Prognostic value of sarcopenia in patients with colorectal liver metastases undergoing hepatic resection
Prognostic value of sarcopenia in patients with colorectal liver metastases undergoing hepatic resection
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DOI：
10.1038/s41598-020-63644-x
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发表时间：
2020-04-15
影响因子：
4.6
通讯作者：
Hung, Chao-Hung
中科院分区：
文献类型：
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作者：
Liu, Yueh-Wei;Lu, Chien-Chang;Hung, Chao-Hung
肌肉减少症的预后意义已经在不同的癌症患者中得到了广泛的研究。本研究旨在分析肌肉减少症对结直肠癌肝转移（CRLM）患者行肝切除术后长期生存的影响。对182例因CRLM行肝切除术的患者进行了回顾性分析。用Hounsfield单位平均值计算法（HUAC）确定肌肉减少症，HUAC是一种测量术前腹部计算机断层扫描时肌肉质量-肌肉密度的方法。肌肉减少症定义为使用受试者工作特征分析计算的HUAC评分小于22 HU。评估临床变量和总生存期（OS）及无复发生存期（RFS）的预后相关性。与未患肌肉减少症的患者相比，患有肌肉减少症的患者年龄更大（p <0.001），糖尿病患病率更高（p = 0.004），体重指数（BMI）更高（p < 0.001），嗜中性粒细胞与淋巴细胞比率更高（p = 0.026）。肌肉减少症与OS和RFS无显着相关性。多因素考克斯回归分析显示，多结节（>3）（风险比（HR）2.736; 95%置信区间（CI）1.631-4.589; p < 0.001），高CEA水平（>= 20纳克/毫升）（HR 1.793; 95% CI，1.092-2.945; p = 0.021）和失血量（>= 300 cc）（HR 1.793; 95% CI，1.084-2.964; p = 0.023）是与OS相关的独立因素。在亚组分析中，单因素分析显示，肌肉减少是多结节患者OS差的重要因素（p = 0.002）和多变量分析（HR 3.571; 95% CI，1.508-8.403; p = 0.004）。多结节性（>3）（HR 1.750; 95% CI，1.066-2.872; p = 0.027），天冬氨酸转氨酶水平高（HR 1.024; 95% CI，1.003-1.046; p = 0.025）和男性（HR 1.688; 95% CI，1.036-2.748; p = 0.035）是RFS的独立因素。总之，尽管在整个队列中无显著性，但肌肉减少症可预测部分肝切除术后多发性CRLM患者的OS更差。
The prognostic significance of sarcopenia has been widely studied in different cancer patients. This study aimed to analyze the influence of sarcopenia on long-term survival in patients with colorectal liver metastasis (CRLM) undergoing hepatic resection. A retrospective analysis of 182 patients undergoing hepatic resection for CRLM was performed. Sarcopenia was determinedusing the Hounsfield unit average calculation (HUAC), a measure of muscle quality-muscledensity at preoperative abdominal computed tomography scans. Sarcopenia was defined as an HUAC score of less than 22 HU calculated using receiver operating characteristic analysis. The prognostic relevance of clinical variables and overall survival (OS) and recurrence-free survival (RFS) was evaluated. Patients with sarcopenia were older (p < 0.001) and had higher prevalence of diabetics (p = 0.004), higher body mass index (BMI) (p < 0.001) and neutrophil-to-lymphocyte ratio (p = 0.026) compared to those without. Sarcopenia was not significantly associated with OS and RFS. Multivariate Cox's regression analysis showed that multinodularity (>3) (hazard ratio (HR) 2.736; 95% confidence interval (CI), 1.631-4.589; p < 0.001), high CEA level (>= 20 ng/ml) (HR 1.793; 95% CI, 1.092-2.945; p = 0.021) and blood loss (>= 300 cc) (HR1.793; 95% CI, 1.084-2.964; p = 0.023) were independent factors associated with OS. In subgroup analyses, sarcopenia was a significant factor of poor OS in the patients with multinodularity by univariate (p = 0.002) and multivariate analyses(HR 3.571; 95% CI, 1.508-8.403; p = 0.004). Multinodularity (>3) (HR 1.750; 95% CI, 1.066-2.872; p = 0.027), high aspartate aminotransferase level (HR 1.024; 95% CI, 1.003-1.046; p = 0.025) and male gender (HR 1.688; 95% CI, 1.036-2.748; p = 0.035) were independent factors of RFS. In conclusion, despite no significance in whole cohort, sarcopenia was predictive of worse OS in patients with multiple CRLM after partial hepatectomy.