Impact of preoperative quality as well as quantity of skeletal muscle on survival after resection of pancreatic cancer
Impact of preoperative quality as well as quantity of skeletal muscle on survival after resection of pancreatic cancer
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DOI：
10.1016/j.surg.2015.02.002
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发表时间：
2015-06-01
期刊：
影响因子：
3.8
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
--
作者：
Okumura, Shinya;Kaido, Toshimi;Uemoto, Shinji
背景骨骼肌耗竭，称为肌肉减少症，是消化道手术患者死亡率的预测指标。然而，肌肉质量对结果的影响尚不清楚。本回顾性研究调查了术前骨骼肌数量和质量对胰腺癌切除患者生存率的影响。我们调查了2004年至2013年间接受胰腺癌切除术的230例患者。在术前计算机断层扫描图像上测量骨骼肌的数量和质量，以腰大肌质量指数（PM）和肌内脂肪组织含量（IMAC）表示。根据PMI和IMAC比较总生存率（OS）和无复发生存率（RFS），并评估胰腺切除术后的预后因素。低PMI患者的OS和RFS率低于正常/高PMI患者（P <0.001，P <0.001），平均生存时间分别为17.7和33.2个月。高IMAC患者的OS和RFS率也低于正常/低IMAC患者（P <0.001，P = 0.003）（平均生存时间分别为21.5和56.5个月）。低PMI（低肌肉质量）和高IMAC（低肌肉质量）分别是OS（风险比[HR] = 1.999，P < .001; HR = 2.527，P < .001）和RFS（HR = 1.607，P = .007; HR = 1.640，P = .004）差的独立预后因素。术前骨骼肌减少症，即骨骼肌质量和数量的低下，与胰腺癌切除术后的死亡率密切相关
Background. Skeletal muscle depletion, referred to as sarcopenia, is predictive of mortality in patients undergoing digestive operations. The impact of muscle quality on outcomes, however, is unclear. This retrospective study investigated the impact of preoperative skeletal muscle quantity and quality on survival in patients undergoing resection of pancreatic cancer.Methods. We investigated 230 patients who underwent resection of pancreatic cancer between 2004 and 2013. The quantity and quality of skeletal muscle, indicated by psoas muscle mass index (PM) and intramuscular adipose tissue content (IMAC), were measured in preoperative computed tomography images. Overall survival (OS) and recurrence-free survival (RFS) rates were compared according to PMI and IMAC, and prognostic factors after pancreatic resection were assessed.Results. The OS and RFS rates in patients with low PMI were lesser than in those with normal/high PMI (P < .001, P < .001), with a mean survival time of 17.7 and 33.2 months, respectively. The OS and RFS rates in patients with high IMAC also were less than in those with normal/low IMAC (P < .001, P = .003) (mean survival time = 21.5 and 56.5 months, respectively). Low PMI (low muscle mass) and high IMAC (low muscle quality) were independent prognostic factors of poor OS (hazard ratio [HR] = 1.999, P < .001; HR = 2.527, P < .001) and RFS (HR = 1.607, P = .007; HR = 1.640, P = .004), respectively.Conclusion. Preoperative sarcopenia, indicating low quality and quantity of skeletal muscle, is closely related to mortality after resection of pancreatic cancer