Palmas Fiorella X, Ricart Marta, Lluch Amador, Mucarzel Fernanda, Cartiel Raul, Zabalegui Alba, Barrera Elena, Roson Nuria, Rodriguez Aitor, Espin-Basany Eloy, Burgos Rosa M
Nutrition Support Unit, Endocrinology and Nutrition Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain.
Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain.
Nutrients. 2025 Jul 9;17(14):2264. doi: 10.3390/nu17142264.
: Prehabilitation programs improve postoperative outcomes in vulnerable patients undergoing major surgery. However, current screening tools such as the Malnutrition Universal Screening Tool (MUST) may lack the sensitivity needed to identify those who would benefit most. Muscle quality assessed by Computed Tomography (CT), specifically muscle radiodensity in Hounsfield Units (HUs), has emerged as a promising alternative for risk stratification. : To evaluate the prognostic performance of CT-derived muscle radiodensity in predicting adverse postoperative outcomes in colorectal cancer patients, and to compare it with the performance of the MUST score. : This single-center cross-sectional study included 201 patients with non-metastatic colon cancer undergoing elective laparoscopic resection. Patients were stratified based on enrollment in a multimodal prehabilitation program, either within an Enhanced Recovery After Surgery (ERAS) protocol or a non-ERAS pathway. Nutritional status was assessed using MUST, SARC-F questionnaire (strength, assistance with walking, rise from a chair, climb stairs, and falls), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. CT scans at the L3 level were analyzed using automated segmentation to extract muscle area and radiodensity. Postoperative complications and hospital stay were compared across nutritional screening tools and CT-derived metrics. : MUST shows limited sensitivity (<27%) for predicting complications and prolonged hospitalization. In contrast, CT-derived muscle radiodensity demonstrates higher discriminative power (AUC 0.62-0.69), especially using a 37 HU threshold. In the non-ERAS group, patients with HU ≤ 37 had significantly more complications (33% vs. 15%, = 0.036), longer surgeries, and more severe events (Clavien-Dindo ≥ 3). : Opportunistic CT-based assessment of muscle radiodensity outperforms traditional screening tools in identifying patients at risk of poor postoperative outcomes, and may enhance patient selection for prehabilitation strategies like the ERAS program.
术前康复计划可改善接受大手术的脆弱患者的术后结局。然而，当前的筛查工具，如营养不良通用筛查工具（MUST），可能缺乏识别最能从中受益患者的敏感性。通过计算机断层扫描（CT）评估的肌肉质量，特别是以亨氏单位（HU）表示的肌肉放射密度，已成为一种有前景的风险分层替代方法。
为了评估CT衍生的肌肉放射密度在预测结直肠癌患者术后不良结局方面的预后性能，并将其与MUST评分的性能进行比较。
这项单中心横断面研究纳入了201例接受择期腹腔镜切除术的非转移性结肠癌患者。根据是否纳入多模式术前康复计划进行分层，该计划要么在术后加速康复（ERAS）方案内，要么在非ERAS路径中。使用MUST、SARC - F问卷（力量、行走辅助、从椅子上起身、爬楼梯和跌倒）以及全球营养不良领导倡议（GLIM）标准评估营养状况。使用自动分割分析L3水平的CT扫描，以提取肌肉面积和放射密度。比较不同营养筛查工具和CT衍生指标的术后并发症和住院时间。
MUST在预测并发症和延长住院时间方面显示出有限的敏感性（<27%）。相比之下，CT衍生的肌肉放射密度显示出更高的判别力（AUC为0.62 - 0.69），特别是使用37 HU阈值时。在非ERAS组中，HU≤37的患者并发症明显更多（33%对15%，P = 0.036），手术时间更长，且严重事件更多（Clavien - Dindo≥3）。
基于CT的机会性肌肉放射密度评估在识别术后结局不良风险患者方面优于传统筛查工具，并且可能增强像ERAS计划这样的术前康复策略的患者选择。
