根据亚洲恶病质工作组2023年标准诊断的胃肠恶性肿瘤恶病质病人术后临床结局分析  

Clinical outcomes of gastrointestinal cancer patients diagnoseddiagnosed with cachexia based on cachexia diagnostic criteria released by Asian Working Group for Cachexia in 2023

作　　者：张知格 严明月 奚秋磊[1] 谈善军[1] 吴国豪[1] ZHANG Zhi-ge;YAN Ming-yue;XI Qiu-lei(Department of General Surgery Gastrointestinal Surgery/Shanghai Clinical Nutrition Research Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院普通外科胃肠外科,上海市临床营养研究中心,上海200032

出　　处：《中国实用外科杂志》2024年第2期190-193,198,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.2373412);上海市“医苑新星”青年医学人才培养资助计划项目(No.沪卫人事[2022]65号);复旦大学附属中山医院优秀青年人才计划项目(No.2021ZSYQ14);复旦大学附属中山医院临床研究专项基金项目(No.2020ZSLC17,No.2020ZSLC53)。

摘　　要：目的分析亚洲恶病质工作组(AWGC)2023年发布的恶病质新诊断标准(以下简称AWGC 2023标准)诊断的胃肠恶性肿瘤恶病质病人术后短期和长期临床结局。方法回顾性分析2020年1月至2021年1月在复旦大学附属中山医院因胃肠恶性肿瘤接受手术治疗的641例病人资料,根据AWGC 2023标准将病人分为恶病质组(125例)和非恶病质组(516例)。比较两组病人术前营养状态,以及术后短期和长期临床结局的差异。结果与非恶病质组比较,恶病质组病人术前营养不良发生率显著增加(P<0.05),体重指数、骨骼肌指数、白蛋白以及前白蛋白显著降低(P<0.05),C-反应蛋白、白介素-6(IL-6)显著升高(P<0.05),体重、握力、转铁蛋白差异无统计学意义(P>0.05)。与非恶病质组比较,恶病质组病人术后并发症发生率显著增加(25.6%vs.16.9%,χ^(2)=5.084,P=0.024),术后住院时间和30 d再入院率差异无统计学意义(P>0.05)。长期随访显示,恶病质组病人无复发转移生存率(65.6%vs.78.7%,χ^(2)=9.477,P=0.002)与总体生存率(76.0%vs.87.2%,χ^(2)=9.929,P=0.002)均低于非恶病质组。结论根据AWGC 2023标准诊断的胃肠恶性肿瘤恶病质病人术前营养状态差,术后并发症发生风险高,预后差。Objective To analyze the short-term and long-term clinical outcomes of r gastrointestinal cancer patients diagnosed with cachexia based on dcachexia diagnostic criteria released by the Asian Working Group for Cachexia(AWGC) in 2023(in brief AWGC 2023 criteria).Methods Clinical data of 641 surgical patients with gastrointestinal cancer from November 2020 to November 2021 were retrospectively collected.Enrolled patients were assigned to the cachexia group(125 patients) and non-cachexia group(516 patients) based on AWGC 2023 criteria.The preoperative nutrition status follow-up data of both groups were compared.Results Compared with a non-cachexia group,patients in the cachexia group presented a higher rate of malnutrition(P<0.05) and a significant decrease in body mass index,skeletal mass index,albumin,pre-albumin(P<0.05),and a higher level of C-reactive protein and interleukin-6(P<0.05).There is no significant difference in weight,grip,and serum level of transferrin between the two groups(P>0.05).Compared with a non-cachexia group,patients in the cachexia group presented a higher level of postoperative complication rate(25.6% vs.16.9% χ^(2)=5.084 P=0.024),but there were no significant differences in postoperative hospital stay and 30 days readmission rate(P>0.05).Long-term follow-up results showed that the recurrence and free free free-metastasis-free survival(65.6% vs.78.7%,χ^(2)=9.477 P=0.002) and overall survival(76.0% vs.87.2%,χ^(2)=9.929 P=0.002) were lower in the cachexia group than in the non-cachexia group.Conclusion Gastrointestinal cancer patients diagnosed with cachexia based on AWGC 2023 criteria presented poorer preoperative nutrition status,higher complication rate,and worse prognosis.

关 键 词：胃肠恶性肿瘤 癌性恶病质 诊断标准 营养不良 

分 类 号：R6[医药卫生—外科学]