术前恶病质对接受肝胆胰恶性肿瘤大手术患者预后的影响

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-02-18 DOI:10.1016/j.clnu.2025.02.014

Yuki Fugane , Shinya Tanaka , Yota Mizuno , Hiroki Nakajima , Hiromasa Yamamoto , Takayuki Inoue , Motoki Nagaya , Yoshihiro Nishida , Shunsuke Onoe , Junpei Yamaguchi , Takashi Mizuno , Yukihiro Yokoyama , Tomoki Ebata

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引用次数: 0

摘要

背景,目的：关于肝胆胰恶性肿瘤恶病质与临床预后之间关系的数据有限。本回顾性研究旨在探讨术前恶病质对恶性肿瘤大HPB手术患者预后的影响。方法回顾性分析2014年3月至2018年12月期间接受大型开放手术的HPB恶性肿瘤患者的数据。在手术前几天评估恶病质，并根据修订的亚洲恶病质工作组标准定义：低体重指数（<21 kg/m2）和握力下降（<；28 kg[男性]和<；18 kg[女性]）或c反应蛋白水平升高（>0.5 mg/dL）。主要终点为术后总生存期（OS）；次要终点包括无病生存期（DFS）和术后并发症。结果332例患者中，男性228例；平均年龄（68.8±10.3岁），术前恶病质93例（28%）。在5年随访期间（平均3.3±1.7年），有154例（46%）死亡，181例（55%）合并事件（死亡或复发），两组主要术后并发症无显著差异（P = 0.329）。校正协变量后，恶病质（n = 93）与较短的OS有显著相关性(校正风险比[HR] 1.65[95%置信区间（CI） 1.18-2.30]；P = 0.004)和DFS(调整后危险度1.39 [95% CI 1.01-1.91；P = 0.043)与非恶病质组（n = 239）比较。恶病质仅在病理分期≤II的亚群中显著缩短OS(调整后危险度2.45 [95% CI 1.27-4.74]；P = 0.008)，其他方面无差异（相互作用P为0.040）。结论HPB恶性肿瘤手术患者术后恶病质不影响短期手术并发症，但明显恶化术后预后。

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Prognostic impact of preoperative cachexia in patients undergoing major hepatopancreatobiliary surgery for malignancy

Background & aims

Data regarding the association between cachexia and clinical outcomes in hepatopancreatobiliary (HPB) malignancies are limited. This retrospective study sought to investigate the prognostic significance of preoperative cachexia in patients undergoing major HPB surgery for malignancies.

Methods

Data from patients, who underwent major open surgery for HPB malignancies between March 2014 and December 2018, were retrospectively reviewed. Cachexia was evaluated a few days before surgery, and defined according to modified Asian Working Group for Cachexia criteria: low body mass index (<21 kg/m²) and decreased handgrip strength (<28 kg [males] and <18 kg [females]) or elevated C-reactive protein level (>0.5 mg/dL). The primary endpoint was postoperative overall survival (OS); secondary endpoints included disease-free survival (DFS) and postoperative complications.

Results

Of 332 patients (228 male; mean age, 68.8 ± 10.3 years), 93 (28 %) had preoperative cachexia. There were 154 (46 %) deaths and 181 (55 %) combined events (death or recurrence) during a five-year follow-up (mean, 3.3 ± 1.7 years), with no significant differences in major postoperative complications between the 2 groups (P = 0.329). After adjusting for covariates, cachexia (n = 93) exhibited significant associations with shorter OS (adjusted hazard ratio [HR] 1.65 [95 % confidence interval (CI) 1.18–2.30]; P = 0.004) and DFS (adjusted HR 1.39 [95 % CI 1.01–1.91; P = 0.043) compared with non-cachexia (n = 239). Cachexia significantly shortened OS only in a subset with pathological stage ≤ II disease (adjusted HR 2.45 [95 % CI 1.27–4.74]; P = 0.008) but not otherwise (P for interaction, 0.040).

Conclusions

Preoperative cachexia did not affect short-term surgical complications but significantly deteriorated postoperative prognosis in patients who underwent surgery for HPB malignancies.

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.