CT定量腹部内脏脂肪面积对男性直肠癌根治术患者预后评估价值  

Prognostic evaluation of quantification of abdominal visceral fat area based on CT in male patients after radical resection of rectal cancer

作　　者：吴云桦 宋斌[1] 龙延滨[1] 余磊 师帅 段降龙[1] 刘栋[1] WU Yun-hua;SONG Bin;LONG Yan-bin;YU Lei;SHI Shuai;DUAN Jiang-long;LIU Dong(Second Department of General Surgery,Shaanzi Provincial People's Hospital,Xian 710061,China)

机构地区：[1]陕西省人民医院普外二科,陕西西安710061

出　　处：《中华肿瘤防治杂志》2022年第10期756-762,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：陕西省重点研发计划-社会发展领域(2018SF-041);西安市社会发展引导计划[2017113SF/YX007(12)];陕西省人民医院2021年科技人才支持计划资助项目(2021JY-15)。

摘　　要：目的 探讨腹部内脏脂肪面积(VFA)及与皮下脂肪面积(SFA)比(VFA/SFA)对男性直肠癌患者预后的评估价值。方法 回顾性收集2016-05-01-2018-03-01在陕西省人民医院行直肠癌根治手术的男性患者88例临床资料,术后定期随访,随访截止时间为2021-03-01,中位随访时间47个月。采用Slice-O-Matic 5.0软件计算第3腰椎层面的VFA与SFA,通过受试者工作曲线(ROC)对患者腹部VFA和VFA/SFA与总体生存进行相关分析,有意义的数据进行不同组别间手术近远期疗效及其他相关数据对比。结果 ROC分析发现,SFA及VFA/SFA对男性患者总体生存有预测价值,根据尤登指数将2个指标各分为2组,其中低VFA组52例,高VFA组36例;低VFA/SFA组33例,高VFA/SFA 55例。高VFA(t=-5.543,P=0.001)及高VFA/SFA组(t=-3.292,P=0.001)患者体质量指数(BMI)较高,高VFA组患者术中出血量多(t=-2.724,P=0.006),手术清除淋巴结数目少(t=-3.640,P<0.001),切口并发症(χ^(2)=7.570,P=0.006)及尿潴留发生率(P=0.025)高。高VFA/SFA组患者较低VFA/SFA组患者术中出血量多,t=-2.940,P=0.003;术后清除淋巴结数目少,t=-4.679,P<0.001;术后排气时间(t=-2.824,P=0.006)及排便时间(t=-2.348,P=0.021)长。高VFA及VFA/SFA组患者总体生存(P值分别为0.012和0.002)及无病生存(P值分别为0.024和0.011)均较低VFA及低VFA/SFA组患者差。Cox回归分析发现,在调整淋巴结有无转移、有无脉管癌栓侵犯、TNM分期危险性因素后,VFA及VFA/SFA是男性直肠癌患者总体生存(HR=1.907,95%CI为0.731~4.977;HR=4.421,95%CI为0.897~21.791)及无病生存(HR=1.984,95%CI为0.865~4.550;HR=1.975,95%CI为0.704~5.541)的危险因素。结论 VFA及VFA/SFA是男性直肠癌患者预后的危险因素,VFA及VFA/SFA可影响男性直肠癌患者手术效果。Objective To explore the prognostic value of abdominal visceral fat area(VFA) and the VFA to subcutaneous fat area ratio(SFA) in evaluating the prognosis of patients with rectal cancer.Methods We retrospectively collected the clinical data of patients undergoing radical surgery for rectal cancer in Shaanxi Provincial Hospital from May 1,2016 to March 1,2018.The patients had been followed up regularly after operation until March 1,2021.The median follow-up time was 47 months.A total of 150 patients were enrolled, including 88 males and 62 females.The Slice-O-Matic 5.0 software was used to calculate abdominal VFA and SFA at the third lumbar vertebral level, and the ROC curve was used to analyze the correlation between the patient’s abdominal VFA and the ratio of VFA to SFA on the one hand and overall survival on the other hand.The meaningful data were compared between different groups of short-term and long-term effects of surgery and compared with other related data.Results According to the ROC curve, it was found that SFA and VFA/SFA ratio had predictive value for the overall survival of male patients.According to the Youden index, the two indicators were divided into two groups, including 52 cases in the low VFA group, 36 cases in the high VFA group.There were 33 cases in the low VEF/SFA group,and 55cases in the high VFA/SFA group.A group of patients with high VFA and VFA/SFA had a higher BMI index(VFA,t=-5.543,P=0.001;VFA/SFA,t=-3.292,P=0.001);patients with high VFA had more intraoperative blood loss(t=-2.724,P=0.006),fewer lymph nodes removed by surgery(t=-3.640,P<0.001),high incidence of incision complications(χ^(2)=7.570,P=0.006)and urinary retention(P=0.025).The group of patients with high VFA/SFA had more intraoperative blood loss(t=-2.940,P=0.003),fewer lymph nodes removed(t=-4.679,P<0.001),longer exhausting time(t=-2.824,P=0.006)and defecation time(t=-2.348,P=0.021)than those with low VFA/SFA.The overall survival and disease-free survival of patients with high VFA and VFA/SFA were worse than those in

关 键 词：直肠癌根治术 腹部内脏脂肪 CT定量 预后评估 

分 类 号：R735.37[医药卫生—肿瘤]