| background and purpose:Gastric cancer(GC)is a disease with high morbidity and mortality in China.The treatment of gastric cancer is time-consuming and costly,and the prognosisis of gastric cancer is Poor.It is necessary to improve the process of diagnosis and treatment of gastric cancer.Sarcopenia is a metabolic disorder associated with age,chronic diseases.It can affect the development of multiple diseases.This study will collect the clinical and pathological data of gastric cancer patients.Preoperative CT image of the gastric cancer patients will be use to quantitative measurement and analysis for the diagnosis of sarcopenia.We will analysis the different between the patients who was diagnosis with sarcopenia or not.We also try to find the risk factors of Gastric cancer patients who get the sarcopenia aim to improvent the awareness of sarcopenia and improve the Methods of preoperative evaluation and to guide the formulation of nutrition plan for patients with gastric cancerMethods:a total of 98 pieces of clinicopathological data and preoperative abdominal CT images of gastric cancer patients receiving surgical treatment in general surgery department of Qingdao municipal hospital on October 8,2017 and September30,2018 were collected.Skeletal muscle index(SMI)was calculated as follows:skeletal muscle index(cm~2/m~2)=skeletal muscle area(cm)~2/(height(m))~2 at L3 level;skeletal muscle index(SMI)was calculated as follows:Criteria for defining Sarcopenia by sex:male,SMI<5500mm ~2/m~2,female,SMI<3900mm~2/m~2.Patients with gastric cancer were divided into two groups:the muscular dysplasia group and the non-muscular dysplasia group.Age,gender,body mass idex(BMI),totallymphocyte count(TLC),and hemoglobin(hemoglobin(HB)),serum albumin,,propagated serum albumin(prealbumin,PA),NRS2002 nutritional risk score,operation time,blood loss of operation,pathological staging(AJCC staging gastric carcinoma(8 edition))and tissue differentiation,total length of hospital stay,postoperative hospital stay,postoperative complications and complications classification(Clavien-Dindo hierarchical),hospitalization cost Will be compared.Results:There are 56.1%(55/98)pients was determined to be Sarcopenia,and43.9%(43/98)of those without muscular dysplasia.Sarcopenia group was elder with an average age of(65.91±6.99vs63.02±6.45 P=0.039),according to the NRS score,Sarcopenia group with higher percentage of patients who get higher score compared with other group(36(64.3%)vs18(42.9%),P=0.035),the hemoglobin,lymphocyte count,and serum albumin of Sarcopenia group were lower than the other group(122.32±16.59vs130.67±13.88 P=0.008,1.40±0.36 vs1.83±0.75 P=0.001,37.30±3.70vs39.47±2.80 P=0.001),and no statistical difference was found in propagated serum albumin and body mass idex between the two groups(215.93±45.20vs216.18±70.22P=0.984,23.25±2.68 vs24.05±3.51 P=0.204).Rank-sum test was performed on the pathological staging of patients in the two groups,and it was found that there was a difference in case staging between the two groups(P=0.004),and a higher proportion of patients with later tumor staging in the Sarcopenia group.There was no statistically significant difference in operative time and intraoperative blood loss between the two groups(214.73±51.66 vs 199.88±49.15 P=0.745,183.93±98.68 vs 154.76±70.55P=0.107).Patients in the sarcopenia group had a higher hospitalization cost(74667.176491.24 vs72240.46 4380.10)than those in the non-sarcopenia group.There was no statistically significant difference in the incidence of postoperative complications between the sarcopenia group and the non-sarcopenia group(29(51.8%),vs15(35.7%),P=0.113).The incidence of high grade postoperative complications was higher in the sarcopenia group than in the non-sarcopenia group.Clavien-Dindo grading was further used to grade postoperative complications,The rank sum test showed that there was a difference in the incidence of complications between the two groups(P=0.043).The incidence of postoperative complications was higher in the sarcopenia group than in the non-sarcopenia group.Univariate Logistic regression analysis was performed on preoperative examination and pathological results,it suggest that:Age,NRS2002 score,lymphocyte count and pathological stage were the related factors of gastric cancer patients with sarcopenia.Further multivariate Logistic regression analysis suggested that Age,NRS2002 score,lymphocyte count and pathological stage were independent risk factors for gastric cancer patients with sarcopenia.The risk of sarcopenia in older patient was higher(OR 1.101,95%CI(1.008-1.204),P=0.033).The risk of sarcopenia was lower when the mphocyte count was higher(OR 0.138,95%CI(0.039-0.489),P=0.033).the risk of sarcopenia is higher when the postoperative pathologic staging was late(Ⅱphase(A,B):OR 8.674,95%CI(1.239-60.739),P=0.030;Ⅲ(A,B)):OR 43.908,95%CI(4.908-386.827),P=0.001).Conclusion:1.The proportion of gastric cancer patients with myopenia was higher,Gastric cancer patients with sarcopenia was older,and with a higher scores on Preoperative NRS2002 nutritional risk assessment,Inversed,Preoperative hemoglobin,lymphocyte count and serum albumin were lower in the sarcopenia group.2.The Postoperative complications of sarcopenia group were more serious,pathological staging of sarcopenia group was later,hospitalization time of sarcopenia group was longer,and hospitalization cost of sarcopenia group was higher.3.Advanced age,high NRS2002 score and later pathological stage were risk factors for gastric cancer patients with sarcopenia.Quantitative determination of muscle content of patients with gastric cancer before operative is conducive to assess the preoperative nutritional status of patients,guide the preparation before surgery and the formulation of postoperative nutritional support plan. |
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