术前CT测量的肌肉质量减少与肌肉脂肪含量增多在预测中低位直肠癌术后远期结局的价值  

Clinical value of preoperative CT-derived myopenia and myosteatosis in predicting the long-term outcomes of patients with middle-low rectal cancer who received curative intent surgery

作　　者：刘佶阳 余雄峰 黄雪清 陈杰云[1] LIU Ji-yang;YU Xiong-feng;HUANG Xue-qing(Department of Radiology,Fujian Medical University Affiliated First Quanzhou Hospital,Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院影像科,福建362000 [2]福建医科大学附属第二医院CT/MR室,福建362000

出　　处：《放射学实践》2023年第6期756-762,共7页Radiologic Practice

摘　　要：目的:探究术前CT测量的肌肉质量、肌肉脂肪含量与中低位直肠癌根治术后远期结局的相关性。方法:回顾性分析2014年1月-2016年6月125例行腹腔镜下根治性手术治疗的中低位直肠癌患者资料。在L 3椎体水平轴面CT测量肌肉质量、肌肉脂肪含量并分析其与5年总体生存期、5年无病生存期的关系。结果:125例患者随访时间7~72个月,中位随访65个月。随访期38例患者肿瘤复发或转移,1、3、5年无病生存率分别约92%,71%,68%;18例患者死亡,1、3、5年总体生存率分别约92%、88%、86%。肌肉质量减少患者死亡风险约是正常患者的6.4倍(P=0.012);肌肉脂肪含量增多的患者死亡风险约是正常患者的3.9倍(P=0.013)。肌肉质量减少的患者与正常患者复发转移风险之间的差异无统计学意义;肌肉脂肪含量增多患者复发转移风险约是正常患者2.0倍(P=0.035)。结论:在接受中低位直肠癌根治术后,肌肉质量减少的患者死亡风险约是正常患者的6.4倍,总体生存期短于正常患者;肌肉脂肪含量增多的患者死亡风险约是正常患者的3.9倍,复发转移风险约是正常患者的2.2倍,总体生存期及无病生存期均短于正常患者。肌肉脂肪含量增多在预测中低位直肠癌根治术后远期结局方面优于肌肉质量减少。Objective:To explore the correlation between preoperative CT-derived muscle mass,muscle fat content and long-term outcomes in patients with middle-low rectal cancer who received curative intent surgery.Methods:The data of 125 patients with middle-low rectal cancer who underwent laparoscopic radical surgery in our hospital from January 2014 to June 2016 were analyzed retrospectively.Muscle mass and muscle fat content were measured using preoperative axial CT images on the level of L 3.The relationship between muscle mass,muscle fat content and 5-year overall survival(OS)and 5-year disease-free survival(DFS)was analyzed.Results:125 patients with median follow-ups of 65 months(range 7~72 months)were included for the final analysis.During the follow-up period,38 patients had tumor recurrence with 1,3,5 year DFS rates of 92%,71%,68%,respectively;18 patients died with 1,3,5 year OS rates of 92%,88%,86%,respectively.The risk of death in patients with reduced muscle mass was 6.4 times higher than patients with normal muscle mass(P=0.012);The death risk of patients with increased muscle fat content was 3.9 times higher than patients with normal muscle fat content(P=0.012);There was no significant difference in the risk of recurrence or metastasis between patients with and without reduced muscle mass;The risk of recurrence or metastasis in patients with increased muscle fat content was 2.0 times higher than patients with normal muscle fat content(P=0.035).Conclusion:After radical resection of middle-low rectal cancer,the death risk of patients with reduced muscle mass is about 6.4 times higher than patients with normal muscle mass.And OS is significantly shorter in patients with reduced muscle mass.The death risk of patients with increased muscle fat content is about 3.9 times higher than patients with normal muscle fat content,and the risk of recurrence or metastasis is about 2.0 times higher than patients with normal muscle fat content.OS and DFS are both significantly shorter in patients with increased muscle fat conten

关 键 词：肌减少症 体层摄影术 X线计算机 直肠肿瘤 预后 

分 类 号：R746.4[医药卫生—神经病学与精神病学] R814.4[医药卫生—临床医学] R735.37R449