体重指数与食管鳞状细胞癌切除术后转归及总生存率关系的研究  

Impact of Body Mass Index on the Outcome and Overall Survival of Patients with Esophageal Squamous Cell Cancer after Surgery

作　　者：罗越魁 王成[2] 孟于琪[2] 郭权威[2] 张建华[2] 

机构地区：[1]兰州大学第二临床医学院,兰州730030 [2]兰州大学第二医院胸外科,兰州730030

出　　处：《中国胸心血管外科临床杂志》2016年第5期467-471,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省自然科学基金(145RJZA137)~~

摘　　要：目的明确食管鳞状细胞癌患者术前的体重指数对围手术期及预后的影响。方法回顾性分析2001年1月至2009年12我院手术治疗503例食管癌患者的临床资料,其中男268例、女235例,中位年龄57(32~88)岁。术前的体重指数和临床病理学特征分析采用χ2检验或者Fisher确切概率算法,生存分析采用Kaplan-Meier曲线获取并进行log-rank检验比较各组生存率差异。结果总体患者的1年、3年、5年和10年的总生存率分别为64.0%、49.0%、43.0%和41.0%;体重下降、淋巴结转移、肿瘤低分化发生率在BMI≤18.5 kg/m^2患者中明显高于BMI>18.5 kg/m^2患者(P=0.026,P=0.006,P=0.048)。Kaplan-Meier生存分析表明:消瘦的食管癌患者术后有生存期缩短的趋势(P=0.001);不同BMI患者的总并发症、吻合口瘘及肺部并发症发生率差异无统计学意义(P=0.162,P=0.590,P=0.376);单变量及多变量分析表明:消瘦、饮酒史及肿瘤分化程度是影响患者预后的独立因素。结论食管癌切除术后的并发症发生率与术前体重指数无关,而低体重患者因确诊时病情较晚,致使预后较正常体重及超重患者差。Objectives To evaluate the effect of preoperative body mass index（BMI） on the perioperative and long-term results in esophageal squamous cell cancer patients.Method We retrospectively analyzed the clinical data of 503 patients with esophageal cancer between January 2001 and December 2009.There were 268 males and 235 females with the median age of 57 years ranging from 32-88 years.The associations between preoperative BMI and clinic pathological characteristics were assessed by using the χ~2 or Fisher＇s exact test.Survival analysis was performed by Kaplan-Meier curves with log-rank tests.Results The 1-year,3-year,5-year,and 10-year overall survival rate for the entire cohort of patients was 64.0%,49.0%,43.0%,and 41.0% respectively.The occurance rates of weight loss,lymph node metastases,and poorly differentiated tumorigenesis represented statistically higher in patients with BMI ≤ 18.5 kg/m^2 than those in the patients with BMI18.5 kg/m^2（P=0.026,P=0.006,P=0.048）.For the cohort,the Kaplan-Meier survival analysis showed a significant trend toward a decreased survival in esophageal cancer patients with underweight（P=0.001）.No statistical difference in overall complication,anastomotic leakage,and pulmonary complication rate was detected among the different BMI classes（P=0.162,P=0.590,P=0.376）.Univariate and multivariate analysis showed that the drinking status,pathological stage,and underweight were the independent prognostic factors.Conclusions After esophagectomy,BMI is not associated with the incidence of postoperative complications in patients.Patients with underweight are usually diagnosed with advanced stage,therefore tend to have poorer survivals than those with normal or over-weight.

关 键 词：食管鳞状细胞癌 体重指数 术后并发症 手术 预后 

分 类 号：R735.1[医药卫生—肿瘤]