肌肉减少症与新辅助化疗后食管鳞癌患者术后肺炎发生的关系

The effect of sarcopenia on postoperative pneumonia in esophageal squamous cell carcinoma patients after neoadjuvant chemotherapy

目的:探讨肌肉减少症与新辅助化疗后接受食管癌根治术的食管鳞癌患者术后肺炎发生的关系。方法:回顾性分析自2020年01月至2023年06月在我院接受新辅助化疗后再行食管癌根治术的130例食管鳞癌患者的临床资料,统计临床病理相关指标以及新辅助化疗前后的骨骼肌指标,分析其与术后肺炎发生的相关性。结果:本组接受新辅助化疗的食管癌患者术后发生肺炎的比例为20.0%,肺炎组患者在≥65岁、病理T分期、化疗前合并肌肉减少症、术前合并肌肉减少症、骨骼肌过度损失等比例上明显高于非肺炎组(P<0.05),化疗前的SMI值、术前的SMI值和术前血清前白蛋白指标均明显低于非肺炎组,差异有统计学意义(t=2.262、2.812、3.050,P<0.05);logistic多因素分析显示,合并肌肉减少症(化疗前)、骨骼肌过度损失、更高的病理T分期、血清前白蛋白<200 g/L和高NLR是新辅助治疗后食管鳞癌患者术后发生肺炎的危险因素(Wald值分别为6.257、16.257、4.548、6.375、7.243,P<0.05)。结论:新辅助化疗前合并肌肉减少症、新辅助化疗期间骨骼肌过度损失可增加新辅助治疗后食管鳞癌患者术后肺炎的风险,具有较好的术前预测肺炎的临床价值。

Objective:To explore the impact of sarcopenia on postoperative pneumonia in esophageal squamous cell carcinoma patients undergoing radical esophagectomy after neoadjuvant chemotherapy.Methods:Retrospective analysis was made on the clinical data of 130 esophageal squamous cell carcinoma undergoing radical resection of esophageal cancer after neoadjuvant chemotherapy in our hospital from January 2020 to June 2023.The correlation between clinical pathological indicators,skeletal muscle indicators before and after neoadjuvant therapy and postoperative pneumonia was statistically analyzed.Results:The proportion of postoperative pneumonia in esophageal squamous cell carcinomapatients receiving neoadjuvant chemotherapy was 20.0%.The proportion of patients with pneumonia in groups of≥65 years old,pathological T stage,sarcopenia before chemotherapy,sarcopenia before surgery,and skeletal muscle transition loss were significantly higher than that of patients without pneumonia(P<0.05).The skeletal muscle index before chemotherapy,preoperative skeletal muscle index,and preoperative serum albumin indicators were significantly lower than those in the non-pneumonia group,with statistically significant differences(t=2.262,2.812,3.050,P<0.05).Logistic multivariate analysis showed that comorbidities with sarcopenia(before chemotherapy),skeletal muscle transition loss,higher pathological T stage,serum prealbumin<200 g/L,and high NLR were risk factors for postoperative pneumonia in esophageal squamous cell carcinoma patients after neoadjuvant therapy(Wald values were 6.257,16.257,4.548,6.375,7.243,P<0.05,respectively).Conclusion:The combination of sarcopenia before neoadjuvant chemotherapy and skeletal muscle transition loss during neoadjuvant chemotherapy increase the risk of postoperative pneumonia in esophageal squamous cell carcinoma patients after neoadjuvant therapy,which has good clinical value in predicting pneumonia before surgery.