体质量指数对胃癌根治术病人远期预后的影响  

Effect of body mass index on long-term prognosis of radical gastrectomy

作　　者：陈杰[1,2] 李政焰 季刚 王士祺[1] 白槟[1] 赵青川[1] Chen Jie;Li Zhengyan;Ji Gang;Wang Shiqi;Bai Bing;Zhao Qingchuan(Department of Digestive Surgery,National Clinical Research Center for Digestive Diseases,Xijing Hospital of Digestive Diseases,Fourth Military Medical University,Shaaxi Xi'an 710032,China;Tibet Autonomous Region Nyingchi People's Liberation Army 77675 Troops 50th Team,Xizang Linzhi 860000,China)

机构地区：[1]第四军医大学西京消化病医院消化外科国家消化系统疾病临床医学研究中心,陕西西安710032 [2]中国人民解放军77675部队50分队,西藏林芝860000

出　　处：《腹部外科》2019年第4期239-245,共7页Journal of Abdominal Surgery

基　　金：国家重点研发计划(2017YFC1311002,2017YFC1311004);陕西省重点研发计划(2017ZDXM-SF-053)

摘　　要：目的评价病人术前体质量指数(body mass index,BMI)对胃癌根治术后远期生存情况的影响.方法回顾性收集2009年6月至2013年7月于第四军医大学西京消化病医院行胃癌根治术1 973例病人的临床资料,按照2003版卫生部疾控司中国肥胖问题工作组编写的《中国成人超重和肥胖症预防控制指南(试行)》标准分为体重过低组(BMI<18.5 kg/m^2 ),体重正常组(18.5 kg/m^2 ≤BMI<24 kg/m^2 ),超重组(24 kg/m^ 2 ≤BMI<28 kg/m^2 ),肥胖组(BMI≥28 kg/m^2 ).采用Cox比例风险回归模型计算影响胃癌病人生存率危险因素的风险比( HR )以及置信区间(CI).结果共有1 973例病人纳入研究,体重过低组190例(9.6 %),体重正常组1 205例(61.1%),超重组490例(24.8%),肥胖组88例(4.5%).单因素分析显示:BMI、肿瘤长径、TNM分期与远期预后有关(P <0.05),4组病人中肿瘤长径分别为:体重过低组(5.01± 2.451 ) cm、体重正常组(4.51± 2.326 ) cm、超重组(4.41±2.271) cm、肥胖组(4.16±2.178) cm (F = 3.883 , P <0.01).生存分析显示,体重过低组、体重正常组、超重组、肥胖组病人的5年总生存率分别为 37.9%、60.7%、61.6%、 71.6%,体重过低组5年总生存率明显低于其他3组( P <0.05),其余3组间两两比较差异无统计学意义( P >0.05),5年肿瘤无进展生存比较结果与总生存比较结果相同.结论术前低BMI是胃癌病人远期预后不良的独立危险因素,即使相同的TNM分期亦有此规律.低BMI病人围手术期应予以充分营养支持以改善病人远期预后.Objective To evaluate the effect of preoperative body mass index (BMI) on the long-term survival of patients after radical gastrectomy. Methods The clinical data of 1973 patients who underwent radical gastrectomy in the Xijing Hospital of Digestive Diseases from June 2009 to July 2013 were retrospectively analyzed. Patients were divided into 4 groups:underweight group(BMI< 18.5 kg/m^2 ),normal weight group (18.5 kg/m^2 ≤BMI<24.0 kg/m^2 ),overweight group(24 kg/m^2 ≤BMI< 28 kg/m^2 ) and obesity group(BMI≥28 kg/m^2 ) according to the "Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults (Trial)". Hazard ratios ( HR ) and con dence interval( CI )for the factors affecting overall survival (OS) were calculated using Cox proportional hazard regression models. Results A total of 1 973 patients were enrolled in the study,190 (9.6%) in the underweight group,1 205 (61.1%) in the normal weight group,490 (24.8%) in the overweight group,and 88 (4.5%) in the obese group. Univariate analysis showed that BMI,tumor length and TNM stage were related to long-term prognosis ( P <0.05). Among the four groups of BMI patients,tumor length was 5.01±2.451 cm in underweight group,4.51±2.326 cm in normal weight group, 4.41 ±2.271 cm in overweight group and 4.16±2.178 cm in obese group ( F =3.883, P <0.01). Survival analysis showed that the 5-year overall survival rates of underweight group,normal weight group,overweight group and obese group were 37.9%,60.7%,61.6% and 71.6%,respectively. The 5-year overall survival rate of underweight group was significantly lower than that of the other three groups ( P <0.05). There was no significant difference between the other three groups ( P >0.05). The 5-year tumor progression-free survival comparison results were the same as the overall survival comparison results. Conclusion Low preoperative BMI is an independent risk factor for poor long-term prognosis in patients with gastric cancer,even with the same TNM stage. Patients with low BMI should receive adequate

关 键 词：胃癌 体质量指数 胃切除术 远期预后 

分 类 号：R619[医药卫生—外科学]