背景:手术切除是胃肠道(GI)癌症的主要治疗方法,但术后骨骼肌丢失(SML)很常见,并与不良预后相关。这项研究旨在确定肌肉变化的模式,检查其与生活质量(QoL)的关系,并探索前3个月SML的预测因子。
方法:对2021年9月至2022年5月在中国新诊断为胃肠道癌并接受手术的患者进行了前瞻性队列研究。入院时评估骨骼肌质量(SMM)和QoL,7天,1个月,术后3个月.人口统计,临床资料,并收集生物标志物。使用多重插补来估算缺失的数据。使用生长混合物模型分析数据,双变量分析,和逻辑回归。
结果:共有483名患者完成了基线评估。在242名完成肌肉评估的患者中,92%的人经历过SML。确定了三种不同的肌肉变化模式:57%的术前SMM正常,术后SML轻度,16%术前SMM较低,SML中度,27%的术前肿块正常,但术后SML严重。中度/重度SML与更多的术后并发症相关,健康状况较差,和更高的症状负担。独立预测因素包括高龄,术前肌肉减少症,晚期癌症阶段,预后营养指数低(PNI≤45)。使用估算值时,结果没有变化。
结论:尽管SML很普遍,肌肉改变的模式在患者之间是异质的。高龄,术前肌肉减少症,晚期癌症阶段,与癌症相关的炎症是中度/重度SML的预测因子,强调早期发现和管理的必要性。
BACKGROUND: Surgical resection is the primary treatment for gastrointestinal (GI) cancers, but postoperative skeletal muscle loss (SML) is common and linked to poor prognosis. This study aims to identify patterns of muscle change, examine its association with quality of life (QoL), and explore predictors of SML in the first 3 months.
METHODS: A prospective cohort study was conducted on patients newly diagnosed with GI cancer and undergoing surgery in China between September 2021 and May 2022. Skeletal muscle mass (SMM) and QoL were assessed at admission, 7 days, 1 month, and 3 months post-surgery. Demographic, clinical data, and biomarkers were collected. Missing data were imputed using multiple imputation. Data were analyzed using growth mixture modelling, bivariate analyses, and logistic regression.
RESULTS: A total of 483 patients completed baseline assessment. Of the 242 patients with complete muscle assessments, 92% experienced SML. Three distinct patterns of muscle change were identified: 57% had normal preoperative SMM with mild postoperative SML, 16% had low preoperative SMM with moderate SML, and 27% had normal preoperative mass but severe postoperative SML. Moderate/severe SML was associated with more postoperative complications, poorer health, and higher symptom burden. Independent predictors included advanced age, preoperative sarcopenia, advanced cancer stage, and low prognostic nutrition index (PNI ≤ 45). The results did not change when using imputed values.
CONCLUSIONS: Although SML is prevalent, patterns of muscle change are heterogeneous among patients. Advanced age, preoperative sarcopenia, advanced cancer stage, and cancer-related inflammation are predictors for moderate/severe SML, highlighting the need for early detection and management.