腹部内脏脂肪与皮下脂肪面积比对根治性胃癌切除术男性患者预后诊断价值  

Value of the ratio of abdominal visceral fat area to subcutaneous fat area for the prognosis of 195 patients undergoing radical gastrectomy after gastric cancer

作　　者：王子君 吴云桦 沈聪 申田力 魏光兵[1] 樊林[1] 李徐奇[1] WANG Zi-jun;WU Yun-hua;SHEN Cong;SHEN Tian-li;WEI Guang-bing;FAN Lin;LI Xu-qi(First Affiliated Hospital of Xi’an Jiaotong University,Xi'an 710061,China;Department of General Surgery,Shaanxi Provincial People’s Hospital,Xi'an 710068,China)

机构地区：[1]西安交通大学第一附属医院普通外科,陕西西安710061 [2]陕西省人民医院普通外科,陕西西安710061 [3]西安交通大学第一附属医院影像科,陕西西安710068

出　　处：《中华肿瘤防治杂志》2022年第7期516-522,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81970456);陕西省重点研发计划(2019SF-052)。

摘　　要：目的探讨腹部内脏脂肪面积(VFA)与皮下脂肪面积(SFA)的比值(VFA/SFA)对根治性胃癌切除术患者预后诊断的价值。方法回顾性分析2016-01-01-2017-12-31于西安交通大学第一附属医院普通外科确诊为胃癌并行根治性胃癌切除术的195例患者临床资料,所有患者均需术前行腹部CT扫描且术后随访资料完整。CT扫描获得的图像采用Slice-O-Matic,根据密度(-29~150 HU)及肌肉位置图像特征得到第3腰椎层面所有VFA和SFA。通过受试者工作特征(ROC)曲线评估VFA/SFA对男、女性根治性胃癌切除术患者预后诊断的价值,并得到其阳性判断值(cutoff值),根据cutoff值所对应的VFA/SFA将男性患者分为高VFA/SFA组(42例)和低VFA/SFA组(103例),比较2组患者一般资料、术后病理资料、手术资料和术后近期疗效。结果全部胃癌根治术患者、男性和女性患者的ROC曲线发现,仅有男性胃癌患者预后与VFA/SFA有关,且cutoff值为0.292,与其对应的灵敏度为73.0%,特异度为56.2%,VFA/SFA为1.046。遂将男性患者分为2组,且2组患者一般资料差异无统计学意义,P>0.05。男性高VFA/SFA组肿瘤脉管癌栓浸润更高(χ^(2)=4.398,P=0.036)。手术资料对比发现,高VFA/SFA组患者手术时间较低VFA/SFA组较长[(223.57±67.34)min vs(261.71±60.56)min],t=-3.182,P=0.002;高VFA/SFA组患者出血量较低VFA/SFA组多[(100.00±66.03)mL vs(200.00±66.10)mL],P=0.026;高VFA/SFA组患者淋巴结清除数目较低VFA/SFA组少[(29.28±13.77)个vs(23.32±11.81)个],t=-0.141,P=0.002;但手术方式、术后有无输血、术后排气时间、术后排便时间、首次进食时间和手术并发症差异均无统计学意义,均P>0.05。Cox回归单因素及多因素分析发现,肿瘤N分期(OR=2.793,95%CI:1.380~5.654,P=0.004)及VFA/SFA(OR=2.683,95%CI:1.544~4.600,P<0.001)是男性胃癌患者预后的独立危险因素。结论VFA/SFA是男性胃癌患者预后的独立危险因素,可作为根治性胃癌切除术后男性患者预后评估Objective To investigate the value of the ratio of abdominal visceral fat area(VFA)to subcutaneous fat area(SFA)in the prognostic diagnosis of patients undergoing radical gastrectomy.Methods We respectively collected patients who were diagnosed with gastric cancer and underwent radical gastrectomy in the Department of General Surgery of the First Affiliated Hospital of Xi’an Jiaotong University during January 1,2016 to December 31,2017.The abdominal visceral fat area(VFA)and subcutaneous fat area(SFA)were measured by CT before operation and all patients received postoperative follow-up.Slice O-Matic software was used to obtain the VFA and the abdominal SFA at the third lumbar level according to the density(-29HU-150HU)and muscle position image features.ROC curve was used to evaluate the correlation between the ratio of abdominal VFA to SFA and the prognosis radical gastrectomy for male and female patients to get the positive judgment value or cutoff value.According the cutoff value,patients were divided into high VFA/SFA groups(42cases)and low VFA/SFA groups(103cases).The general data,postoperative pathological data,surgical data and short-term postoperative efficacy of the two groups were compared.Results ROC curves of all radical gastrectomy patients,male patients and female patients found that the ratio of the VFA to SFA was related to the prognostic diagnosis in the male patients(P<0.05),and the cutoff value was 0.292.The sensitivity and specificity corresponding to the cutoff value were 73.0%and 56.2%,respectively.The VFA/SFA value corresponding to the cutoff value was 1.046.Male patients were divided into two group,103patients in VFA/SFA high group and 42patients in VFA/SFA low group.There was no statistical difference in the patients’baseline data between the two groups(P>0.05).Pathological data showed that high VFA/SFA was accompanied by high degree of microvascular tumor infiltration(χ^(2)=4.398,P=0.036).Comparison of intraoperative data showed that the operation time of male patients in the high VF

关 键 词：腹部内脏脂肪面积 腹部皮下脂肪面积 比值 根治性胃癌切除术 预后 

分 类 号：R735.2[医药卫生—肿瘤]