Abstract：
BACKGROUND: Accurate preoperative risk assessment for major colorectal cancer (CRC) surgery remains challenging. Body composition (BC) and cardiopulmonary exercise testing (CPET) can be used to evaluate risk. The relationship between BC and CPET in patients undergoing curative CRC surgery is unclear.
METHODS: Consecutive patients undergoing CPET prior to CRC surgery between 2010 and 2020 were identified between two different UK hospitals. Body composition phenotypes such as sarcopenia, myosteatosis, and visceral obesity were defined using widely accepted thresholds using preoperative single axial slice CT image at L3 vertebrae. Relationships between clinicopathological, BC, and CPET variables were investigated using linear regression analysis.
RESULTS: Two hundred eighteen patients with stage I-III CRC were included. The prevalence of sarcopenia, myosteatosis, and visceral obesity was 62%, 33%, and 64%, respectively. The median oxygen uptake at anaerobic threshold (VO2 at AT) was 12.2 mL/kg/min (IQR 10.6-14.2), and oxygen uptake at peak exercise (VO2 peak) was 18.8 mL/kg/min (IQR 15.4-23). On univariate linear regression analysis, male sex (P < 0.001) was positively associated with VO2 at AT. While ASA grade (P < 0.001) and BMI (P = 0.007) were negatively associated with VO2 at AT, on multivariate linear regression analysis, these variables remained significant (P < 0.05). On univariate linear regression analysis, male sex (P < 0.001) was positively associated with VO2 peak, whereas age (P < 0.001), ASA grade (P < 0.001), BMI (P = 0.003), sarcopenia (P = 0.015), and myosteatosis (P < 0.001) were negatively associated with VO2 peak. On multivariate linear regression analysis age (P < 0.001), ASA grade (P < 0.001), BMI (P < 0.001), and sarcopenia (P = 0.006) were independently and negatively associated with VO2 peak.
CONCLUSIONS: The novel finding that sarcopenia is independently associated with reduced VO2 peak performance in CPET supports the supposition that reduced muscle mass relates to poor physical function in CRC patients. Further work should be undertaken to assess whether sarcopenia diagnosed on CT can act as suitable surrogate for CPET to further enhance personalized risk stratification.
METHODS: Consecutive patients undergoing CPET prior to CRC surgery between 2010 and 2020 were identified between two different UK hospitals. Body composition phenotypes such as sarcopenia, myosteatosis, and visceral obesity were defined using widely accepted thresholds using preoperative single axial slice CT image at L3 vertebrae. Relationships between clinicopathological, BC, and CPET variables were investigated using linear regression analysis.
RESULTS: Two hundred eighteen patients with stage I-III CRC were included. The prevalence of sarcopenia, myosteatosis, and visceral obesity was 62%, 33%, and 64%, respectively. The median oxygen uptake at anaerobic threshold (VO2 at AT) was 12.2 mL/kg/min (IQR 10.6-14.2), and oxygen uptake at peak exercise (VO2 peak) was 18.8 mL/kg/min (IQR 15.4-23). On univariate linear regression analysis, male sex (P < 0.001) was positively associated with VO2 at AT. While ASA grade (P < 0.001) and BMI (P = 0.007) were negatively associated with VO2 at AT, on multivariate linear regression analysis, these variables remained significant (P < 0.05). On univariate linear regression analysis, male sex (P < 0.001) was positively associated with VO2 peak, whereas age (P < 0.001), ASA grade (P < 0.001), BMI (P = 0.003), sarcopenia (P = 0.015), and myosteatosis (P < 0.001) were negatively associated with VO2 peak. On multivariate linear regression analysis age (P < 0.001), ASA grade (P < 0.001), BMI (P < 0.001), and sarcopenia (P = 0.006) were independently and negatively associated with VO2 peak.
CONCLUSIONS: The novel finding that sarcopenia is independently associated with reduced VO2 peak performance in CPET supports the supposition that reduced muscle mass relates to poor physical function in CRC patients. Further work should be undertaken to assess whether sarcopenia diagnosed on CT can act as suitable surrogate for CPET to further enhance personalized risk stratification.
摘要：
背景：对主要结直肠癌（CRC）手术进行准确的术前风险评估仍然具有挑战性。身体成分（BC）和心肺运动测试（CPET）可用于评估风险。接受根治性CRC手术的患者中BC和CPET之间的关系尚不清楚。
方法：在2010年至2020年期间，在英国两家不同的医院中确定了连续接受CRC手术前CPET的患者。身体成分表型，如肌肉减少症，肌肉骨化病,使用广泛接受的阈值，使用术前L3椎骨的单轴CT图像来定义内脏肥胖。临床病理之间的关系，BC,和CPET变量使用线性回归分析进行调查。
结果：纳入118例I-III期CRC患者。肌少症的患病率，肌肉骨化病,内脏肥胖占62%，33%,64%,分别。无氧阈值（AT处的VO2）的摄氧量中位数为12.2mL/kg/min（IQR10.6-14.2），运动峰值（VO2峰值）时的摄氧量为18.8mL/kg/min（IQR15.4-23）。在单变量线性回归分析中，男性（P<0.001）与AT时的VO2呈正相关。而在AT时,ASA等级(P<0.001)和BMI(P=0.007)与VO2呈负相关,关于多元线性回归分析，这些变量仍然显著(P<0.05).在单变量线性回归分析中，男性(P<0.001)与VO2峰值呈正相关,而年龄（P<0.001），ASA等级（P<0.001），BMI（P=0.003），肌肉减少症（P=0.015），肌骨形成(P<0.001)与VO2峰值呈负相关。多元线性回归分析年龄(P<0.001),ASA等级（P<0.001），BMI（P<0.001），和肌肉减少症（P=0.006）与VO2峰值独立相关。
结论：肌肉减少症与CPET中VO2峰值表现降低独立相关的新发现支持了以下假设：在CRC患者中，肌肉质量降低与身体功能不良有关。应开展进一步的工作，以评估CT诊断的肌少症是否可以作为CPET的合适替代品，以进一步增强个性化风险分层。
方法：在2010年至2020年期间，在英国两家不同的医院中确定了连续接受CRC手术前CPET的患者。身体成分表型，如肌肉减少症，肌肉骨化病,使用广泛接受的阈值，使用术前L3椎骨的单轴CT图像来定义内脏肥胖。临床病理之间的关系，BC,和CPET变量使用线性回归分析进行调查。
结果：纳入118例I-III期CRC患者。肌少症的患病率，肌肉骨化病,内脏肥胖占62%，33%,64%,分别。无氧阈值（AT处的VO2）的摄氧量中位数为12.2mL/kg/min（IQR10.6-14.2），运动峰值（VO2峰值）时的摄氧量为18.8mL/kg/min（IQR15.4-23）。在单变量线性回归分析中，男性（P<0.001）与AT时的VO2呈正相关。而在AT时,ASA等级(P<0.001)和BMI(P=0.007)与VO2呈负相关,关于多元线性回归分析，这些变量仍然显著(P<0.05).在单变量线性回归分析中，男性(P<0.001)与VO2峰值呈正相关,而年龄（P<0.001），ASA等级（P<0.001），BMI（P=0.003），肌肉减少症（P=0.015），肌骨形成(P<0.001)与VO2峰值呈负相关。多元线性回归分析年龄(P<0.001),ASA等级（P<0.001），BMI（P<0.001），和肌肉减少症（P=0.006）与VO2峰值独立相关。
结论：肌肉减少症与CPET中VO2峰值表现降低独立相关的新发现支持了以下假设：在CRC患者中，肌肉质量降低与身体功能不良有关。应开展进一步的工作，以评估CT诊断的肌少症是否可以作为CPET的合适替代品，以进一步增强个性化风险分层。
