术前肌肉减少症对胃癌病人临床预后的影响:一项前瞻性队列研究

Effect of Saropenia on Clinical Prognosis of Gastric Cancer Patients: A Prospective Cohort Study

目的:探讨胃癌病人术前存在肌肉减少症对术后病人临床预后的影响。方法:前瞻性纳入93例胃癌病人,使用生物电阻抗法检测骨骼肌质量,分为两组:肌肉减少症组和非肌肉减少症组,比较分析术前存在肌肉减少症对胃癌病人术后总并发症发生率、住院时间、住院费用、60天再入院及病死率等指标的影响。结果:术前存在肌肉减少症的病人与正常对照组相比:总并发症发生率、总住院天数和术后住院天数具有显著性差异(P<0.05)。60天再入院率、60天病死率和总住院费用方面肌肉减少症组略高于正常对照组,但无统计学差异(P>0.05)。单因素和多因素分析显示,术前存在肌肉减少症及存在营养风险是增加术后并发症发生率的独立危险因素。结论:术前存在肌肉减少症可导致胃癌病人术后不良临床预后,肌肉减少症是胃癌病人术后并发症增加的独立危险因素,术前应常规进行筛查与评估并及时纠正。

Objective： To investigate the effects of preoperative sarcopenia on postoperative clinical outcome in patients with gastric cancer. Methods： A prospective study was performed in 93 patients with gastric cancer and the skeletal muscle mass was examined by bioelectrical impedance. The primary outcome was postoperative complications. The secondary outcomes were postoperative length of stay, overall hospital costs, 60 days re-admission and mortality rate. Results： A significant difference（sarcopenia group vs. non-sarcopenia group） was observed in the rates of overall postoperative complications, incidence of pleural effusion and intra-abdominal infection, overall hospital stay and postoperative hospital stay（P〈0. 05）. The rates of 60 days readmission,60 days mortality and hospital costs in sarcopenia group were not different between the two groups（ P〉0. 05）. By univariate and multivariate analysis, preoperative sarcopenia and preoperative nutritional risk are the risk factors of postoperative complications. Conclusion： Sarcopenia is an independent risk factor for postoperative complications in patients with gastric cancer; preoperative patients with sarcopenia have a worse prognosis and should be screened and optimized before surgery.