术前肌肉脂肪变性联合白蛋白–球蛋白评分对根治性术后胆管癌患者预后的预测价值

Prognostic Value of Preoperative Myosteatosis Combined with Albumin-Globulin Score in Patients with Cholangiocarcinoma after Radical Surgery

摘要: 背景与目的：肌肉脂肪变性与多种恶性肿瘤的不良预后相关。术前白蛋白与球蛋白联合得到的白蛋白–球蛋白评分(AGS)，可预测食管癌、肺癌等恶性肿瘤的预后。本研究旨在探索术前肌肉脂肪变性联合白蛋白–球蛋白评分对胆管癌根治性切除患者的预测价值。方法：回顾性纳入2017年1月至2022年3月在青岛大学附属医院接受根治性切除手术的155例胆管癌患者。收集患者的血清学及影像学资料，采用Slice-O-Matic软件进行身体成分分析，Kaplan-Meier方法进行生存分析，Cox回归分析与患者总生存期和无复发生存期相关的风险因素。结果：本研究共纳入82例肌肉脂肪变性，73例非肌肉脂肪变性患者。Kaplan-Meier曲线显示肌肉脂肪变性与总生存期和无复发生存期相关(P = 0.022和P = 0.017)，高AGS组患者的总生存期和无复发生存期明显短于低AGS组患者(P = 0.015和P = 0.009)。同时存在高AGS和肌肉脂肪变性的患者生存期和无复发生存期最短(P = 0.005和P = 0.002)。结论：本研究表明，对于接受根治性切除手术的胆管细胞癌患者，术前存在肌肉脂肪变性且高白蛋白–球蛋白评分时，预后最差。以上提示临床医生尽早开展营养支持以及干预肌肉衰减的治疗。

Abstract: Background and Purpose: Myosteatosis is associated with poor prognosis of various malignancies. The albumin-globulin score (AGS) obtained by the combination of albumin and globulin before op-eration can predict the prognosis of malignant tumors such as esophageal cancer and lung cancer. The objective of this study was to explore the predictive value of preoperative myosteatosis com-bined with albumin-globulin score in patients undergoing radical cholangiocarcinoma resection. Methods: A total of 155 patients with cholangiocarcinoma who underwent radical resection in the Affiliated Hospital of Qingdao University from January 2017 to March 2022 were retrospectively in-cluded. Serological and imaging data of the patients were collected. Slice-O-Matic software was used for body composition analysis, Kaplan-Meier method for survival analysis, and Cox regression anal-ysis was performed to analyze the risk factors associated with overall survival and relapse-free sur-vival of the patients. Results: A total of 82 patients with myosteatosis and 73 patients with non-myosteatosis were included in this study. Kaplan-Meier curve showed that myosteatosis was correlated with overall survival and relapse-free survival (P = 0.022 and P = 0.017), and the overall survival and relapse-free survival of patients with high AGS were significantly shorter than those in patients with low AGS (P = 0.015 and P = 0.009). Patients with both high AGS and myosteatosis had the shortest survival and relapse-free survival (P = 0.005 and P = 0.002). Conclusions: This study showed that patients with cholangiocarcinoma who underwent radical resection had the worst prognosis when myosteatosis and high albumin-globulin score were present before surgery. These results suggest that clinicians should start nutritional support and intervention therapy for muscle decay as early as possible.