术前肌肉减少症胸段食管癌患者的术后疗效分析  

Analysis of the curative effect of sarcopenia diagnosed before operation in patients with thoracic esophageal cancer

作　　者：孙晓忠 刘彩云 杨志刚[2] 拾博[2] 宦刚 渠敬明[3] SUN Xiao-zhong;LIU Cai-yun;YANG Zhi-gang;SHI Bo;HUAN Gang;QU Jing-ming(Department of Imaging,Tongshan District People's Hospital,Xuzhou 221002,China;Xuzhou Tumor Hospital,Xuzhou 221005,China)

机构地区：[1]徐州市铜山区人民医院影像科,江苏徐州221002 [2]徐州市肿瘤医院影像科,江苏徐州221005 [3]徐州市肿瘤医院胸外科,江苏徐州221005

出　　处：《中华肿瘤防治杂志》2021年第13期1007-1013,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：徐州市科技局重点研发课题(KC18200);江苏大学课题(JLY20180119)。

摘　　要：目的探讨胸段食管癌患者术前肌肉减少症和身体组成成分(BCPs)与术后并发症的相关性。方法回顾性分析2017-08-01-2020-02-10在徐州市肿瘤医院接受食管切除术的97例胸段食管癌患者的病例资料。在术前上腹部CT(包括腰3双侧横突)图像上评估骨骼肌指数和BCPs,根据肌肉减少症诊断标准分为72例肌肉减少症组(肌少症组)和25例非肌肉减少症组(非肌少症组)。采用病例对照研究方法比较2组疗效,应用二元Logistic回归分析模型评估肌肉减少症对术后预后的影响。结果肌少症组并发症发生率为54.2%(39/72),高于非肌少症组的48.0%(12/25),但差异无统计学意义,χ2=0.283,P=0.595。肌少症组肺部并发症发生率为34.7%(25/72),高于非肌少症组的12.0%(3/25),差异有统计学意义,χ2=6.170,P=0.013。单因素分析显示,骨骼肌密度降低(OR=0.707,95%CI为0.539~0.927,P=0.012)、脂肪指数升高(OR=1.536,95%CI为1.138~2.626,P=0.023)与肺部并发症发生率有关联。多因素分析结果显示,脂肪指数综合评分与单个或多个肺部并发症发病高风险有关联,OR=3.414,95%CI为1.483~7.069,P=0.005;预测准确率为80.4%。结论术前采用CT评估骨骼肌消耗、脂肪量的变化可对术前风险评估提供帮助。因样本量小,后续还需增加样本量进一步验证。Objective To explore the correlation between preoperative sarcopenia and body composition parameters(BCPs)and postoperative complications in patients with thoracic esophageal cancer.Methods We retrospectively analyzed the data of 97 patients with thoracic esophageal cancer who underwent esophagectomy at Xuzhou Cancer Hospital from August 1,2017 to February 10,2020.The skeletal muscle index and BCPs were evaluated on preoperative upper abdominal CT(including lumbar 3 bilateral)images.Patients were categorised by the diagnostic criteria of sarcopenia:72 in sarrcopenia cohort and 25 in non-sarcopenia cohort.Case-control study analysis method was used to compare the efficacy of the two groups»and a binary logistic regression analysis model was used to evaluate the effect of sarcopenia on the postoperative prognosis.Results The total complication rate of the sarcopenia group was 54.2%(39/72)higher than 48.0%(12/25)of the non-sarcopenia group,but there was no statistically significant difference,X^(2)=0.283,P=0.595.The incidence of pulmonary complications in the sarcopenia group was 34.7%(25/72)higher than that in the non-sarcopenia group which was 12.0%(3/25),the difference was statistically significant,X^(2)=6.170,P=0.013.Univariate analysis showed that decreased skeletal muscle density(OR=0.707,95%CI:0.539-0.927,P=0.012),increased fat index(OR=1.536,95%CI:1.138-2.626,P=0.023)were associated with the incidence of pulmonary complications.Multivariate results showed that composite sarcopenia score was associated with a high risk of one or more pulmonary complications(OR=3.414,95%CI:1.483-7.069,P=0.005).The prediction accurate rate was 80.4%.Conclusions Skeletal muscle consumption and fat mass changes assessed by CT before-surgery can provide help for preoperative risk assessment.Due to the small sample size,the sample size needs to be increased for further verification.

关 键 词：肌肉减少症 身体组成成分 食管恶性肿瘤 肺部并发症 

分 类 号：R735.1[医药卫生—肿瘤]