肌少症对胃癌患者术后早期临床预后的影响

夏德鑫; 左君波; 严玉兰; 张珍珍; 高生宝; 步雪峰

doi:10.7619/jcmp.20230242

肌少症对胃癌患者术后早期临床预后的影响

1.
江苏大学临床医学院, 江苏镇江, 212013
2.
江苏大学附属人民医院普通外科, 江苏镇江, 212003
3.
香港大学深圳医院呼吸危重症科, 广东深圳, 518048

基金项目:

江苏省镇江市社会发展项目 SH2020034

详细信息

通讯作者:
步雪峰, E-mail: xuefengbu05@163.com

中图分类号: R735.2;R604
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- 文章访问数: 179
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- PDF下载量: 15
出版历程
- 收稿日期: 2023-02-02
- 修回日期: 2023-04-07
- 网络出版日期: 2023-05-24
- 刊出日期: 2023-05-14

Effect of sarcopenia on early postoperative clinical prognosis of patients with gastric cancer

1.
School of Clinical Medicine in Jiangsu University, Zhenjiang, Jiangsu, 212013
2.
Department of General Surgery, People′s Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, 212003
3.
Department of Respiratory Critical Care, Shenzhen Hospital of Hong Kong University, Shenzhen, Guangdong, 518048

摘要

摘要:
目的
探讨肌少症对胃癌患者的术后早期临床预后的影响。
方法
选取行根治性胃切除术的胃癌患者189例为研究对象，根据2019年亚洲肌少症工作组(AWGS)推荐肌少症诊断标准分为肌少症组41例和非肌少症组148例。比较2组一般临床特征。分析肌少症对胃癌患者主要和次要临床结局的影响，以及根治性胃癌切除术后早期并发症的独立危险因素。
结果
与非肌少症组相比，肌少症组患者年龄、查尔森合并症指数(CCI)、C反应蛋白(CRP)水平、美国麻醉医师协会(ASA)分级高于非肌少症组，体质量指数(BMI)以及白蛋白、血红白水平低于非肌少症组(P < 0.05或P < 0.01或P < 0.001)。肌少症组术后总早期并发症发生率高于非肌少症组，差异有统计学意义(36.6%、14.9%、P=0.002)。肌少症组术后住院时间长于非肌少症组，总住院费用高于非肌少症组，差异有统计学意义(P < 0.05或P < 0.01)。
结论
肌少症是根治性胃癌切除术后早期并发症的独立危险因素。
- 胃癌 /
- 肌少症 /
- 胃切除术 /
- 预后 /
- 并发症 /
- 骨骼肌指数
Abstract:
Objective
To investigate the effect of sarcopenia on early postoperative clinical prognosis in patients with gastric cancer.
Methods
A total of 189 gastric cancer patients who underwent radical gastrectomy were selected as the study subjects. According to the diagnostic criteria for sarcopenia recommended by the Asian Working Group for Sarcopenia (AWGS) in 2019, they were divided into the sarcopenia group (41 cases) and the non-sarcopenia group (148 cases). The general clinical features of the two groups were compared. The effects of sarcopenia on primary and secondary clinical outcomes in patients with gastric cancer, and independent risk factors for early complications after radical gastrectomy were analyzed.
Results
Age, Charson Comorbidities Index (CCI), C-reactive protein (CRP) level, and American Society of Anesthesiologists (ASA) grade were significantly higher in the sarcopenia group, body mass index (BMI) and albumin and hemoglobin levels were significantly lower than those in the non-sarcopenia group (P < 0.05, P < 0.01 or P < 0.001). The incidence of postoperative total early complications in the sarcopenia group was significantly higher than that in the non-sarcopenia group (36.6% versus 14.9%, P=0.002). The postoperative hospital stay in the sarcopenia group was significantly longer than that in the non-sarcopenia group, and the total hospital cost was significantly higher than that in the non-sarcopenia group (P < 0.05 or P < 0.01).
Conclusion
Sarcopenia is an independent risk factor for early complications after radical gastrectomy.
- gastric cancer /
- sarcopenia /
- gastrectomy /
- prognosis /
- complications /
- skeletal muscle index

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表 1 患者一般临床特征(x±s)[M(Q₂₅, Q₇₅)][n(%)]

变量	总体(n=189)	肌少症组(n=41)	非肌少症组(n=148)	P
年龄/岁	68.0(60.0, 71.5)	70.0(61.5, 74.5)	67. 0(60.0, 71.0)	0.026
性别				0.939
男	130(38.8)	28(68.3)	102(68.9)
女	59(31.2)	13(31.7)	46(31.1)
体质量指数/(kg/m²)	23.4±3.7	20.9±2.4	24.1±3.6	< 0.001
吸烟				0.400
是	80(42.3)	15(36.6)	65(43.9)
否	109(57.7)	26(63.4)	83(56.1)
饮酒				0.110
是	61(32.3)	9(22.0)	52(35.1)
否	128(67.7)	32(78.0)	96(64.9)
CCI				0.001
0	146(77.2)	24(58.5)	122(82.4)
≥1	43(22.8)	17(41.5)	26(17.6)
NRS-2002≥3分	122(64.6)	36(87.8)	86(58.1)	< 0.001
CRP/(mg/L)	0.8(0.5, 2.5)	1.4(0.5, 7.5)	0.7(0.5, 2.1)	0.028
血红蛋白/(g/L)	120.0(104.0, 135.0)	110.0(95.5, 130.0)	122.5(109.0, 136.8)	0.033
白蛋白/(g/L)	37.2±4.3	37.6±4.2	35.9±4.3	0.027
NLR	2.3(1.7, 3.4)	2.4(1.9, 3.8)	2.2(1.6, 3.2)	0.158
L₃ SMI/(cm²/m²)	44.9±7.7	36.0±3.8	47.3±6.7	< 0.001
握力/kg	32.6±8.8	28.9±6.8	33.6±9.0	0.001
6米步行速度/(m/s)	1.1±0.1	1.1±0.1	1.1±0.1	0.006
5次起坐时间/s	12.5(11.4, 14.0)	13.5(12.3, 14.7)	12.1(11.1, 13.7)	< 0.001
ASA分级				0.023
Ⅰ~Ⅱ级	145(76.7)	26(63.4)	119(80.4)
Ⅲ级	44(23.3)	15(36.6)	29(19.6)
腹部手术史				0.863
有	34(18.0)	7(17.1)	27(18.2)
无	155(82.0)	34(82.9)	121(81.8)
腹腔镜手术				0.085
是	163(86.2)	32(78.0)	131(88.5)
否	26(13.8)	9(22.0)	17(11.5)
胃切除方式				0.777
远端胃	65(34.4)	16(39.0)	49(33.1)
全胃	95(50.3)	19(46.3)	76(51.4)
近端胃	29(15.3)	6(14.6)	23(15.5)
手术时间/min	240. 0(190.0, 292.5)	240. 0(172.5, 300.0)	244.0(190.0, 290.0)	0.825
肿瘤大小/cm	4.0(2.8, 5.5)	4.0(3.3, 6.0)	4.0(2.7, 5.5)	0.341
分化程度				0.250
低	96(50.8)	23(56.1)	73(49.3)
中	81(43.9)	18(43.9)	65(43.9)
高	10(5.3)	0	10(6.8)
TNM分期				0.454
Ⅰ期	51(27.0)	8(19.5)	43(29.1)
Ⅱ期	49(25.9)	11(26.8)	38(25.7)
Ⅲ期	89(47.1)	22(53.7)	67(45.2)
CCI: 查尔森合并症指数; NRS-2002: 2002营养风险筛评分; CRP: C反应蛋白; NLR: 中性粒细胞与淋巴细胞比值; L₃ SMI: 第3腰椎骨骼肌指数; ASA: 美国麻醉医师协会。

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表 2 肌少症对胃癌患者主要和次要临床结局的影响[n(%)]

临床结局		总体(n=189)	肌少症组(n=41)	非肌少症组(n=148)	P
总并发症		37(19.6)	15(36.6)	22(14.9)	0.002
Grade Ⅱ		29(15.3)	12(29.3)	17(11.5)	0.005
Grade Ⅲ		6(3.2)	2(4.9)	4(2.7)	0.842
Grade Ⅳ		2(1.1)	1(2.4)	1(0.7)	0.909
具体并发症	肺部感染	20(10.6)	10(24.4)	10(6.8)	0.003
	腹腔感染	5(2.6)	1(2.4)	4(2.7)	1.000
	尿路感染	1(0.5)	1(2.4)	0	0.217
	胰瘘	2(1.1)	1(2.4)	1(0.7)	0.388
	出血	2(1.1)	0	2(1.4)	1.000
	肠梗阻	1(0.5)	0	1(0.7)	1.000
	吻合口瘘	2(1.1)	1(2.4)	1(0.7)	0.388
	胃瘫	3(1.6)	1(2.4)	2(1.4)	1.000
	吻合口狭窄	1(0.5)	0	1(0.7)	1.000
再入院		7(3.7)	2(4.9)	5(3.4)	0.653
术后住院时间/d		11(8.0, 13.0)	12(9.0, 15.0)	10(8.0, 12.8)	0.007
总住院费用/元人民币		54 198.1(49 845.6, 59 659.5)	57 402.7(51 046.0, 66 658.6)	53 422.6(49 745.2, 59 044.9)	0.015

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表 3 术后并发症单因素与多因素分析

因素	单因素分析			多因素分析
因素	并发症(n=37)	无并发症(n=152)	P	OR(95%CI)	P
年龄/岁	70.0(64.0, 72.0)	67.0(60.0, 71.0)	0.099	1.032(0.977, 1.091)	0.259
性别			0.566
男	24(64.9)	106(69.7)
女	13(35.1)	46(30.3)
体质量指数/(kg/m²)	22.6±4.9	23.6±3.3	0.304
吸烟			0.538
是	14(37.8)	66(43.4)
否	23(62.2)	86(56.6)
饮酒			0.712
是	11(29.7)	50(32.9)
否	26(70.3)	102(67.1)
CCI			0.799
0	28(75.7)	118(77.6)
≥1	9(24.3)	34(22.4)
NRS-2002≥3分			0.050	1.417(0.547, 6.675)	0.473
是	29(78.4)	93(61.2)
否	8(21.6)	59(38.8)
CRP/(mg/L)	1.5(0.5, 3.7)	0.8(0.5, 2.2)	0.156
血红蛋白/(g/L)	113.0(95.5, 132.0)	121.5(105.0, 135.8)	0.186
白蛋白/(g/L)	36.4±5.1	37.4±4.1	0.191
NLR	2.3(1.8, 3.4)	2.3(1.7, 3.4)	0.750
肌少症			0.002	3.100(1.296, 7.415)	0.011
是	15(40.5)	26(17.1)
否	22(59.5)	126(82.9)
ASA分级			0.142
Ⅰ~Ⅱ级	25(67.6)	120(78.9)
Ⅲ级	12(32.4)	32(21.1)
腹部手术史			0.263
有	9(24.3)	25(16.4)
无	28(75.7)	127(83.6)
腹腔镜手术			0.628
是	31(83.8)	132(86.9)
否	6(16.2)	20(13.2)
胃切除方式			0.253
远端胃	9(24.3)	56(36.8)
全胃	23(62.2)	72(47.4)
近端胃	5(13.5)	24(15.8)
手术时间/min	295.0(240.0, 315.0)	235.0(181.0, 280.3)	< 0.001	1.011(1.005, 1.018)	0.001
术中输血量≥400 mL	11(29.7)	18(11.8)	0.007	1.970(0.757, 5.128)	0.165
肿瘤大小/cm	4.5(3.0, 5.8)	4(2.5, 5.5)	0.195
分化程度			0.217
低	18(48.6)	78(51.3)
中	19(51.4)	64(42.1)
高	0	10(6.6)
TNM分期			0.510
Ⅰ期	10(27.0)	41(27.0)
Ⅱ期	7(18.9)	42(27.6)
Ⅲ期	20(54.1)	69(45.4)
CCI: 查尔森合并症指数; NRS-2002: 2002营养风险筛评分; CRP: C反应蛋白; NLR: 中性粒细胞与淋巴细胞比值; ASA: 美国麻醉医师协会。

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