低内脏脂肪组织可预测结直肠癌肝转移新辅助化疗的疗效：一项多中心真实世界研究
Low Visceral Adipose Tissue Predicts the Outcome of Neoadjuvant Chemotherapy for Colorectal Liver Metastases: A Multicentre Real-World Study.
作者信息
Chen Yizhen, Jia Hangdong, Ye Rong, Zhou Zhenyuan, Chen Weijie, Zheng Ming, Zheng Yuanyuan
机构信息
Department of Geriatric Medicine, Fujian Key Laboratory of Geriatrics Diseases, Fujian Provincial Center for Geriatrics, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China.
General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
出版信息
J Cachexia Sarcopenia Muscle. 2025 Apr;16(2):e13785. doi: 10.1002/jcsm.13785.
BACKGROUND
Visceral obesity (VO), associated with excessive visceral adipose tissue (VAT), has been extensively studied in cancer. However, whether low VAT can predict the prognosis of colorectal liver metastases (CRLM) undergoing neoadjuvant chemotherapy (NAC) remains unknown.
METHODS
This multicentre real-world cohort study analysed data from initially resectable CRLM patients who received NAC. The predictive effect of VAT on progression-free survival (PFS) and overall survival (OS) was evaluated using restricted cubic splines (RCS). VAT was categorized into low/normal VAT and VO groups using X-tile. The prognostic differences were further assessed through Kaplan-Meier (KM) analysis. The impact of changes in VAT (ΔVAT) after NAC was evaluated.
RESULTS
Among 1524 CRLM patients, 1105 patients (72.51%) were under 65 years old, with a median VAT of 84.00 (36.24-148.00) cm. Of all patients, 804 (52.76%) were female. A U-shaped nonlinear relationship was observed between VAT and both PFS/OS (p < 0.001). Compared with the normal VAT, both low VAT and VO groups showed worsened PFS and OS (p < 0.05). The 3-year PFS rate was 31.6%, 69.0% and 42.0% in the low, normal VAT and VO groups (p < 0.05). The 3-year OS rate was 76.4%, 88.9% and 79.4% in the low, normal VAT and VO groups (p < 0.05). There was also a nonlinear relationship between VAT and NAC-related adverse events, objective response rate and postoperative complications (p < 0.001). An increase in ΔVAT in the low VAT group was associated with better PFS and OS (p < 0.05). In the VO group, both increases and decreases in ΔVAT were associated with worsened PFS and OS (p < 0.05).
CONCLUSIONS
This study is the first to reveal that low VAT and VO can predict PFS and OS in CRLM patients undergoing NAC. Baseline VAT and ΔVAT may serve as important indicators for risk stratification and personalized treatment in CRLM patients.
背景
内脏肥胖（VO）与过多的内脏脂肪组织（VAT）相关，已在癌症领域得到广泛研究。然而，低内脏脂肪组织能否预测接受新辅助化疗（NAC）的结直肠癌肝转移（CRLM）患者的预后仍不清楚。
方法
这项多中心真实世界队列研究分析了最初可切除的接受NAC的CRLM患者的数据。使用受限立方样条（RCS）评估内脏脂肪组织对无进展生存期（PFS）和总生存期（OS）的预测作用。使用X-tile将内脏脂肪组织分为低/正常内脏脂肪组织组和内脏肥胖组。通过Kaplan-Meier（KM）分析进一步评估预后差异。评估NAC后内脏脂肪组织变化（Δ内脏脂肪组织）的影响。
结果
在1524例CRLM患者中，1105例患者（72.51%）年龄在65岁以下，内脏脂肪组织中位数为84.00（36.24 - 148.00）cm。所有患者中，804例（52.76%）为女性。在内脏脂肪组织与PFS/OS之间观察到U形非线性关系（p < 0.001）。与正常内脏脂肪组织相比，低内脏脂肪组织组和内脏肥胖组的PFS和OS均较差（p < 0.05）。低、正常内脏脂肪组织组和内脏肥胖组的3年PFS率分别为31.6%、69.0%和42.0%（p < 0.05）。低、正常内脏脂肪组织组和内脏肥胖组的3年OS率分别为76.4%、88.9%和79.4%（p < 0.05）。在内脏脂肪组织与NAC相关不良事件、客观缓解率和术后并发症之间也存在非线性关系（p < 0.001）。低内脏脂肪组织组中Δ内脏脂肪组织增加与更好的PFS和OS相关（p < 0.05）。在内脏肥胖组中，Δ内脏脂肪组织增加和减少均与较差的PFS和OS相关（p < 0.05）。
结论
本研究首次揭示低内脏脂肪组织和内脏肥胖可预测接受NAC的CRLM患者的PFS和OS。基线内脏脂肪组织和Δ内脏脂肪组织可能作为CRLM患者风险分层和个性化治疗的重要指标。
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