Quantitative CT Study On Body Components Of Patients With Common Malignant Tumors Of Digestive System Parenchyma And Organs Before And After Treatment

PART 1 Quantitative CT study on body components of patients with common malignant tumors of digestive system parenchyma and organs before and after treatmentObjective:Quantitative CT(QCT)was used to measure lumbar bone density,abdominal fat and muscle area and lumbar posterior muscle and fat area before and after treatment in patients with common malignant tumors of digestive system parenchymal organs,and to explore the changes of body components before and after treatment in patients with malignant tumors of digestive system parenchymal organs.Methods:CT imaging data of 159 patients with common malignant tumors of digestive system parenchyma and organs confirmed by surgery and pathology from Yijishan Hospital of Wannan Medical Colley fom January 2013 to January 2021 were rerrospectively analyzed,including 51 cases of hepatocellular carcinoma,40 cases of intrahepatic bile duct carcinoma and 64 cases of panreatic cancer.Quantitative CT was used to measuce the fat area(Fat Area,FA),muscle area(MA),degree of fat infiltration(Muscle Fat Infiltration,MFI)and total abdominal fat area(Total Fat Area,TFA),intra-abdominal fat area(Visceral Fat Area,VFA),subcutaneous fat area(Subcutaneous Fat Area,SFA)and lumbar bone mineral density(Bone Mineral Density,MD)of posterior lumbar muscles at the middle level of L3 lumbar vertebrae before and after operation in 51 patients with hepatocellular carcinoma,40 patients with intrahepatic cholangiocarcinoma and 64 patients with pancreatic cancer.Pairedt test or Wilcoxon signed rank test and Kruskal-Waills H test were used for statistical analysis,and P<0.05 was considered to be statistically significant.Results:In hepatocellular carcinoma patients,BMD,TFA,SFA,FA and MA were different before and after treatment,and all P values were<0.05.In patients with intrahepatic cholangiocarcinoma,BMD,TFA,SFA,FA and MA weae different before and after treatment,and all P values were<0.05.In patients with pancreatic cancer,there were statistical differences in all body components before and after treatment,with all P values<0.05.There were no significant differences in the changes of body components among hepatocellular carcinoma,intrahepatic cholangiocarcinoma and pancreatic cancer,and all P values were>0.05.Conclusions:1、Treatment decreased bone mineral density,abdominal total fat area,subcutaneous fat area,posterior muscle fat area,and posterior muscle muscle area in patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma.2、Treatment has agreat impact on pancreatic cancer patients,which can reduce the body components of pancreatic cancer patients.3、For common malignant tumors of the parenchymal organs of the digestive system,treatment has almost no difference in the degree of changes of various body components in patients with hepatocellular carcinoma,intrahepatic bile duct carcinoma and pancreatic cancer,and the degree of influence of treatment on the body components of patients is basically the same.PART 2 Clinical diagnostic value of quantitative CT in patients with cachexia of pancreatic cancerObjective:By measuring the changes of body components before and after treatment in patients with pancreatic cancer,the diagnostic value of the changes of body components before and after teatment in patients with pancreatic cancer in patients with cachexia of pancreatic cancer was studied,providing a new method for clinical diagnosis of cachexia in patients with pancreatic cancer.Methods:The CT data of 64 patients with pancreatic cancer confnmed by operation and pathology in Yijishan Hospital of Southem Anhui Medical College fom January 2013 to January 2020 were analyzed retrospectively.Quantitative CT was used to measure the fat area(Fat Area,FA),muscle area(Muscle Area,MA),degree of fat infiltration(Muscle Fat Infiltration,MFI)and total abdominal fat area(Total Fat Area,TFA),intra-abdominal fat area(Visceral Fat Area,VFA),subcutaneous fat area(Subcutaneous Fat Area,SFA)and lumbar bone mineral density(Bone Mineral Density,BMD)of posterior lumbar muscles at the middle level of L3 lumbar vertebrae before and after operation in 64 patients with pancreatic cancer.The changes of body components cFA,cMA,cMFI,cTFA,cVFA,cSFA and cBMD before and after operation were calculated.Independent sample t test or Mann-Whitney U test were used for statistical analysis,multi-factor Logistics regression analysis was used for regression analysis,and ROC curve was used to evaluate the diagnostic efficacy of cachexia in panceatic cancer patients.Results:There were significant differences in cTFA,cVFA,cSFA and cMA before and after treatment between patients with cachexia of pancreatic cancer and those without cachexia,with all P<0.05.The multi-factor Logistics regression diagnosis model takes the patients with cachexia or not as dependent variables,and gender,age and changes in body composition before and after teatment as independent variables.The results showed that cBMD and cSFA were independent risk factors for cachexia in pancreatic cancer patients.Therefore,the Logistics regression diagnosis model for cachexia patients was established as follows:Logit P=-2.069+0.057cBMD+0.100cSFA.The ROC curve is established based on the diagnosis probability of Logistics regression prediction model.The area under the curve was 0.919(95%CI:0.823～0.972).P is the probability value of cachexia,ranging from 0 to 1.The critical value of P(cutoff)is 0.4,the sensitivity is 87.5%,and the specificity is 92.5%.Conclusions:1、The change degree of body components in patients with and without cachexia of pancreatic cancer was in the range of cTFA,cVFA,The changes of cTFA,cVFA,cSFA and cMA were greater in patients with cachexia than in patients without cachexia;2、The model based on quantitative CT measurement of body component changes in patients with pancreatic cancer before and after treatment has high evaluation efficiency and can be used to diagnose patients with cachexia of pancreatic cancer.