体重指数与胃癌患者胃切除术术后生存质量的相关性研究
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摘要
目的初步探讨体重指数与胃癌患者胃切除术术后生存质量的相关性。方法选取该院行胃切除术的早期胃癌患者且符合研究要求的950例病例资料进行回顾性分析,根据患者于术前或术后1年的体重指数(BMI),分别将其分为:低体重组、正常体重组和高体重组。采集患者的年龄、性别、术前到术后1年的BMI、手术类型、胃根治性切除术类型、病理分期和组织学分型。并通过电话随访了解所有患者术后1年的生存情况,计算总生存率和无复发生存率。结果 3组患者的年龄分布、手术类型、胃根治切除术类型、病理分期及组织学分型比较,差异有统计学意义(P<0.05),高体重组术前不同BMI的总生存率高于低体重组和正常体重组,差异有统计学意义(P<0.05)。3组术后1年不同BMI的总生存率和无复发生存率比较,差异具有统计学意义(P<0.05),高体重组>正常体重组>低体重组。多因素分析显示,65岁及以上、术后1年低BMI、R1及R2的姑息性切除、肿瘤病理分期高(Ⅱ、Ⅲ和Ⅳ期)对早期胃癌患者的术后生存起到负向影响,均为风险因素。而术后1年高BMI对早期胃癌患者的术后生存起到正向影响,为保护因素。结论体重干预对于早期胃癌患者行胃切除术的治疗效果的提高具有重要意义,值得临床深入研究与推广。
Objective To explore the correlation between body mass index(BMI) and quality of life after gastrectomy in patients with gastric cancer. Methods A total of 950 patients who underwent gastrectomy for early gastric cancer were retrospectively analyzed. According to BMI of the patients before operation or one year after operation, they were divided into underweight group, normal weight group and overweight group. The age and sex of the patients, the BMI before operation to one year after operation, the operation mode, the type of radical resection,the tumor pathological stage and histological type were collected. All patients were followed up by telephone for one year, and the overall survival rate and recurrence-free survival rate were calculated. Results There were significant differences in the age distribution, the preoperative BMI, the BMI at 1 year after operation, the surgical mode, the type of radical resection, the tumor pathological stage and histological type among the three groups(P < 0.05). The overall survival rate of the patients in the overweight group(84%) was higher than that in the underweight group(58%) and the normal weight group(68%), the differences were statistically significant(P < 0.05). The overall survival and relapse-free survival rates of the 3 groups at 1 year after operation were in the sequence of overweight group(88%, 82%) > normal weight group(70%, 66%) and underweight group(54%, 54%), the differences were statistically significant(P < 0.05). Multivariate analysis showed that age over 65 years, low BMI at 1 year after operation, R1 and R2 palliative resection and high tumor stage(stage Ⅱ, Ⅲ and Ⅳ) were the risk factors for postoperative survival of early gastric cancer patients. However, high BMI at 1 year after operation had positive effect on the survival of the patients with early gastric cancer. Conclusions Body weight intervention is of great significance for the improvement of therapeutic effect of gastrectomy in patients with early gastric cancer. It is worthy of further research and promotion.
Objective To explore the correlation between body mass index(BMI) and quality of life after gastrectomy in patients with gastric cancer. Methods A total of 950 patients who underwent gastrectomy for early gastric cancer were retrospectively analyzed. According to BMI of the patients before operation or one year after operation, they were divided into underweight group, normal weight group and overweight group. The age and sex of the patients, the BMI before operation to one year after operation, the operation mode, the type of radical resection,the tumor pathological stage and histological type were collected. All patients were followed up by telephone for one year, and the overall survival rate and recurrence-free survival rate were calculated. Results There were significant differences in the age distribution, the preoperative BMI, the BMI at 1 year after operation, the surgical mode, the type of radical resection, the tumor pathological stage and histological type among the three groups(P < 0.05). The overall survival rate of the patients in the overweight group(84%) was higher than that in the underweight group(58%) and the normal weight group(68%), the differences were statistically significant(P < 0.05). The overall survival and relapse-free survival rates of the 3 groups at 1 year after operation were in the sequence of overweight group(88%, 82%) > normal weight group(70%, 66%) and underweight group(54%, 54%), the differences were statistically significant(P < 0.05). Multivariate analysis showed that age over 65 years, low BMI at 1 year after operation, R1 and R2 palliative resection and high tumor stage(stage Ⅱ, Ⅲ and Ⅳ) were the risk factors for postoperative survival of early gastric cancer patients. However, high BMI at 1 year after operation had positive effect on the survival of the patients with early gastric cancer. Conclusions Body weight intervention is of great significance for the improvement of therapeutic effect of gastrectomy in patients with early gastric cancer. It is worthy of further research and promotion.
引文
[1]刘震,黄斌,靳雁,等.远端胃切除术与全胃切除术治疗远端胃癌的术后并发症和长期预后比较[J].中华胃肠外科杂志,2015,18(12):1240-1243.
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[11]刘松平,王连臣,柯延壮,等.手术前降低体重对胃癌患者生存状况影响的研究[J].中国现代医学杂志,2015,25(15):80-83.
[12]胡建,周阮萍,陈梦婷,等.近端胃癌的全胃切除术与近端胃切除术术后5年生存率Meta分析[J].南昌大学学报(医学版),2016,56(4):43-47.
[13]丁海坤.胃全切除术和近端胃切除术对胃癌患者预后影响临床分析[J].中国实用医药,2013,8(8):129-130.
[14]袁玉青,张煜程,庄成乐,等.胃癌根治术后出院30天内非计划再入院危险因素分析[J].浙江医学,2016,38(11):794-798.
[2]陆俊,黄昌明,郑朝辉,等.腹腔镜根治性全胃切除术治疗老年原发性胃癌患者的倾向评分配比预后分析[J].中华消化外科杂志,2016,15(3):221-227.
[3]王家镔,黄昌明,郑朝辉,等.腹腔镜胃癌D2根治术218例疗效评价[J].中华外科杂志,2010,48(7):502-505.
[4]姚震旦,杨宏,崔明,等.POSSUM评分系统对胃癌患者手术风险的评估[J].中华胃肠外科杂志,2015(8):791-796.
[5]李彬,张惠玲.体质指数对胃癌患者术后预后的影响[J].实用医学杂志,2015,31(10):1620-1623.
[6]顾劲松,张文浩.超重对接受胃切除术治疗的胃癌患者的影响[J].中国医科大学学报,2011,40(4):372-375.
[7]卢昕,孟庆彬,邵永胜,等.进展期近端胃癌近端胃与全胃切除的对比研究[J].中华普通外科杂志,2016,31(2):97-99.
[8]鲁明典,李永翔.785例胃癌根治术后预后的多因素分析[J].安徽医科大学学报,2014,49(11):1654-1657.
[9]叶景旺,付涛,王祥峰,等.老年胃癌患者胃切除术后并发症相关发病因素分析[J].检验医学与临床,2015(18):2684-2687.
[10]鲍新洲,金炯,张明,等.胃癌根治术后患者预后的影响因素探讨[J].中国医师杂志,2015(3):451-453.
[11]刘松平,王连臣,柯延壮,等.手术前降低体重对胃癌患者生存状况影响的研究[J].中国现代医学杂志,2015,25(15):80-83.
[12]胡建,周阮萍,陈梦婷,等.近端胃癌的全胃切除术与近端胃切除术术后5年生存率Meta分析[J].南昌大学学报(医学版),2016,56(4):43-47.
[13]丁海坤.胃全切除术和近端胃切除术对胃癌患者预后影响临床分析[J].中国实用医药,2013,8(8):129-130.
[14]袁玉青,张煜程,庄成乐,等.胃癌根治术后出院30天内非计划再入院危险因素分析[J].浙江医学,2016,38(11):794-798.