胃癌根治术后肌少症发病状况及其危险因素分析

Prevalence and risk factors of sarcopenia after radical gastrectomy for gastric cancer

目的探讨胃癌根治术后患者肌少症的发病情况及发病的风险因素,以期为临床干预提供参考。方法本研究采用回顾性观察性研究方法。纳入2021年6月至2022年6月期间、来自解放军总医院第一医学中心复查的、胃癌根治术后9~12个月患者。病例纳入标准:(1)曾在本院接受胃癌根治术,且术后病理确诊为原发性胃癌;(2)术中或术后证实无邻近器官侵犯、腹膜播散或远处转移;(3)术后9~12个月期间到本院复查,腹部增强CT、血常规检查等临床资料完整。排除标准:(1)年龄<18岁;(2)残胃癌或既往行胃切除术;(3)5年内曾罹患或现合并其他原发性肿瘤;(4)术前已确诊为肌少症患者[男性骨骼肌指数(SMI)≤52.4 cm^(2)/m^(2),女性SMI≤38.5 cm^(2)/m^(2)]。主要观察本组胃癌患者肌少症发生情况;并采用单因素分析及多因素logistic回归方法筛选胃癌根治术后肌少症的危险因素。结果本研究共纳入373例患者,年龄为(57.1±12.3)岁;包括男性292例(78.3%),女性81例(21.7%)。全组术后1年内发生肌少症共81例(21.7%)。全组患者的SMI为(41.79±7.70)cm^(2)/m^(2);其中男性SMI为(46.40±5.03)cm^(2)/m^(2),女性SMI为(33.52±3.63)cm^(2)/m^(2)。多因素logistic回归分析结果显示:年龄≥60岁(OR=2.170,95%CI:1.175~4.007,P=0.013)、文化程度为大专及以上(OR=2.512,95%CI:1.238~5.093,P=0.011)、偶尔运动(OR=3.263,95%CI:1.648~6.458,P=0.001)、罹患低蛋白血症(OR=2.312,95%CI:1.088~4.913,P=0.029)、罹患高血压(OR=2.169,95%CI:1.180~3.984,P=0.013)和全胃切除手术(OR=2.444,95%CI:1.214~4.013,P=0.012)是胃癌根治术后肌少症发病的独立危险因素(均P<0.05)。结论胃癌根治术后肌少症发病率不低;高龄、高学历、运动少以及合并低蛋白血症和高血压是胃癌根治性切除术后发生肌少症的危险因素。

Objective To investigate the prevalence and risk factors of sarcopenia in patients following radical gastrectomy with the aim of guiding clinical decisions.Methods This was a retrospective observational study of data of patients who had undergone radical gastrectomy between June 2021 and June 2022 at the Department of General Surgery,First Medical Center of Chinese PLA General Hospital.Participants were reviewed 9−12 months after surgery.Inclusion criteria were as follows:(1)radical gastrectomy with a postoperative pathological diagnosis of primary gastric cancer;(2)no invasion of neighboring organs,peritoneal dissemination,or distant metastasis confirmed intra-or postoperatively;(3)availability of complete clinical data,including abdominal enhanced computed tomography and pertinent blood laboratory tests 9-12 after surgery.Exclusion criteria were as follows:(1)age<18 years;(2)presence of gastric stump cancer or previous gastrectomy;(3)history of or current other primary tumors within the past 5 years;(4)preoperative diagnosis of sarcopenia(skeletal muscle index(SMI)≤52.4 cm^(2)/m^(2)for men,SMI≤38.5 cm^(2)/m^(2)for women).The primary focus of the study was to investigate development of postoperative sarcopenia in the study cohort.Univariate and multivariate logistic regression were used to identify the factors associated with development of sarcopenia after radical gastrectomy.Results The study cohort comprised 373 patients of average age of 57.1±12.3 years,comprising 292(78.3%)men and 81(21.7%)women.Postoperative sarcopenia was detected in 81(21.7%)patients in the entire cohort.The SMI for the entire group was(41.79±7.70)cm^(2)/m^(2):(46.40±5.03)cm^(2)/m^(2) for men and(33.52±3.63)cm^(2)/m^(2) for women.According to multivariate logistic regression analysis,age≥60 years(OR=2.170,95%CI:1.175−4.007,P=0.013),high literacy(OR=2.512,95%CI:1.238−5.093,P=0.011),poor exercise habits(OR=3.263,95%CI:1.648−6.458,P=0.001),development of hypoproteinemia(OR=2.312,95%CI:1.088–4.913,P=0.029),development of hypertension(OR=2.169,95%CI:1.180−3.984,P=0.013),and total gastrectomy(OR=2.444,95%CI:1.214−4.013,P=0.012)were independent risk factors for postoperative sarcopenia in post-gastrectomy patients who had had gastric cancer(P<0.05).Conclusion Development of sarcopenia following radical gastrectomy demands attention.Older age,higher education,poor exercise habits,hypoproteinemia,hypertension,and total gastrectomy are risk factors for its development post-radical gastrectomy.