A clinically applicable muscular index predicts long-term survival in resectable pancreatic cancer
A clinically applicable muscular index predicts long-term survival in resectable pancreatic cancer
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DOI：
10.1016/j.surg.2016.09.038
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发表时间：
2017-04-01
期刊：
影响因子：
3.8
通讯作者：
Trevino, Jose G.
中科院分区：
文献类型：
--
作者：
Delitto, Daniel;Judge, Sarah M.;Trevino, Jose G.
背景在临床可切除的胰腺癌患者中，肌减少症、营养状况和长期肿瘤学结局之间的关系仍不明确。我们试图以一种适用于任何临床环境的方式来可靠地量化术前恶病质的预后指标。2010年11月至2014年2月期间，82例连续胰腺癌患者中有73例接受了胰腺切除术，术前计算机断层扫描可通过电子方式获得，适用于分析。腰大肌指数的计算方法是将腰大肌的横截面积标准化为第三腰椎的椎体面积。相关性和比例风险分析用于确定肌肉发达、术前营养指标、临床病理参数和长期生存率之间的关系。腰大肌指数与术前血红蛋白和白蛋白水平密切相关（分别为P = 0.001和0.014），确定了术前虚弱的模式。高腰大肌指数、白蛋白和血红蛋白水平与长期生存率的改善相关（风险比0.014，P <0.001;风险比0.43，P <0.001;风险比= 0.80，P = 0.014）;然而，在多变量分析中，腰大肌指数被证明是生存率的唯一独立预测因子（风险比0.021; P = .003）。新辅助化疗期间腰大肌指数的快速下降与不良的术后结局相关，术后腰大肌指数的下降也是如此。这些数据表明，腰肌指数，一个来自临床要求的计算，术前计算机断层扫描，是一个统计学上强大的和容易计算的预测胰腺癌的生存期相比，肿瘤分级和阶段，以及以前验证的营养参数。
Background. The relationship between myopenia, nutritional status, and long-term oncologic outcomes remains poorly characterized in patients with clinically resectable pancreatic cancer. We sought to reliably quantify prognostic indicators of preoperative cachexia in a manner applicable to any clinical setting.Methods. Preoperative computed tomographies were available electronically and suitable for analysis in 73 of 82 consecutive patients with pancreatic cancer undergoing pancreatoduodenectomy between November 2010 and February 2014. The psoas index was computed from the cross-sectional area of the psoas muscles normalized to vertebral body area at the third lumbar vertebra. Correlation and proportional hazards analyses were performed to identify relationships between muscularity, preoperative nutritional markers, clinicopathologic parameters, and long-term survival.Results. The psoas index correlated strongly with preoperative hemoglobin and albumin levels (P = .001 and .014, respectively) identifying a pattern of preoperative frailty. High psoas index and the albumin and hemoglobin levels were associated with improved long-term survival (hazard ratio 0.014, P < .001; hazard ratio 0.43, P < .001; and hazard ratio = 0.80, P = .014); however, on multivariate analysis, the psoas index proved to be the only independent predictor of survival (hazard ratio 0.021; P = .003). Rapid decreases in the psoas index during neoadjuvant chemotherapy were associated with poor postoperative outcomes, as were decreases in the psoas index during the postoperative period.Conclusion. The data indicate that the psoas index, a calculation derived from a clinically mandated, preoperative computed tomography, is a statistically powerful and easily calculated predictor of survival in pancreatic cancer when compared to tumor grade and stage as well as previously validated nutritional parameters.