内容紹介
Summary
Introduction: Some studies reported that the decrease in skeletal muscle mass worsens the immune and nutritional status and related to the poor prognosis in colorectal cancer. We examined the relationship of skeletal muscle mass, immune and nutritional index, and outcome in patients with colorectal cancer at our hospital. Subjects and methods: We retrospectively analyzed 196 patients of cStageⅡandⅢcolorectal cancer who underwent curative surgery in our institution between 2007 and 2013. The cross-sectional area of the psoas muscle at the level of the third lumbar vertebra on preoperative computed tomography was assessed to calculate the psoas muscle index(PMI). Patients are divided into high PMI group(H-group)and low PMI group(L-group)with cut off value(6.36 cm2/m2 for males and 3.92 cm2/m2 for females). Patient background, tumor factor, overall survival(OS), recurrence free survival(RFS)were examined retrospectively. Results: There were 119 cases in H-group and 77 cases in L-group. Significant differences were recognized in gender, age, Alb value, BMI, and adjuvant chemotherapy between 2 groups. The 5-year survival rate was significantly different from 82.8% in H-group and 70.3% in L-group(p<0.01). The 5-year recurrence-free survival rate was 74.0% in the H-group, and 68.3% in the L-group(p=0.46). Univariate and multivariate analysis showed that age(OR: 1.90, p<0.01), high CEA(OR: 0.012, p<0.05), depth of invasion(OR: 2.19, p<0.05), lymph node metastasis(OR: 2.21, p<0.01), and preoperative low PMI(OR: 2.05, p<0.01), were significantly related to decrease of OS. Conclusion: Preoperative PMI suggested to become prognostic factors in StageⅡandⅢcolorectal cancer.
要旨
はじめに: 近年,様々な悪性腫瘍において骨格筋量の低下がその予後を悪化させるという報告が散見される。cStageⅡ,Ⅲ大腸癌において骨格筋量の低下が予後に与える影響について検討した。対象と方法: 2007～2013年に根治的手術を行ったcStageⅡ,Ⅲ大腸癌の症例196例を対象とした。L3下縁領域での大腰筋面積を身長で補正したpsoas muscle index(PMI)を測定,男性6.36 cm2/m2,女性3.92 cm2/m2をcut off値とし,cut off値以上をH群,未満をL群に分類した。全生存期間(OS),無再発生存期間(RFS)について後方視的に検討した。結果: すべて開腹手術で,H群119例,L群77例であった。性別,年齢,術前Alb値,BMI,術後補助化学療法の有無において両群間で有意差を認めた。OSではH群の5年OSが82.8%,L群70.3%(p<0.01)と有意差を認めたがRFSでは有意差を認めなかった。単変量,多変量解析では年齢(OR 1.90,p<0.01),CEA高値(OR 0.012,p<0.05),深達度(OR 2.19,p<0.05),リンパ節転移の有無(OR 2.21,p<0.01)および術前PMI低下(L群)(OR 2.05,p<0.01)がOS低下の独立予測因子であった。結論: 術前の大腰筋面積はcStageⅡ,Ⅲ大腸癌において再発率には影響せず,全生存期間に影響することがわかった。
目次
Introduction: Some studies reported that the decrease in skeletal muscle mass worsens the immune and nutritional status and related to the poor prognosis in colorectal cancer. We examined the relationship of skeletal muscle mass, immune and nutritional index, and outcome in patients with colorectal cancer at our hospital. Subjects and methods: We retrospectively analyzed 196 patients of cStageⅡandⅢcolorectal cancer who underwent curative surgery in our institution between 2007 and 2013. The cross-sectional area of the psoas muscle at the level of the third lumbar vertebra on preoperative computed tomography was assessed to calculate the psoas muscle index(PMI). Patients are divided into high PMI group(H-group)and low PMI group(L-group)with cut off value(6.36 cm2/m2 for males and 3.92 cm2/m2 for females). Patient background, tumor factor, overall survival(OS), recurrence free survival(RFS)were examined retrospectively. Results: There were 119 cases in H-group and 77 cases in L-group. Significant differences were recognized in gender, age, Alb value, BMI, and adjuvant chemotherapy between 2 groups. The 5-year survival rate was significantly different from 82.8% in H-group and 70.3% in L-group(p<0.01). The 5-year recurrence-free survival rate was 74.0% in the H-group, and 68.3% in the L-group(p=0.46). Univariate and multivariate analysis showed that age(OR: 1.90, p<0.01), high CEA(OR: 0.012, p<0.05), depth of invasion(OR: 2.19, p<0.05), lymph node metastasis(OR: 2.21, p<0.01), and preoperative low PMI(OR: 2.05, p<0.01), were significantly related to decrease of OS. Conclusion: Preoperative PMI suggested to become prognostic factors in StageⅡandⅢcolorectal cancer.
要旨
はじめに: 近年,様々な悪性腫瘍において骨格筋量の低下がその予後を悪化させるという報告が散見される。cStageⅡ,Ⅲ大腸癌において骨格筋量の低下が予後に与える影響について検討した。対象と方法: 2007～2013年に根治的手術を行ったcStageⅡ,Ⅲ大腸癌の症例196例を対象とした。L3下縁領域での大腰筋面積を身長で補正したpsoas muscle index(PMI)を測定,男性6.36 cm2/m2,女性3.92 cm2/m2をcut off値とし,cut off値以上をH群,未満をL群に分類した。全生存期間(OS),無再発生存期間(RFS)について後方視的に検討した。結果: すべて開腹手術で,H群119例,L群77例であった。性別,年齢,術前Alb値,BMI,術後補助化学療法の有無において両群間で有意差を認めた。OSではH群の5年OSが82.8%,L群70.3%(p<0.01)と有意差を認めたがRFSでは有意差を認めなかった。単変量,多変量解析では年齢(OR 1.90,p<0.01),CEA高値(OR 0.012,p<0.05),深達度(OR 2.19,p<0.05),リンパ節転移の有無(OR 2.21,p<0.01)および術前PMI低下(L群)(OR 2.05,p<0.01)がOS低下の独立予測因子であった。結論: 術前の大腰筋面積はcStageⅡ,Ⅲ大腸癌において再発率には影響せず,全生存期間に影響することがわかった。