Computed tomography-measured body composition: correlation with postoperative morbidity and mortality in patients with gastroesophageal cancer

Abstract Objective: To determine whether preoperative anthropometric and computed tomography (CT) measurements of body composition can predict postoperative morbidity and mortality in patients with gastric or esophageal cancer. Materials and Methods: This was a retrospective study in which we reviewed the medical records and abdominal CT scans of patients with gastric or esophageal cancer who underwent surgery in 2015 at a cancer center. CT scans performed during routine preoperative evaluation were retrospectively assessed to measure the area of lean body mass at the level of the third lumbar vertebra, as well as the area of visceral and subcutaneous fat. Results: Seventy patients were included in the study. The mean age was 59.9 years (range, 33-82 years), and 47 patients (67.1%) were men. The mean postoperative follow-up period was 14.9 months. Neither postoperative morbidity nor postoperative mortality correlated significantly with gender, age, the type of primary tumor, the presence of comorbidities, smoking status, body mass index, nutritional status, or visceral fat area. The survival rate was higher for patients with normal lean body mass than for those with low lean body mass (hazard ratio = 0.116; 95% confidence interval: 0.015-0.906; p = 0.040). Conclusion: Our data suggest that lean body mass can be a relevant prognostic factor in patients with gastric or esophageal cancer, and that CT measurements should be included in the routine preoperative evaluation, because it may provide information that aids nutritional and clinical care for these patients.

**摘要**
**研究目的**：明确术前人体测量学与计算机断层扫描（computed tomography, CT）测得的身体成分指标，能否预测胃或食管癌患者的术后并发症发生率与死亡率。
**材料与方法**：本研究为回顾性研究，回顾了某癌症中心2015年接受手术治疗的胃或食管癌患者的病历与腹部CT扫描资料。对术前常规评估时完成的CT扫描进行回顾性分析，测量第三腰椎水平的瘦体重（lean body mass）面积，以及内脏脂肪与皮下脂肪面积。
**结果**：本研究共纳入70例患者，平均年龄为59.9岁（范围：33~82岁），其中男性47例（占比67.1%）；术后平均随访时长为14.9个月。术后并发症发生率与术后死亡率均未与患者性别、年龄、原发肿瘤类型、合并症情况、吸烟史、体重指数（body mass index, BMI）、营养状况及内脏脂肪面积呈现显著相关性。瘦体重正常患者的生存率高于瘦体重偏低患者（风险比（hazard ratio, HR）=0.116；95%置信区间（confidence interval, CI）：0.015~0.906；p=0.040）。
**结论**：本研究数据表明，瘦体重可作为胃或食管癌患者的有效预后因素，CT测量结果应纳入术前常规评估流程，因其可为此类患者的营养管理与临床诊疗提供参考依据。