CRC.
肌肉减少症预示着结直肠癌（CRC）患者术后预后更差，生存率更低。目前对于术前老年CRC患者中检测肌肉减少症的最有效评估工具的研究较少。我们的目的是比较各种工具的诊断准确性，如小腿围度（CC）、力量、行走辅助需求、从坐姿站起、爬楼梯以及跌倒发生率（SARC-F）、SARC-F加CC（SARC-CalF）、迷你肌肉减少症风险评估简版（MSRA-5）、迷你肌肉减少症风险评估完整版（MSRA-7）以及石井评分表，以筛查术前老年CRC患者的肌肉减少症。
在2021年4月至2023年9月期间，我们进行了一项横断面研究，纳入了连续接受结直肠手术的老年患者。根据老年人肌肉减少症欧洲工作组2（EWGSOP2）和2019年亚洲肌肉减少症工作组（AWGS2019）提出的诊断标准来定义肌肉减少症。基于EWGSOP2和AWGS2019提出的标准，通过受试者工作特征（ROC）曲线、ROC曲线下面积（AUC）以及敏感性/特异性分析来评估筛查工具的性能。
我们纳入了482例患者，平均年龄为71.86±5.60岁。根据EWGSOP2和AWGS2019诊断标准，肌肉减少症的发生率分别为19.5%和21.6%。SARC-F、SARC-CalF、MSRA-5、MSRA-7和石井评分表的敏感性分别为51.92%至56.38%、84.62% - 85.11%、86.54% - 88.30%、65.96% - 67.31%和73.08% - 74.47%，而特异性分别为84.92%至85.05%、70.36% - 71.69%、36.86% - 37.04%、60.57% - 61.64%和77.32% - 78.31%。无论使用何种肌肉减少症诊断标准，石井评分表（0.87至0.88）和SARC-CalF（0.89至0.90）的AUC均显著大于其他工具（P<0.05）。女性中SARC-F、SARC-CalF和石井评分表的AUC之间无显著差异。
在这五种肌肉减少症筛查工具中，石井评分表和SARC-CalF对术前老年CRC患者肌肉减少症的总体诊断准确性最高。
