Modified intramuscular adipose tissue content as a feasible surrogate marker for malnutrition in gastrointestinal cancer
Modified intramuscular adipose tissue content as a feasible surrogate marker for malnutrition in gastrointestinal cancer
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DOI：
10.1016/j.clnu.2021.03.036
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发表时间：
2021-05-01
影响因子：
6.3
通讯作者：
Kusunoki, Masato
中科院分区：
文献类型：
--
作者：
Kusunoki, Yukina;Okugawa, Yoshinaga;Kusunoki, Masato
背景与目的：肌肉脂肪变性作为肌肉减少症和发病风险增加的可行指标正在引起人们的关注。然而，肌内脂肪组织含量（IMAC）作为一种评估方法的预测价值仍然存在争议。本研究的目的是比较肌内脂肪组织含量（IMAC）与我们新开发的改良IMAC（mIMAC）的预后价值，并评估mIMAC在结直肠癌（CRC）和胃癌（GC）中的临床意义。方法：我们评估了892例CRC或GC患者，并评估术前IMAC和mIMAC，以比较两组患者术后感染并发症的预后和预测价值。在结直肠癌和胃癌患者中，术前IMAC和mIMAC均具有性别和疾病依赖性，并与年龄呈正或负相关（IMAC：CRC：r = 0.33，P < 0.0001; GC：r = 0.304，P < 0.0001; mIMAC：CRC：r =-0.364，P < 0.0001; GC：r =-0.263，P < 0.0001）。与IMAC相比，术前较低的mIMAC与疾病发展因素显著相关，并且是两种CRC患者总生存期（OS）和无病生存期（DFS）的独立预后因素。（OS：风险比（HR）：1.95，95%置信区间（CI）：1.25-3.03，p = 0.003; DFS：HR：1.93，95% CI：1.22 - 3.04，p = 0.005）和GC患者（OS：HR：2.11，95%CI：1.22-3.68，P = 0.008; DFS：HR：2.03，95%CI：1.18 - 3.5，P = 0.011）。两个队列中有术后远端感染的患者与无术后远端感染的患者相比预后较差（CRC：HR：2.67，95%CI：1.46-4.89，P = 0.002; GC：HR：3.01，95%CI：1.47 - 6.19，P = 0.003），低mIMAC是两种癌症术后远端感染的独立危险因素（CRC：优势比（OR）：2.56，95%CI：1.06-6.23，P = 0.038; GC：OR：2.8，95%CI：1.03-7.58，P = 0.043）。最后，我们评估了IMAC或mIMAC与代表性虚弱标志物体重指数（BMI）、血清白蛋白和预后营养指数（PNI）之间的相关性。我们发现两个队列中术前mIMAC与所有这些标志物之间呈正相关（CRC：BMI：r = 0.193，P < 0.0001;血清白蛋白：r = 0.42，P < 0.0001; PNI：r = 0.39，P <0.0001; GC：BMI：r = 0.22，P < 0.0001;血清白蛋白：r = 0.42，P <0.0001; PNI：r = 0.39，P < 0.0001; GC：r = 0.22，P < 0.0001;结论：术前mIMAC对结直肠癌和胃癌的围术期和术后处理有一定的指导意义。(c)2021爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
Background & aims: Myosteatosis is gathering attention as a feasible indicator for sarcopenia and increased risk of morbidity. However, the prognostic value of intramuscular adipose tissue content (IMAC) as an assessment method for myosteatosis remains controversial. The objectives of this study are to compare the prognostic value of intramuscular adipose tissue content (IMAC) with our newlydeveloped modified IMAC (mIMAC), and to assess the clinical significance of mIMAC in colorectal cancer (CRC) and gastric cancer (GC).Methods: We evaluated 892 patients with CRC or GC, and assessed preoperative IMAC and mIMAC to compare their prognostic and predictive values for postoperative infectious complications in both cohorts.Results: Both preoperative IMAC and mIMAC were sex- and disease-dependent, and positively or negatively correlated with age in CRC and GC patients (IMAC: CRC: r = 0.33, P < 0.0001; GC: r = 0.304, P < 0.0001; mIMAC: CRC: r = -0.364, P < 0.0001; GC: r = -0.263, P < 0.0001). In contrast to IMAC, lower preoperative mIMAC was significantly associated with disease-development factors, and was an independent prognostic factor for both overall survival (OS) and disease-free survival (DFS) in both CRC (OS: hazard ratio (HR): 1.95, 95% confidence interval (CI): 1.25-3.03, p = 0.003; DFS: HR: 1.93, 95% CI: 1.22 -3.04, p = 0.005) and GC patients (OS: HR: 2.11, 95% CI: 1.22-3.68, P = 0.008; DFS: HR: 2.03, 95% CI: 1.18 -3.5, P = 0.011). Patients with postoperative remote infections had a poorer prognosis compared with those without in both cohorts (CRC: HR: 2.67, 95% CI: 1.46-4.89, P = 0.002; GC: HR: 3.01, 95% CI: 1.47 -6.19, P = 0.003), and low mIMAC was an independent risk factor for postoperative remote infection in both cancers (CRC: odds ratio (OR): 2.56, 95% CI: 1.06-6.23, P = 0.038; GC: OR: 2.8, 95% CI: 1.03-7.58, P = 0.043). Finally, we assessed the correlation between IMAC or mIMAC and the representative frailty markers body mass index (BMI), serum albumin, and prognostic nutritional index (PNI). We found a positive correlation between preoperative mIMAC and all of these markers in both cohorts (CRC: BMI: r = 0.193, P < 0.0001; serum albumin: r = 0.42, P < 0.0001; PNI: r = 0.39, P < 0.0001; GC: BMI: r = 0.22, P < 0.0001; serum albumin: r = 0.212, P < 0.0001; PNI: r = 0.287, P < 0.0001).Conclusions: Preoperative mIMAC could be useful for perioperative and postoperative management in CRC and GC.(c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.