体质量指数和性别交互作用对晚期胃癌免疫治疗后生存的影响  

The effect of interaction between body mass index and gender on the survival of advanced gastric cancer after immunotherapy

作　　者：陈涛[1] 谭昕 李风萍[1] 赵丽瑛[1] 李国新[2] 刘浩[1] Chen Tao;Tan Xin;Li Fengping;Zhao Liying;Li Guoxin;Liu Hao(Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor,Guangzhou 510515,China;Department of Cancer Center,Beijing Tsinghua Changgung Hospital Affiliated to Tinghua University,Beijing 102218,China)

机构地区：[1]南方医科大学南方医院普通外科广东省胃肠肿瘤精准微创诊疗重点实验室,广州510515 [2]清华大学附属北京清华长庚医院肿瘤中心,北京102218

出　　处：《中华消化外科杂志》2025年第3期374-381,共8页Chinese Journal of Digestive Surgery

基　　金：广东省重点领域研发计划项目(2023B1111050009)。

摘　　要：目的探讨体质量指数(BMI)和性别交互作用对晚期胃癌免疫治疗后生存的影响。方法采用回顾性队列研究方法。收集2019年11月至2023年10月南方医科大学南方医院收治的317例晚期胃癌患者的临床病理资料;男205例,女112例;年龄为56(21~79)岁。317例患者根据BMI分为3组,58例BMI<18.5 kg/m^(2)设为低体质量组,183例BMI为18.5~24.0 kg/m^(2)设为正常体质量组,76例BMI>24.0 kg/m^(2)设为超重或肥胖组。根据患者具体情况采用基于程序性死亡受体配体1(PD-L1)的免疫联合化疗方案实施3个周期治疗,经评估疗效后再决定是否行根治性手术或继续综合治疗。观察指标:(1)患者临床病理特征。(2)随访和患者死亡情况。(3)影响晚期胃癌患者行免疫治疗后生存的因素分析。正态分布的计量资料多组间比较采用方差分析。偏态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料多组间比较采用χ^(2)检验。采用Cox比例风险模型进行单因素和多因素分析。采用限制性立方样条(RCS)曲线分析非线性趋势,采用rcssci程序包(V1.0)制作趋势图和校正图形。结果(1)患者临床病理特征。3组患者性别、年龄、Borrmann分型、Lauren分型、PD-L1联合阳性分数、人表皮生长因子受体-2表达、爱泼斯坦-巴尔病毒感染、癌胚抗原、CA19-9、CA72-4、甲胎蛋白、转化手术比较,差异均无统计学意义(P>0.05);错配修复+微卫星稳定检查比较,差异有统计学意义(P<0.05)。(2)随访和患者死亡情况。317例患者中,316例完成随访,1例超重或肥胖组患者失访,随访时间为13.8(0.9~48.2)个月。随访期间,低体质量组、正常体质量组、超重或肥胖组患者死亡例数分别为27、70、31例。(3)影响晚期胃癌患者行免疫治疗后生存的因素分析。多因素分析结果显示:性别、BMI均是晚期胃癌行免疫治疗后生存的独立影响因素(风险比=0.066、0.922,95%可信区间为0.005~0.846Objective To investigate the effect of interaction between body mass index(BMI)and gender on the survival of advanced gastric cancer after immunotherapy.Methods The retrospective cohort study was conducted.The clinicopathological data of 317 patients with advanced gastric cancer who were admitted to the Nanfang Hospital,Southern Medical University from November 2019 to October 2023 were collected.There were 205 males and 112 females,aged 56(range,21−79)years.All 317 patients were divided into three groups based on BMI of patients,including 58 cases with BMI<18.5 kg/m^(2)were classified as the low body mass group,183 cases with BMI 18.5−24.0 kg/m^(2)were classified as the normal body mass group,and 76 cases with BMI>24.0 kg/m^(2)were classified as the overweight or obese group.Patients included in the study were treated with a programmed death-ligand 1(PD-L1)based immunotherapy regimen for 3 cycles based on their specific conditions,and further decision was made whether to undergo radical surgery or continue comprehensive treatment after evaluating the efficacy.Observation indicators:(1)clinicopathological characteristics of patients;(2)follow-up and mortality status;(3)analysis of factors affecting survival of patients with advanced gastric cancer after immunotherapy.Comparison of measurement data with normal distribution among groups was conducted using the ANOVA.Comparison of measurement data with skewed distribution among groups was conducted using the Kruskal-Wallis H test.Comparison of count data among groups was conducted using the chi‑square test.The Cox proportional hazard model was used for univariate and multivariate analyses.Nonlinear trend was analyzed using the restricted cubic spline(RCS)curve,and trend and correction graphs were created using the rcssci package(v1.0).Results(1)Clinicopathological characteristics of patients.There was no significant difference in gender,age,Borrmann classification,Lauren classification,combined positive score of PD-L1,expression of human epidermal growth facto

关 键 词：胃肿瘤 晚期 免疫治疗 预后 体质量指数 性别 限制性立方样条曲线 

分 类 号：R735.2[医药卫生—肿瘤]