JAMA Surg:肌肉减少是肝肿瘤切除后患者预后的重要影响因素

2020-09-29 MedSci原创 MedSci原创

肌肉减少与恶性肿瘤肝切除术后的不良结局相关。为了更好地对患者进行分类,并将发病风险降至最低,应在首次临床就诊时进行肌肉和握力评估

回顾性研究显示,肌肉减少对恶性肝脏肿瘤切除术后患者预后有显著影响,但其证据仅限于小规模的回顾性研究,且缺乏肌肉减少的量化标准。近日研究人员考察了肌肉减少作为恶性肝肿瘤切除术后90天预后危险因素的预测作用。

研究在意大利开展,234名因恶性肿瘤而接受肝脏切除术的患者参与,分别在术前接受握力测试和骨骼肌指数(SMI)评估。根据结果将患者分为4组:A组(肌肉质量和强度正常)、B组(肌肉强度降低)、C组(肌肉质量下降)和D组(肌肉质量和强度降低)。研究的主要终点为90天的发病率,次要结果包括90天死亡率、住院时间和再入院率。

234例患者,平均年龄66.50岁,158名男性(67.5%)。患者接受了64例大型肝切除术和170例小型肝切除术。整个人群的平均SMI为46.22cm/m2。手握力中位数为30.80kg。D组患者的90天发病率在统计学上显著高于其他组(51.5% vs C组38.7%,B组23.1%,A组6.4%)。与其他组相比,D组患者的住院时间更长(10天vs C组8天,B组9天,A组6天),且再次入院率较高(8.8% vs C组5.3%,B组7.7%,A组0%)。肌肉减少症、门静脉高压、肝硬化和胆道重建是与90天发病率相关的独立危险因素。

研究认为,肌肉减少与恶性肿瘤肝切除术后的不良结局相关。为了更好地对患者进行分类,并将发病风险降至最低,应在首次临床就诊时进行肌肉和握力评估。

原始出处:

Giammauro Berardi et al. Association of Sarcopenia and Body Composition With Short-term Outcomes After Liver Resection for Malignant Tumors.JAMA Surg. September 23, 2020.

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1647101, encodeId=c82b164e101c2, content=<a href='/topic/show?id=fd6d809e535' target=_blank style='color:#2F92EE;'>#肌肉减少#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80975, encryptionId=fd6d809e535, topicName=肌肉减少)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d18723374958, createdName=shizhenshan, createdTime=Sat Dec 12 09:04:10 CST 2020, time=2020-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1692156, encodeId=e4471692156fb, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Tue Mar 16 00:04:10 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1686970, encodeId=c70916869e040, content=<a href='/topic/show?id=468a82841d7' target=_blank style='color:#2F92EE;'>#肿瘤切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82841, encryptionId=468a82841d7, topicName=肿瘤切除)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0c0b28305155, createdName=12498561m41(暂无昵称), createdTime=Sun May 09 18:04:10 CST 2021, time=2021-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1465607, encodeId=fe74146560e35, content=<a href='/topic/show?id=144f5032688' target=_blank style='color:#2F92EE;'>#影响因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50326, encryptionId=144f5032688, topicName=影响因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a06745918, createdName=chenzhuanggui, createdTime=Thu Oct 01 11:04:10 CST 2020, time=2020-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036289, encodeId=4933103628935, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Sep 29 23:04:10 CST 2020, time=2020-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=889281, encodeId=803488928182, content=肿瘤患者往往伴有<a href='/topic/show?id=cf7f4e2366e' target=_blank style='color:#2F92EE;'>#少肌症#</a>,这样预后就不会好,可能与营养不良,或肿瘤增殖快等因素有关,也可能是转向<a href='/topic/show?id=e96b529e45a' target=_blank style='color:#2F92EE;'>#恶液质#</a>的一个过程。在<a href='/topic/show?id=370d8126914' target=_blank style='color:#2F92EE;'>#肝癌#</a>中是这样,在其它肿瘤中应该也是一样, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47236, encryptionId=cf7f4e2366e, topicName=少肌症), TopicDto(id=52974, encryptionId=e96b529e45a, topicName=恶液质), TopicDto(id=81269, encryptionId=370d8126914, topicName=肝癌)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Tue Sep 29 20:43:25 CST 2020, time=2020-09-29, status=1, ipAttribution=)]
    2020-09-29 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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    2020-09-29 lovetcm

    肿瘤患者往往伴有#少肌症#,这样预后就不会好,可能与营养不良,或肿瘤增殖快等因素有关,也可能是转向#恶液质#的一个过程。在#肝癌#中是这样,在其它肿瘤中应该也是一样

    0

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