Purpose:

Sarcopenia and suboptimal performance status are associated with postoperative complications and morbidity in cancer patients. Prehabilitation has emerged as an approach to improve fitness and muscle strength in patients preoperatively. We sought to describe the frequency of sarcopenia and sarcopenic obesity (SO) in a cohort of cancer patients referred for prehabilitation and the association between body composition and physical function.

Methods:

In this retrospective review of 99 consecutive cancer patients referred for prehabilitation prior to intended oncologic surgery, prehabilitation included physical medicine and rehabilitation (PM&R) physician evaluation of function and physical therapy for individualized home-based exercise. Sarcopenic A was defined using sex-adjusted norms of skeletal muscle (SKM), measured using the sliceOmatic software (TomoVision, 2012) on computed tomography images at baseline. Sarcopenic B was defined by abnormal SKM and physical function. SO was defined as sarcopenia with BMI ≥ 25. Six-minute walk test (6MWT), 5 times sit-to-stand (5×STS), and grip strength were obtained at consultation (baseline) and at preoperative follow-up (if available).

Results:

Forty-nine patients (49%) were Sarcopenic A, 28 (28%) SO, and 38 (38%) Sarcopenic B. Age was negatively correlated with SKM (P = .0436). There were no significant associations between Sarcopenic A/B or SO with baseline or changes in physical function. Assessed by sex, Sarcopenic A females had low 5×STS (P = .04) and Sarcopenic B females had low GS (P = .037). Sarcopenic B males had low preoperative GS (P = .026). 6MWT and grip strength at baseline were lower than age- and sex-related norms (both P < .001). Preoperatively, 6MWT distance and 5×STS time improved (both P < .001). Functional improvement in the sarcopenic and nonsarcopenic patients did not differ according to sex.

Conclusions:

In this cohort of prehabilitation surgical oncology patients, frequencies of sarcopenia and SO were high, and baseline physical function was abnormal but improved significantly regardless of body composition. These findings suggest that patients have considerable prehabilitation needs and are capable of improving with comprehensive care.

中文翻译：

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转诊接受康复治疗的外科肿瘤患者的肌肉减少症、肌肉减少性肥胖症和身体功能变化的频率

目的：

肌肉减少症和次优的体能状态与癌症患者的术后并发症和发病率有关。康复训练已成为术前改善患者体能和肌肉力量的一种方法。我们试图描述一组癌症患者的肌肉减少症和肌肉减少性肥胖 (SO) 的频率，以及身体成分和身体功能之间的关联。

方法：

在对 99 名连续癌症患者进行预期肿瘤手术之前转诊进行康复的回顾性研究中，康复包括物理医学和康复 (PM&R) 医师对功能的评估和针对个性化家庭运动的物理治疗。肌肉减少症 A 使用经性别调整的骨骼肌规范 (SKM) 定义，使用 sliceOmatic 软件 (TomoVision, 2012) 对基线的计算机断层扫描图像进行测量。肌肉减少症 B 定义为 SKM 和身体机能异常。SO 定义为 BMI ≥ 25 的肌肉减少症。 在咨询（基线）和术前随访（如果可用的）。

结果：

49 名患者 (49%) 为肌肉减少症 A、28 名 (28%) SO 和 38 (38%) 名肌肉减少症 B。年龄与 SKM 呈负相关 ( P  = .0436)。肌肉减少症 A/B 或 SO 与基线或身体机能变化之间没有显着关联。按性别评估，肌肉减少症 A 女性的 5×STS 较低 ( P  = .04)，肌肉减少症 B 女性的 GS 较低 ( P  = .037)。肌肉减少症 B 男性术前 GS 较低 ( P  = .026)。基线时的 6MWT 和握力低于与年龄和性别相关的规范（均P  < .001）。术前 6MWT 距离和 5×STS 时间有所改善（均P  < .001）。肌肉减少症和非肌肉减少症患者的功能改善不因性别而异。

结论：

在这个康复外科肿瘤患者队列中，肌肉减少症和 SO 的频率很高，基线身体功能异常但无论身体成分如何都显着改善。这些发现表明，患者有相当大的康复需求，并且能够通过综合护理来改善。