诊断前后体质指数与结直肠癌患者死亡风险关系的前瞻性队列研究  

Pre-and post-diagnosis body mass index in association with colorectal cancer death in a prospective cohort study

作　　者：李泓澜[1] 方婕[1] 吴春晓[2] 高立峰[1] 谭玉婷[1] 顾凯[2] 施燕[3] 项永兵[1] Li Honglan;Fang Jie;Wu Chunxiao;Gao Lifeng;Tan Yuting;Gu Kai;Shi Yan;Xiang Yongbing(State Key Laboratory of Oncogenes and Related Genes and Department of Epidemiology,Shanghai Cancer Institute,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200032,China;Department of Cancer Control and Prevention,Division of Noncommunicable Diseases and Injury,Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China;Division of Noncommunicable Diseases and Injury,Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]上海交通大学医学院附属仁济医院上海市肿瘤研究所癌基因及相关基因国家重点实验室和流行病学研究室,上海200032 [2]上海市疾病预防控制中心慢性非传染病与伤害防治所肿瘤防治科,上海200336 [3]上海市疾病预防控制中心慢性非传染病与伤害防治所,上海200336

出　　处：《中华肿瘤杂志》2023年第8期657-665,共9页Chinese Journal of Oncology

基　　金：国家重点研发计划(2021YFC2500404、2021YFC2500405);上海市卫生和计划生育委员会卫生行业临床研究专项(201840068)。

摘　　要：目的探讨结直肠癌诊断前后体质指数(BMI)与死亡风险的关系。方法利用上海市区2009年1月1日至2011年12月31日诊断的、年龄为20~74岁的3057例结直肠癌病例队列,通过基线调查收集诊断前后BMI、临床和生活方式等相关信息。采取与上海市肿瘤登记部门记录联动和电话随访相结合的方式确定死亡信息,随访截止时间为2019年12月31日。采用Cox比例回归风险模型计算HR和95%CI。结果多因素Cox回归分析显示,在男、女性结直肠癌患者中诊断前BMI均与死亡风险无关。男性结直肠癌患者诊断后消瘦组较正常组死亡风险增加(HR=1.69,95%CI:1.21~2.37),尤其是早期患者;超重和Ⅰ级肥胖组患者的死亡风险较正常组下降,HR分别为0.74(95%CI:0.61~0.89)和0.63(95%CI:0.45~0.89),主要出现在晚期患者中;Ⅱ级肥胖组死亡风险的下降未达到显著性水平(HR=0.57,95%CI:0.24~1.39)。在女性结直肠癌患者中,随诊断后BMI增加死亡风险降低的趋势检验有统计学意义(均P<0.001),在晚期患者中超重和Ⅰ级肥胖组死亡风险降低(HR超重=0.62,95%CI:0.42~0.93;HRⅠ级肥胖=0.39,95%CI:0.16~0.98)。与诊断前后BMI稳定者(增减≤1.0 kg/m^(2))比较,男、女性结直肠癌患者诊断后BMI减少>2.0 kg/m^(2)者,死亡风险均增加;而诊断后BMI增加均不会改变死亡风险。结论男性结直肠癌患者诊断后超重及Ⅰ级肥胖状态可能有利于延长其生存时间,而消瘦则不利于其预后。建议男、女性结直肠癌患者诊断后应尽可能维持原有的体重,避免体重下降过多。Objective To evaluate the association between pre-and post-diagnosis body mass index(BMI)and risk of colorectal cancer(CRC)death.Methods The cohort consisted of 3,057 CRC patients from Shanghai who were diagnosed from Jan.1,2009 to Dec.31,2011 and aged from 20 to 74 years.The pre-and post-diagnosis BMI and clinical and lifestyle factors were collected at baseline.Death information was collected using record linkage with the Shanghai Cancer Registry and telephone confirmation during follow-up by the end of 2019.The Cox proportional regression model was used to estimate HR with 95%CI.Results Analysis by multivariable Cox model showed no association between pre-diagnosis BMI and death risk in both male and female patients.Male patients with a post-diagnosis underweight BMI had an elevated risk of death compared to those in normal weight(HR=1.69,95%CI:1.21-2.37),especially in early stage cases.Overweight patients(HR=0.74,95%CI:0.61-0.89)and patients with obesity classⅠ(HR=0.63,95%CI:0.45-0.89)had better survival with decreased risks of death,especially in advanced stage cases.The decreased death risk in patients with obesity classⅡwas not significant(HR=0.57,95%CI:0.24-1.39).The Ptrend value for decreased risk of death with increased BMI in female patients was statistically significant(P<0.001),and the overweight and obesity classⅠcategories had better survival in advanced stage(HRoverweight=0.62,95%CI:0.42-0.93;HRobesity classⅠ=0.39,95%CI:0.16-0.98).Both male and female patients with post-diagnosis BMI loss>2.0 kg/m^(2) had an increased death risk when compared with those with stable BMI(change≤1.0 kg/m^(2))between pre-and post-diagnosis.BMI gain after diagnosis did not change death risk.Conclusions Post-diagnosis BMI in the overweight or obesity classⅠgroups might be conducive to prolonging male CRC patients′survival,while underweight might result in poor prognosis.Keeping weight and avoiding excessive weight loss should be suggested for all CRC patients after diagnosis.

关 键 词：结直肠肿瘤 体质指数 死亡 队列研究 

分 类 号：R735.34[医药卫生—肿瘤]