肌少症对食管鳞癌围手术期临床结局的影响

Effect of sarcopenia on the perioperative clinical outcomes of esophageal squamous cell carcinoma

    摘要
  • 摘要:
    目的 探讨肌少症对食管鳞癌围手术期临床结局的影响。
    方法 采用回顾性病例对照研究方法。收集2020年1月至2021年12月南京医科大学附属淮安第一人民医院收治的1 148例食管鳞癌患者的临床病理资料；男789例,女359例；年龄为（67±7）岁。所有患者行胸腹腔镜联合食管癌根治术。观察指标：（1）食管鳞癌患者并发肌少症情况。（2）食管鳞癌并发肌少症患者与食管鳞癌非肌少症患者的一般资料比较。（3）食管鳞癌并发肌少症患者与食管鳞癌非肌少症患者的临床结局比较。（4）食管鳞癌患者并发肌少症的影响因素分析。正态分布的计量资料以x±s表示,组间比较采用t检验；计数资料以绝对数表示,组间比较采用χ2检验；等级资料采用Mann‑Whitney U检验。单因素分析采用Logistic回归分析,多因素分析采用Logistic逐步回归向后模型。
    结果 （1）食管鳞癌患者并发肌少症情况。1 148例食管鳞癌患者中,469例并发肌少症,679例非肌少症,肌少症发生率为40.854%（469/1 148）。469例并发肌少症患者中,男313例,女156例；年龄<65岁、≥65岁且<70岁、≥70岁且<75岁、≥75岁分别为125、145、106、93例。（2）食管鳞癌并发肌少症患者与食管鳞癌非肌少症患者的一般资料比较。469例食管鳞癌并发肌少症患者的年龄,肿瘤长径,体质量指数,T分期（T1期、T2期、T3期）,术前白蛋白,术前血清前白蛋白,腰大肌指数,腰大肌密度分别为（68±7）岁,（3.3±1.5）cm,（22.4±2.9）kg/m2,100、105、264例、（43±4）g/L,（193±38）mg/dL,（3.9±0.8）cm2/m2,（48±8）HU；679例食管鳞癌非肌少症患者上述指标分别为（66±7）岁,（3.2±1.4）cm,（23.8±3.0）kg/m2,173、170、336例,（44±4）g/L,（206±37）mg/dL,（6.0±2.2）cm2/m2,（50±7）HU,两者上述指标比较,差异均有统计学意义（t=5.74、2.11、7.57,Z=-2.93,t=2.25、5.52、20.36、4.18,P<0.05）。（3）食管鳞癌并发肌少症患者与食管鳞癌非肌少症患者的临床结局比较。469例食管鳞癌并发肌少症患者的术后住院时间、术后住院时间>30 d、肺炎、急性呼吸衰竭、吻合口瘘、心律失常例数分别为（17±9）d 、32例、158例、39例、33例、103例,679例食管鳞癌非肌少症患者上述指标分别为（15±6）d、15例、102例、18例、19例、85例,两者上述指标比较,差异均有统计学意义（t=4.89,χ²=15.04、55.17、18.86、11.52、18.06,P<0.05）。（4）食管鳞癌患者并发肌少症的影响因素分析。多因素分析结果显示：年龄≥65岁是食管鳞癌患者并发肌少症的独立危险因素（优势比=1.64,95%可信区间为1.26~2.14,P<0.05）；术前血清前白蛋白≥200 mg/dL、腰大肌密度≥48 HU和体质量指数>24 kg/m2是食管鳞癌患者并发肌少症的独立保护因素（优势比=0.64、0.72、0.53,95%可信区间为0.50~0.82、0.56~0.92、0.41~0.69,P<0.05）。
    结论 年龄≥65岁是食管鳞癌患者并发肌少症的独立危险因素,而术前血清前白蛋白≥200 mg/dL、腰大肌密度≥48 HU和体质量指数>24 kg/m2是食管鳞癌患者并发肌少症的独立保护因素。与食管鳞癌非肌少症患者比较,食管鳞癌并发肌少症患者术后更易发生肺炎、急性呼吸衰竭、吻合口瘘、心律失常等并发症,且术后住院时间更长。

     

    Abstract:
    Objective To investigate the effect of sarcopenia on the perioperative clinical outcomes of esophageal squamous cell carcinoma (ESCC).
    Methods The retrospective case‑control study was conducted. The clinicopathological data of 1 148 ESCC patients who were admitted to the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University from January 2020 to December 2021 were collected. There were 789 males and 359 females, aged (67±7)years. All patients under-went thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Observation indicators: (1) incidence of sarcopenia in patients with ESCC; (2) comparison of general data between ESCC patients complicated with sarcopenia and those without sarcopenia; (3) comparison of clinical outcomes between ESCC patients complicated with sarcopenia and those without sarcopenia; (4) analysis of influencing factors for sarcopenia in ESCC patients. Measurement data of normal distri-bution were represented by Mean±SD, and comparison between groups was conducted using the t test. Count data were represented as absolute numbers, and comparison between groups was conducted using the chi‑square test. Ordinal data was analyzed using the Mann‑Whitney U test. Logistic regression analysis was used to conduct univariate analysis. Logistic backward stepwise regression model was used to conduct multivariate analysis.
    Results (1) Incidence of sarcopenia in patients with ESCC. Among 1 148 ESCC patients, 469 cases were complicated with sarcopenia, 679 were without sarcopenia. The incidence of sarcopenia was 40.854%(469/1 148). Among the 469 patients with sarcopenia, there were 313 males and 156 females. There were 125 cases <65 years old, 145 cases ≥65 years old but <70 years old, 106 cases ≥70 years old but<75 years old, 93 cases ≥75 years old, respectively. (2) Comparison of general data between patients with ESCC complicated with sarco-penia and those without sarcopenia. The age, tumor diameter, body mass index, cases in stage T1, T2, T3, preoperative albumin, preoperative serum prealbumin, psoas muscle index, psoas muscle density were (68±7)years, (3.3±1.5)cm, (22.4±2.9)kg/m2, 100, 105, 264, (43±4)g/L, (193±38)mg/dL, (3.9±0.8)cm2/m2, (48±8)HU of 469 ESCC patients complicated with sarcopenia, versus (66±7)years, (3.2±1.4)cm, (23.8±3.0)kg/m2, 173, 170, 336, (44±4)g/L, (206±37)mg/dL, (6.0±2.2)cm2/m2, (50±7)HU of 679 ESCC patients without sarcopenia, showing significant differences between the two groups (t=5.74, 2.11, 7.57, Z=-2.93, t=2.25, 5.52,20.36, 4.18, P<0.05). (3) Comparison of clinical outcomes between patients with ESCC complicated with sarcopenia and those without sarcopenia. The duration of postoperative hospital stay, cases with postoperative hospital stay>30 days, pneumonia, acute respiratory failure, anastomotic fistula, and abnormal heart rhythm were (17±9)days, 32, 158, 39, 33, and 103 of 469 ESCC patients complicated with sarcopenia, respectively, versus (15±6)days, 15, 102, 18, 19, and 85 of 679 ESCC patients without sarcopenia, showing significant differences between the two groups (t=4.89, χ²=15.04, 55.17, 18.86, 11.52, 18.06, P<0.05). (4) Analysis of influencing factors for sarcopenia in ESCC patients. Results of multivariate analysis showed that age ≥65 years was an independent risk factor for sarcopenia in ESCC patients (odds ratio=1.64, 95% confidence interval as 1.26-2.14, P<0.05). Preoperative serum prealbumin ≥200 mg/dL, psoas muscle density ≥48 HU and body mass index >24 kg/m2 were independent protective factors for sarcopenia in ESCC patients (odds ratio=0.64, 0.72, 0.53, 95% confidence interval as 0.50-0.82, 0.56-0.92, 0.41-0.69, P<0.05).
    Conclusions Age ≥65 years is an independent risk factor for sarcopenia in ESCC patients. Preoperative serum prealbumin ≥200 mg/dL, psoas muscle density ≥48 HU and body mass index >24 kg/m2 are independent protective factors for sarcopenia in ESCC patients. Compared with patients without sarcopenia, ESCC patients with sarcopenia are more prone to postoperative compli-cations such as pneumonia, acute respiratory failure, anastomotic fistula, and arrhythmia, and have a longer postoperative hospital stay.

     

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