治疗前体重指数对鼻咽癌患者预后的影响

Impact of pretherapy body mass index on prognosis of nasopharyngeal carcinoma

背景与目的:肥胖和低体重与多种肿瘤的进展及预后相关。本研究探讨体重指数(body mass index,BMI)对鼻咽癌患者预后的影响,为判断鼻咽癌患者的预后提供参考。方法:从1990-2003年在中山大学肿瘤防治中心确诊为鼻咽癌的病例中随机抽取1489例,按照患者的BMI分为正常、低体重、超重和肥胖4组。采用生存分析对4组患者的预后进行综合比较分析。结果:低体重组、超重组和肥胖组患者的年龄、T分期、N分期和总分期与正常体重组相比其差异均有统计学意义(P<0.0001)。以低体重组为对照组,正常组、超重组和肥胖组的总生存率、无复发生存率和无转移生存率的相对危险度均小于1,并且随着体重的增加相对危险度逐渐降低。单因素生存分析结果显示,低体重组总生存率、无复发生存率和无转移生存率低于正常体重组和超重组、肥胖组(P<0.0001);多因素分析结果表显示,年龄、T分期、N分期和BMI分级均可作为显著的独立预后因素(P<0.05)。结论:治疗前低BMI鼻咽癌患者的总生存率、无复发生存率、无转移生存率较正常BMI患者下降。治疗前BMI可作为评价鼻咽癌患者预后的一个重要参考指标。

Background and Objective： Given the limited information regarding the impact of BMI on treatment outcomes for nasopharyngeal carcinoma, we sought to examine the relationship between body mass index （BMI） and cancer control after radiotherapy. Methods： We compared clinic outcome information across BMI groups from 1 489 patients treated with radiotherapy between 1990 and 2003. Multivariate analysis was used to determine if BMI significantly predicted adverse recurrence. Results：In comparison with normal group, there were statistical difference in age, T staging, N staging, and clinical staging （P〈0.0001）. In survival analysis, in comparison with underweight group, we could found the hazard ratio was less than one, in the risk of death, cancer recurrence and local recurrence. Meanwhile, the hazard ratio gradually declined when the body weight increased. In univariate survival analysis, under-weight patient had a significant decrease in overall survival, （P〈0.0001）. When Cox regression model was applied to multivariate analysis, we could found age, T staging, N staging, and BMI grades could be a significant independent prognosis factors（P〈0.05）. Conclusions.Underweight patients had a significant decrease in overall survival rate, distant metastasis failure-free survival, and local relapse-free survival. Pretherapy BMI grades could be a significant independent prognosis factors.