摘要
目的探讨Ⅱ~Ⅲ期结直肠癌(CRC)中术前合并肌少症(SAR)对根治术后近期疗效的影响。方法回顾性分析2015年1月至2021年6月就诊于信阳第一五四医院和河南中医药大学第一附属医院569例Ⅱ~Ⅲ期接受CRC根治术患者的临床资料。采用第3腰椎平面的骨骼肌质量指数(L3SMI)评估是否合并SAR,以男性L3SMI<52.4 cm^(2)/m^(2),女性L3SMI<38.5 cm^(2)/m^(2)作为诊断标准。最终纳入406例,其中SAR组87例,Non-SAR组319例。以CRC根治术后住院期间严重并发症(Clavien-Dindo分级≥Ⅱ)的发生率作为近期疗效评价指标,采用单因素和多因素Logistic回归分析评估术前合并SAR是否为严重并发症的独立危险因素。为校正潜在的混杂因素,利用倾向性评分匹配(PSM)的方法进行多因素Logistic回归分析的敏感性分析。结果整体队列中患者的中位年龄为62.5岁,58.4%为男性,直肠癌占比55.9%。Ⅱ、Ⅲ期CRC患者的占比分别为47.0%、53.0%。与Non-SAR组相比,SAR组有较多的结肠癌患者,接受新辅助放化疗的比例较高,且严重并发症发生率较高,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,SAR组发生严重并发症的风险较高[32.2%(28/87)vs 11.3%(36/319)],比值比(Odds Ratio,OR)为2.498(95%CI:1.204~5.183)。以1∶1的比例进行PSM后150例患者匹配成功,SAR组和Non-SAR组各75例。PSM之后两组患者的各项临床基本特征比较差异均无统计学意义(P>0.05)。敏感性分析结果与多因素Logistic回归分析的结果一致,SAR组仍显示出较高的严重并发症风险[33.3%(25/75)vs 17.3%(13/75)],OR为2.385(95%CI:1.108~5.134)。结论在Ⅱ~Ⅲ期CRC患者中,术前合并SAR是根治术后发生严重并发症的独立危险因素,术前准确识别SAR从而制定个体化的围手术期预康复策略有利于改善CRC患者的临床预后。
Objective To investigate the impact ter radical resection in stageⅡ-Ⅲcolorectal cancer(CRC)patients who underwent radical resection between January 2015 and June 2021 at Xinyang 154th Hospital and the First Affiliated Hospital of Henan University of Chinese Medicine were retrospectively analyzed.Sarcopenia was assessed using the skeletal muscle mass index(L3 SMI)at the third lumbar vertebra,with diagnostic thresholds of L3 SMI<52.4 cm^(2)/m^(2) for males and<38.5 cm^(2)/m^(2) for females.Ultimately,406 patients were included(SAR group:87;Non-SAR group:319).The incidence of severe postoperative complications(Clavien-Dindo grade≥Ⅱ)during hospitalization served as the short-term outcome measure.Univariate and multivariate logistic regression analyses were performed to evaluate whether preoperative SAR was an independent risk factor for severe complications.Propensity score matching(PSM)was employed for sensitivity analysis to adjust for potential confounders.Results The patients in the entire co-hort had a median age of 62.5 years,with 58.4%being male and 55.9%having rectal cancer.StageⅡandⅢCRC ac-counted for 47.0%and 53.0%,respectively.Compared with the Non-SAR group,the SAR group showed a higher rate of colon cancer patients,had a higher proportion of patients receiving neoadjuvant chemoradiotherapy,and exhibited a high-er incidence of severe complications,with all differences being statistically significant(P<0.05).Multivariate analysis re-vealed that SAR was associated with an increased risk of severe complications(32.2%[28/87]vs 11.3%[36/319]),with an odds ratio(OR)of 2.498(95%CI:1.204-5.183).After 1:1 PSM(150 matched patients:75 per group),baseline charac-teristics were balanced(P>0.05).Sensitivity analysis confirmed SAR as an independent risk factor(33.3%[25/75]vs 17.3%[13/75];OR=2.385,95%CI:1.108-5.134).Conclusion Preoperative SAR is an independent risk factor for se-vere complications after radical CRC resection in stageⅡ-Ⅲpatients.Accurate preoperative identification of SAR and tailored perioperative prehabilitation strategies may improve clinical outcomes.
作者
张有泽
余强
杨秀君
李楷威
ZHANG You-ze;YU Qiang;YANG Xiu-jun;LI Kai-wei(Department of General Surgery,Xinyang 154th Hospital,Xinyang 464000,Henan,CHINA;Department of Hepatobiliary Surgery,990 Hospital of Joint Logistics Support Force,PLA,Zhumadian 463000,Henan,CHINA;Department of General Surgery,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,CHINA)
出处
《海南医学》
2025年第13期1871-1878,共8页
Hainan Medical Journal
基金
2024年河南省医学科技攻关联合共建项目(编号:LHGJ20240668)。
关键词
结直肠癌
肌少症
近期疗效
倾向性评分匹配
Colorectal cancer
Sarcopenia
Short-term outcomes
Propensity score matching
