恶病质指数对SiewertⅡ型食管胃交界部腺癌患者术后主要并发症及住院费用的影响  

Effect of cachexia index on major postoperative complications and hospitalization costs in patients with Siewert type II adenocarcinoma of esophagogastric junction

作　　者：张辽 王成[1] 冯泽伟 周芝森 郑世铭 班冰冰 张勐 ZHANG Liao;WANG Cheng;FENG Zewei;ZHOU Zhisen;ZHENG Shiming;BAN Bingbing;ZHANG Meng(Department of Thoracic Surgery,the Second Hospital of Lanzhou University,the Second Clinical College of Lanzhou University,Gansu Lanzhou 730030,China)

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

出　　处：《现代肿瘤医学》2023年第24期4561-4567,共7页Journal of Modern Oncology

基　　金：甘肃省自然科学基金资助项目(编号:21JR7RA405);兰州大学第二医院“萃英科技创新”计划(编号:CY2020-MS11)。

摘　　要：目的:评估恶病质指数(cachexia index,CXI)对SiewertⅡ型食管胃交界部腺癌患者术后主要并发症及住院费用的影响。方法:回顾性收集2018年10月至2023年03月我院收治的符合纳入排除标准的586例SiewertⅡ型食管胃交界部腺癌患者的临床资料,结合第三腰椎骨骼肌面积、术前白蛋白和中性粒细胞-淋巴细胞比值,计算CXI。根据主要并发症ROC曲线和Youden指数确定临界值,将患者分为高CXI组和低CXI组,分析两组患者临床资料。采用单因素和多因素logistic回归分析SiewertⅡ型食管胃交界部腺癌患者主要并发症(Clavien-Dindo分级≥III级)和住院费用增加的独立危险因素。结果:低CXI组主要并发症发生率更高(10.1%vs 2.1%,P<0.001);术后住院时间更长[(14.21±8.22)d vs(12.55±5.09)d,P=0.003];住院费用更高[(78286.42±32118.59)元vs(69804.38±16654.53)元,P<0.001]。多因素logistic回归分析中,CXI(OR=4.903,95%CI:1.974~12.176,P<0.001)和恶病质(OR=4.636,95%CI:1.823~11.790,P=0.001)是主要并发症的独立危险因素;NLR(OR=1.916,95%CI:1.040~3.529,P=0.037)、恶病质(OR=1.620,95%CI:1.115~2.354,P=0.011)、贫血(OR=2.129,95%CI:1.289~3.516,P=0.003)、慢阻肺(OR=3.505,95%CI:1.321~9.300,P=0.012)和主要并发症(OR=21.121,95%CI:6.168~72.322,P<0.001)是住院费用增加的独立危险因素。结论:低CXI预示着SiewertⅡ型食管胃交界部腺癌患者术后主要并发症风险增加,住院费用升高。建议术前计算恶病质指数,并以此作为评估患者术后主要并发症及住院费用的重要指标。Objective:To evaluate the effect of cachexia index(CXI)on major postoperative complications and hospitalization costs in patients with Siewert type II adenocarcinoma of the esophagogastric junction.Methods:The clinical data of 586 patients with Siewert typeⅡadenocarcinoma of esophagogastric junction admitted to our hospital were retrospectively collected from October 2018 to March 2023.The CXI was calculated by combining the skeletal muscle area of the third lumbar spine,preoperative albumin and neutrophil-lymphocyte ratio.The critical value was determined according to the ROC curve and Youden index of the main complications.The patients were divided into high CXI group and low CXI group.The clinical data of the two groups was analyzed.Univariate and multivariate logistic regression were used to analyze the independent risk factors for major complications(Clavien-Dindo grade≥III)and increased hospitalization costs in patients with Siewert type II adenocarcinoma of the esophagogastric junction.Results:The incidence of major complications was higher in the low CXI group(10.1%vs 2.1%,P<0.001).Postoperative hospital stay was longer[(14.21±8.22)d vs(12.55±5.09)d,P=0.003].The hospitalization cost was higher[(78286.42±32118.59)yuan vs(69804.38±16654.53)yuan,P<0.001].In multivariate logistic regression analysis,CXI(OR=4.903,95%CI:1.974~12.176,P<0.001)and cachexia(OR=4.636,95%CI:1.823~11.790,P=0.001)were independent risk factors for major complications.NLR(OR=1.916,95%CI:1.040~3.529,P=0.037),cachexia(OR=1.620,95%CI:1.115~2.354,P=0.011),anemia(OR=2.219,95%CI:1.289~3.516,P=0.003),chronic obstructive pulmonary disease(OR=3.505,95%CI:1.321~9.300,P=0.012)and major complications(OR=21.121,95%CI:6.168~72.322,P<0.001)were independent risk factors for increased hospitalization expenses.Conclusion:Low CXI predicts an increased risk of major postoperative complications and increased hospitalization costs in patients with Siewert type II adenocarcinoma of the esophagogastric junction.It is recommended to calculate the cachexi

关 键 词：SiewertⅡ型食管胃交界部腺癌 恶病质指数 恶病质 主要并发症 住院费用 

分 类 号：R735[医药卫生—肿瘤]