背景:胰腺腺癌(PDAC)正在成为一个公共卫生问题,其5年生存率约为10%。患有PDAC的患者通常是节肌症,影响术后结果。同时,超重人群正在增加,脂肪组织促进肿瘤相关炎症。有几项研究独立支持这些数据,我们的目的是评估两者结合后是否对生存率有影响.
方法:我们纳入了来自两家大学医院的232名患者(CHUdeLille,InstitutPaoliCalmette),2011年1月至2018年12月,接受胰十二指肠切除术(PD)治疗可切除PDAC。术前CT扫描用于根据国际界限测量肌肉减少症和内脏脂肪。使用中性粒细胞与淋巴细胞(NLR)和血小板与淋巴细胞的比率(PLR)来测量炎症。对于单变量和多变量分析,使用Cox比例风险模型.低于0.05的P值被认为是显著的。
结果:在多变量分析中,内脏肥胖的肌肉减少症患者比其他患者更不可能生存(OS,HR1.65,p=0.043)。皮肤肥胖不影响生存。当我们研究内脏肥胖伴肌肉减少症时,我们还观察到了对生存率的影响(OS,p=0.056;PFS,p=0.014),伴有皮肤肥胖的肌肉减少症(PFS,p=0.005)和肌少症伴PLR(PFS,p=0.043)。在高PLR的肌少症肥胖患者中也发现了这种不良预后(OS,p=0.05;PFS,p=0.01)。
结论:肌肉减少性肥胖与PDAC术后不良预后相关,尤其是全身性炎症患者。胰腺癌患者应解决这些因素的术前管理。
BACKGROUND: Pancreatic adenocarcinoma (PDAC) is becoming a public health issue with a 5-years survival rate around 10%. Patients with PDAC are often sarcopenic, which impacts postoperative outcome. At the same time, overweight population is increasing and adipose tissue promotes tumor related-inflammation. With several studies supporting independently these data, we aimed to assess if they held an impact on survival when combined.
METHODS: We included 232 patients from two university hospitals (CHU de Lille, Institut Paoli Calmette), from January 2011 to December 2018, who underwent Pancreaticoduodenectomy (PD) for resectable PDAC. Preoperative CT scan was used to measure sarcopenia and visceral fat according to international cut-offs. Neutrophil to lymphocyte (NLR) and platelet to lymphocyte ratios (PLR) were used to measure inflammation. For univariate and multivariate analyses, the Cox proportional-hazard model was used. P-values below 0.05 were considered significant.
RESULTS: Sarcopenic patients with visceral obesity were less likely to survive than the others in multivariate analysis (OS, HR 1.65, p= 0.043). Cutaneous obesity did not influence survival. We also observed an influence on survival when we studied sarcopenia with visceral obesity (OS, p= 0.056; PFS, p = 0.014), sarcopenia with cutaneous obesity (PFS, p= 0.005) and sarcopenia with PLR (PFS, p= 0.043). This poor prognosis was also found in sarcopenic obese patients with high PLR (OS, p= 0.05; PFS, p= 0.01).
CONCLUSIONS: Sarcopenic obesity was associated with poor prognosis after PD for PDAC, especially in patients with systemic inflammation. Pre operative management of these factors should be addressed in pancreatic cancer patients.