术前肌骨化病和肌间脂肪作为ct衍生的结直肠癌营养预后指标：一项多中心发展验证研究

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-08-11 DOI:10.1016/j.clnu.2025.08.007

Yinghao Cao , Yixin Heng , Mingming Song , Tong Nie , Zhihao Liu , Jiaxin Xu , Xiaoyu Wu , Le Qin , Tao Liu , Feihong Wu , Chuansheng Zheng , Kailin Cai

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引用次数: 0

摘要

背景：通过常规术前影像学量化的机体成分改变可以细化结直肠癌（CRC）的风险分层并指导营养干预。我们的目的是建立ct评估肌肉质量和异位脂肪沉积对长期生存的预后价值。方法采用双中心回顾性研究，分析武汉协和医院收治的850例CRC根治性切除术患者（原始队列）和石河子大学附属医院收治的647例CRC根治性切除术患者（验证队列）。使用预处理腹部CT在L3，我们量化：脂肪指标：内脏脂肪面积（VFA），皮下脂肪面积（SFA）和肌间脂肪面积（IMFA）。肌肉指标：骨骼肌指数（SMI）和放射密度（SMD）性别特异性阈值由X-tile将患者分为高/低组。主要终点是总生存期（OS）和无病生存期（DFS）。结果原始队列和验证队列的死亡率分别为25.65%（218/850）和26.28%（170/647）。多变量Cox回归分析显示，肌肥大症（低SMD: HR 0.58, 95%CI 0.41-0.83）、IMFI升高（HR 1.61, 1.09-2.39）、低SFA （HR 0.66, 0.44-0.98）和IMFA/VFA比值（HR 1.52, 1.06-2.18）是OS的独立预后因素（P均为0.050）。高IMFA （HR 1.46, 1.02-2.08）和IMFA/SFA比值（HR 1.57, 1.06-2.38）也与DFS显著相关（P < 0.050）。联合临床放射学（CRAD）因素的模型比单独基于肿瘤淋巴结转移分期或结合身体组成的模型显示出更好的预测能力（AUC：原始队列：OS: 0.815 vs 0.701/0.772, DFS: 0.794 vs 0.720/0.755；验证队列：OS: 0.841 vs 0.707/0.750, DFS: 0.736 vs 0.662/0.676）。决策曲线分析证实了CRAD模型在跨越风险阈值时具有优越的净效益。结论低SMD和高IMFA独立预测结直肠癌的不良结局。CRAD模型将ct衍生的身体成分与临床参数协同作用，实现个性化的预后分层，支持有针对性的营养策略，以减轻肌肉质量恶化和异位脂肪堆积。

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Preoperative myosteatosis and intermuscular adiposity as CT-Derived nutritional prognostic markers in colorectal cancer: A multicenter development-validation study

Background

Body composition alterations quantified by routine preoperative imaging may refine risk stratification and guide nutritional interventions in colorectal cancer (CRC). We aimed to establish the prognostic value of CT-assessed muscle quality and ectopic fat deposition for long-term survival.

Methods

This dual-center retrospective study analyzed 850 patients from Wuhan Union Hospital (original cohort) and 647 from Shihezi University Hospital (validation cohort) undergoing curative CRC resection. Using pretreatment abdominal CT at L3, we quantified: Adipose metrics: Visceral fat area (VFA), subcutaneous fat area (SFA), and intermuscular fat area (IMFA). Muscle metrics: Skeletal muscle index (SMI) and radiodensity (SMD) Sex-specific thresholds determined by X-tile categorized patients into high/low groups. Primary endpoints were overall survival (OS) and disease-free survival (DFS).

Results

The mortality rates of the original cohort and the validation cohort were 25.65 % (218/850) and 26.28 % (170/647), respectively. Multivariable Cox regression analysis revealed that Myosteatosis (low SMD: HR 0.58, 95%CI 0.41–0.83), elevated IMFI (HR 1.61, 1.09–2.39), low SFA (HR 0.66, 0.44–0.98), and IMFA/VFA ratio (HR 1.52, 1.06–2.18) were independent prognostic factors for OS (all P < 0.050). High IMFA (HR 1.46, 1.02–2.08) and IMFA/SFA ratio (HR 1.57, 1.06–2.38) were also significantly associated with DFS (all P < 0.050). The model combining clinico-radiological (CRAD) factors demonstrated better predictive ability compared to the model based on Tumor Node Metastasis staging alone or in combination with body composition (AUC: Original cohort: 0.815 vs. 0.701/0.772 for OS, 0.794 vs. 0.720/0.755 for DFS; Validation cohort: 0.841 vs. 0.707/0.750 for OS and 0.736 vs. 0.662/0.676 for DFS). Decision curve analysis confirmed superior net benefit of CRAD model across risk thresholds.

Conclusions

Low SMD and high IMFA independently predict adverse CRC outcomes. The CRAD model synergizing CT-derived body composition with clinical parameters enables personalized prognostic stratification, supporting targeted nutritional strategies to mitigate muscle quality deterioration and ectopic fat accumulation.

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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.