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肌少症对食管鳞癌围手术期临床结局的影响

田文泽, 尤振兵, 张明志, 陈梦舟, 冷雪春, 徐达夫, 蒋超, 徐康, 徐克平

田文泽, 尤振兵, 张明志, 等. 肌少症对食管鳞癌围手术期临床结局的影响[J]. 中华消化外科杂志, 2023, 22(11): 1322-1329. DOI: 10.3760/cma.j.cn115610-20230827-00036
引用本文: 田文泽, 尤振兵, 张明志, 等. 肌少症对食管鳞癌围手术期临床结局的影响[J]. 中华消化外科杂志, 2023, 22(11): 1322-1329. DOI: 10.3760/cma.j.cn115610-20230827-00036
Tian Wenze, You Zhenbing, Zhang Mingzhi, et al. Effect of sarcopenia on the perioperative clinical outcomes of esophageal squamous cell carcinoma[J]. Chinese Journal of Digestive Surgery, 2023, 22(11): 1322-1329. DOI: 10.3760/cma.j.cn115610-20230827-00036
Citation: Tian Wenze, You Zhenbing, Zhang Mingzhi, et al. Effect of sarcopenia on the perioperative clinical outcomes of esophageal squamous cell carcinoma[J]. Chinese Journal of Digestive Surgery, 2023, 22(11): 1322-1329. DOI: 10.3760/cma.j.cn115610-20230827-00036

肌少症对食管鳞癌围手术期临床结局的影响

基金项目: 

国家自然科学青年基金 82102969

江苏省医学重点学科建设单位 JWDS202233

淮安市自然科学研究计划 HAB202201

详细信息
    通讯作者:

    徐克平,Email:doctorxukeping@126.com

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

Funds: 

Youth Fund of the National Natural Science Foundation of China 82102969

Jiangsu Provincial Medical Key Discipline Cultivation Unit JWDS202233

Huai′an Natural Science Research Program HAB202201

More Information
  • 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.

  • 田文泽、尤振兵、张明志:文献查阅及论文撰写;陈梦舟、冷雪春、徐达夫、徐康:文献查阅,数据统计及分析;徐克平、蒋超、田文泽:研究方案制订,审阅及论文修改
    所有作者均声明不存在利益冲突
    田文泽, 尤振兵, 张明志, 等. 肌少症对食管鳞癌围手术期临床结局的影响[J]. 中华消化外科杂志, 2023, 22(11): 1322-1329. DOI: 10.3760/cma.j.cn115610-20230827-00036.

    http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn115610-20230827-23036(new)

  • 图  1   第3腰椎横突层面双侧腰大肌CT检查结果

    注:浅绿色区域为双侧腰大肌面积

    Figure  1.   Computed tomography images of bilateral psoas major muscles at the third lumbar transverse process level

    表  1   肌少症与非肌少症食管鳞癌患者的临床资料比较

    Table  1   Comparison of clinical data between esophageal squamous cell carcinoma patients complicated with sarcopenia and patients without sarcopenia

    患者类型例数性别(例)年龄(x±s,岁)高血压病史(例)糖尿病史(例)吸烟史(例)肿瘤位置(例)
    食管上段食管中段食管下段
    肌少症46931315668±73431264303933313655314100
    非肌少症67947620366±74991806225746621382458139
    统计量值χ²=1.46t=-5.74χ²=0.02χ²=0.01χ²=0.74χ²=0.14
    P0.227<0.0010.8930.9620.3900.935
    下载: 导出CSV

    表  2   肌少症与非肌少症食管鳞癌患者的临床结局比较

    Table  2   Comparison of clinical outcomes between esophageal squamous cell carcinoma patients complicated with sarcopenia and patients without sarcopenia

    患者类型例数手术时间(x±s,h)术后住院时间(x±s,d)术后住院30 d内死亡(例)术后住院时间>30 d(例)肺炎(例)急性呼吸衰竭(例)吻合口瘘(例)心律失常(例)胸腔积液(例)
    肌少症4693.8±1.017±9932158393310326
    非肌少症6793.8±1.015±651510218198533
    统计量值t=0.28t=4.89χ²=3.20χ²=15.04χ²=55.17χ²=18.86χ²=11.52χ²=18.06χ²=0.27
    P0.781<0.0010.073<0.001<0.001<0.001<0.001<0.0010.606
    下载: 导出CSV

    表  3   影响1 148例食管鳞癌患者并发肌少症的单因素分析

    Table  3   Univariate analysis of sarcopenia in 1 148 esophageal squamous cell carcinoma patients

    临床病理因素赋值b标准误Wald优势比95%可信区间P
    性别
    00.160.131.461.170.91~1.510.227
    1
    年龄(岁)
    <6500.590.1320.031.791.39~2.32<0.001
    ≥651
    高血压病史
    00.020.140.021.020.78~1.330.893
    1
    糖尿病史
    0-0.010.220.010.990.65~1.520.962
    1
    吸烟史
    0-0.110.130.740.890.69~1.160.391
    1
    肿瘤长径(cm)
    ≥300.180.122.151.190.94~1.510.143
    <31
    肿瘤位置
    食管上段10.040.110.131.040.84~1.280.724
    食管中段2
    食管下段3
    T分期
    T1期10.160.074.891.181.02~1.360.027
    T2期2
    T3期3
    N分期
    N0期00.030.130.071.030.81~1.320.798
    N+期1
    G分期
    G1期1-0.070.100.500.930.77~1.130.481
    G2期2
    G3期3
    术前白蛋白(g/L)
    <400-0.350.174.560.700.51~0.970.033
    ≥401
    术前血清前白蛋白(mg/dL)
    <2000-0.580.1222.450.560.44~0.71<0.001
    ≥2001
    腰大肌密度(HU)
    <480-0.330.127.140.720.57~0.920.008
    ≥481
    体质量指数(kg/m2
    ≤240-0.640.1325.260.530.41~0.68<0.001
    >241
    下载: 导出CSV

    表  4   影响1 148例食管鳞癌患者并发肌少症的多因素分析

    Table  4   Multivariate analysis of sarcopenia in 1 148 esophageal squamous cell carcinoma patients

    临床病理因素b标准误Wald优势比95%可信区间P
    年龄0.500.1313.661.641.26~2.14<0.001
    术前血清前白蛋白-0.450.1312.670.640.50~0.82<0.001
    腰大肌密度-0.330.136.920.720.56~0.920.009
    体质量指数-0.630.1323.030.530.41~0.69<0.001
    下载: 导出CSV
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出版历程
  • 收稿日期:  2023-08-26
  • 网络出版日期:  2024-06-24
  • 刊出日期:  2023-11-19

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