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

Correlation between BMI and quality of life after gastrectomy in patients with gastric cancer

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。

Abstract:

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, Ⅲand 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.