肌肉疏松症对胰腺癌治疗和预后的影响

E. Weledji, Luca Gianotti, Massimo Oldani, F. Uggeri
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摘要

肌肉疏松症是一种亚临床的骨骼肌和力量缺失症,对癌症和手术患者都进行过广泛的研究。肌肉疏松症患者特别容易受到包括手术和手术并发症在内的主要生理压力的影响。因此,"肌肉疏松症 "被认为是影响癌症患者并发症和存活率的重要预后因素。本综述旨在评估当前有关肌肉疏松症对胰腺癌治疗和预后影响的文献。胰腺癌患者中肌肉疏松症的发病率介于 20% 与 65% 之间,这是因为患者群体不同、疾病分期不同以及测量肌肉疏松症的方法不同。利用影像学和临床数据(如虚弱程度)可以更准确地评估肌肉疏松症。虽然营养不良可能是导致胰腺吻合术愈合过程减慢的原因,但肌肉疏松症与胰十二指肠切除术后预后之间的关系还存在争议。大多数研究显示,同时患有肌肉疏松症和高脂肪(肌肉疏松性肥胖)的患者术后形成胰瘘的风险较高。一般来说,肌肉疏松症似乎与存活率较低有关。因此,对肌肉疏松症的评估可改变管理策略、患者选择,并改善胰腺癌手术切除前的知情同意。利用术前计算机断层扫描,包括利用肌肉疏松性肥胖症和皮下脂肪面积进行瘘管风险评分,对胰腺手术后临床相关的胰腺瘘管形成进行更好的预测将非常有用。尽管对肌肉疏松症的治疗仍是一个研究领域,但术前改善营养和体能的方案可能会改善肌肉疏松症和手术效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The implications of sarcopenia in the treatment and prognosis of pancreatic cancer
Sarcopenia is the subclinical loss of skeletal muscle and strength and has been extensively studied in both cancer and surgical patients. Patients with sarcopenia are particularly vulnerable to major physiological stressors including surgery and surgical complications. Sarcopenia has thus gained significant recognition as an important prognostic factor for both complications and survival in cancer patients. The aim of this review was to evaluate the current literature on the effect of sarcopenia on the treatment and prognosis of pancreatic cancer. The prevalence of sarcopenia in pancreatic cancer patients range between 20 and 65% due to the heterogeneous groups of patients, difference in disease stage, and the different methods of measuring sarcopenia. Sarcopenia would be more accurately assessed by utilizing both imaging and clinical data, such as frailty. Although malnutrition could be responsible for the attenuated healing process of pancreatic anastomosis the relationship between sarcopenia and outcome following pancreaticoduodenectomy is debated. Most studies showed a higher risk of postoperative pancreatic fistula formation in patients with concurrent sarcopenia and high fat mass (sarcopenic obesity). Sarcopenia seems generally to be associated with lower survival. The assessment of sarcopenia can therefore lead to changes in management strategy, patient selection, and improved informed consent prior to surgical resection of pancreatic cancer. An improved prediction of clinically relevant pancreatic fistula formation after pancreatic surgery using preoperative computed tomography scan, including a fistula risk score using sarcopenic obesity and subcutaneous fat area will be useful. Although treatment for sarcopenia still remains an area of research a protocol to improve nutrition and fitness preoperatively may improve sarcopenia and surgical outcome.
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