Use of Preoperative L3 Muscle Index to Predict Long Term Survival and in Hospital Complication of Stage I to III Colorectal Cancer

Purpose. Decrease of muscle mass is recognized as a poor prognostic factor in colorectal cancer. This study aimed to examine the association between computed tomography measured muscle index and the long term survival in resectable stage I to III colorectal cancers. Materials and Methods. Data were collected retrospectively from medical records. There were total 236 patients underwent resection with curative intent at Keelung Chang Gung Memorial Hospital from 2006 to 2010. The muscle index was calculated by an open-saurce Image J software from National Institutes of Health U.S.A. (NIH). The cross-sectional muscle area in pre-op CT scan at the 3^(rd) lumbar vertebral (L3) level normalized with patient's height represents the muscle index. The lowest quartile of L3 muscle index was classified as sarcopenia. Other potential predictors of survival were collected and analyzed by Kaplan-Meier curves and Cox proportional hazard models. Results. For the lowest quartile of L3 muscle index, man lower than 36.59 cm2/m2 and woman lower then 36.64 cm^2/m^2 is defined as sarcopenia. The average follow-up duration was 71 months. The patients in sarcopenic group had worse 5-year overall survival rate than non-sarcopenic group (61.02% vs. 76.84%; log-rank test p = 0.001). Multivariate Cox regression analysis revealed that sarcopenia was independently associated with higher mortality rate (HR 2.524; 95% CI 1.4408-4.526; p = 0.002) in patients with colorectal cancer. There was no significant difference in inhospital complication between two groups. Conclusions. Preoperative L3 muscle index can be used to predict the long term survival in patient who undergoes surgical resection for stage I to III colorectal cancer. L3 muscle index less than the 25 percentile can be the prognostic threshold of sarcopenia in our population.

關鍵字

Colorectal cancer ； Sarcopenia ； Muscle index ； Survival

並列摘要

目的：在罹患大腸直腸癌的病人中，肌肉量的減少常被視為一項不良的預後因子。我們希望藉由術前的電腦斷層檢查來評估肌肉減少的程度，並驗證術前發現的肌減少症和大腸直腸癌術後存活率的關係。方法：我們統計了從2006 年1 月到2010 年12 月共236 位在基隆長庚醫院被確診為大腸直腸癌，並接受根治性切除手術的病人資料。利用美國國立衛生研究院發布的自由軟體 - Image J 來計算術前電腦斷層影像中，腰椎第三節橫截面的骨骼肌面積。此肌肉橫截面積以病人的身高做校正後可以得到肌肉質量指數。我們用肌肉質量指數來評估病人是否有肌減少症並預估其術後存活率。結果：在我們的資料庫中，肌肉質量指數低於第一四分位數的病人（男性低於36.59Cm^2/m^2，女性低於36.64 cm^2/m^2）可視為有肌減少症。在平均71 個月的追蹤期間，有肌減少症的病人組別有較差的五年存活率。而肌減少症對於存活率亦是獨立的變相因子。結論：根據我們的結果，術前以電腦斷層影像計算出的肌肉質量指數可作為大腸直腸癌病人術後的預後評估因子。肌肉質量指數低於第一四分位數的病人可視為肌減少症並且有較差的五年存活率。

並列關鍵字

大腸直腸癌；肌減少症；肌肉質量指數；存活率

參考文獻

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國際替代計量

Use of Preoperative L3 Muscle Index to Predict Long Term Survival and in Hospital Complication of Stage I to III Colorectal Cancer

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