背景:肌肉骨化是衡量骨骼肌质量的指标,并且在计算机断层扫描上很容易识别。术前肌萎缩对根治性食管切除术后预后的影响尚不确定。我们的目的是将CT上的肌萎缩症的存在与围手术期发病率相关联,死亡率,3个食道癌中心的澳大利亚人群食管切除术后的生存结局。
方法:对三个中心的所有接受根治性食管癌切除术的患者进行回顾性分析。术前计算机断层扫描(CT)扫描的放射学评估用于确定是否存在肌骨化病。结果测量包括围手术期并发症发生率,总生存率,和无病生存。
结果:462例患者纳入分析(78.4%为男性,中位年龄67岁)。353例(76.4%)患者在CT上有肌骨形成。肌肉骨质疏松患者的主要并发症(Clavien-Dindo3b或更高)发生率较高(24.9%vs.14.7%,p=0.026),和更高的30天死亡率(4%vs.0%,p=0.048)与正常骨骼肌衰减的患者相比。在多变量分析中,肌萎缩与主要并发症相关(HR1.906,95%CI1.057-3.437;p=0.032)。肌骨化性和非肌骨化性患者的总生存期没有差异(59vs.56个月,p=0.465),无病生存率也没有差异(39vs.42个月,p=0.172)。
结论:影像学检查显示肌骨形成与主要并发症和30天死亡率的风险增加相关。识别肌肉骨化可以是术前营养评估和预后的辅助手段。促进早期识别有并发症风险的患者。
BACKGROUND: Myosteatosis is a measure of skeletal muscle quality, and is readily identifiable on computed tomography. The effect of the presence of preoperative myosteatosis on outcomes following radical oesophagectomy is uncertain. We aimed to correlate the presence of myosteatosis on CT to perioperative morbidity, mortality, and survival outcomes following oesophagectomy in an Australian population across three oesophageal cancer centres.
METHODS: A retrospective analysis was performed of all patients undergoing radical oesophagectomy for cancer across three centres. Radiologic assessment of preoperative computed tomography (CT) scans was used to determine the presence of myosteatosis. Outcomes measured included perioperative complication rate, overall survival, and disease-free survival.
RESULTS: 462 patients were included for analysis (78.4% male, median age 67 years). 353 (76.4%) patients had myosteatosis on CT. Myosteatotic patients had a higher rate of major (Clavien-Dindo 3b or higher) complication (24.9% vs. 14.7%, p=0.026), and a higher rate of 30-day mortality (4% vs. 0%, p=0.048) compared to patients with normal skeletal muscle attenuation. Myosteatosis was associated with major complication on multivariate analysis (HR 1.906, 95% CI 1.057-3.437; p=0.032). There was no difference in overall survival between myosteatotic and non-myosteatotic patients (59 vs. 56 months, p=0.465), nor was there a difference in disease-free survival (39 vs. 42 months, p=0.172).
CONCLUSIONS: The presence of myosteatosis on radiologic imaging was associated with increased risk of major complications and 30-day mortality. Identifying myosteatosis can be an adjunct to preoperative nutritional assessment and prognostication, facilitating early recognition of patients at risk of complications.