肌少症对老年肝癌术后恢复及预后的影响

目的:肌少症对老年肝癌术后恢复及预后的影响。方法:选取2015年1月至2017年12月收治的114例老年肝癌,根据有无合并肌少症,分为肌少症组(n=35)和非肌少症组(n=79)。比较两组患者的术后恢复及生存情况。结果:肌少症组总并发症发生率、住院时间和30 d再入院率均高于对照组,差异均有统计学意义(P<0.05)。肌少症组中位生存时间为25.9个月,1年、2年、3年累积总生存率为74.3%、51.1%、24.5%,而非肌少症组中位生存时间为35.7个月,1年、2年、3年累积总生存率为87.3%、75.6%、49.4%,差异有统计学意义(P=0.004)。单因素分析结果显示,老年肝癌术后预后与Charlson合并症指数(CCI)、肌少症、巴塞罗那分期(BCLC)、甲胎蛋白、肿瘤大小、肿瘤个数、肿瘤分化程度、微血管侵犯(MVI)相关(P<0.05)。Cox多因素分析结果显示,CCI、肌少症、BCLC分期、肿瘤个数、MVI是老年肝癌术后预后的独立危险因素(P<0.05)。结论:肌少症会增加老年肝癌患者术后并发症发生率,延长住院时间,影响术后恢复,同时也会降低总生存率。

Effect of sarcopenia on recovery and prognosis of elderly patients with hepatocellular carcinoma after operation

Objective:To explore the effect of sarcopenia on recovery and prognosis of elderly patients with hepatocellular carcinoma after operation.Methods:114 elderly patients with hepatocellular carcinoma admitted from Jan.2015 to Dec.2017 were divided into sarcopenia group (n=35) and non-sarcopenia group (n=79) according to the presence or absence of oligomyosis.Postoperative recovery and survival were compared between the two groups.Results:The incidence of total complications,hospitalization time and re-admission rate in 30 days in sarcopenia group were higher than those in control group (P＜0.05).The median survival time was 25.9 months in the sarcopenia group,and the 1-,2-,3-year overall survival rate was 74.3%,51.1% and 24.5%.The median survival time in the non-oligomyosis group was 35.7 months and the 1-,2-,3-year overall survival rate was 87.3%,75.6% and 49.4%.The differences were significant (P=0.004).Univariate analysis showed that the prognosis of elderly patients with hepatocellular carcinoma was related to Charlson complication index (CCI),sarcopenia,Barcelona clinic liver cancer (BCLC) stage,alpha fetoprotein,tumor size,tumor number,tumor differentiation,and microvascular invasion (MVI) (P＜0.05).Cox multivariate analysis showed that CCI,sarcopenia,BCLC stage,number of tumors and MVI were independent risk factors for the prognosis of elderly patients with hepatocellular carcinoma (P＜0.05).Conclusion:Sarcopenia can increase the incidence of postoperative complications,prolong hospitalization time,affect postoperative recovery,and also reduce the overall survival rate of elderly patients with hepatocellular carcinoma.