体质量指数对胃癌预后影响

Body mass index impact on the prognosis of gastric cancer patients

目的研究体质量指数(BMI)对胃癌预后的影响。方法选取胃癌术后患者132例,记录BMI与肿瘤标志物CA199、CA242、CA724、CEA的动态变化值。采用Pearson法分析BMI与肿瘤标志物CA199、CA242、CA724、CEA的相关性,ROC曲线、Kaplan-Meier生存分析评价BMI与胃癌患者预后的关系。结果 BMI降低值与CEA增高值(r=0.831,P<0.01)呈高度正相关,与CA199增高值(r=0.690,P<0.01)、CA242增高值(r=0.591,P<0.01)、CA724增高值(r=0.694,P<0.01)呈中度正相关。BMI降低值与预后(死亡)之间的ROC曲线下面积为0.742(P<0.01,95%可信区间0.602~0.882),死亡敏感度为0.778、特异度为0.788,最佳界值为2.85 kg/m^2。BMI降低值≥2.85 kg/m^2与BMI降低值<2.85 kg/m^2患者在胃癌病理分化(χ~2=12.530,P<0.01)、浸润深度(χ~2=0.944,P<0.01)、淋巴结转移(χ~2=6.471,P<0.05)、肿瘤分期(χ~2=6.202,P<0.05)等方面,差异具有统计学意义。BMI降低值≥2.85 kg/m^2患者存活率(33.9%)明显低于BMI降低值<2.85 kg/m^2患者(57.8%),差异有统计学意义(P<0.05)。结论胃癌患者BMI降低值与肿瘤标志物CA199、CA242、CA724、CEA增高值呈正相关,BMI降低值<2.85 kg/m^2的胃癌患者预后较好,生存时间较长。

Objective To investigate the body mass index（ BMI） effect on the prognosis of gastric cancer patients. Methods Clinical data was selected from 132 postoperative gastric cancer patients,BMI and tumor markers CA199,CA242,CA724 and CEA,the dynamic change of values were recorded. Using Pearson correlation to analyze BMI and tumor markers CA199,CA242,CA724 and CEA,ROC curve,Kaplan Meier survival analysis to evaluate relationship between BMI and the prognosis of patients with gastric cancer.Results Pearson correlation analysis showed that BMI reduced value had highly positive correlation with CEA increased value（ r =0. 831,P〈0. 01）,moderately positive correlation with CA199 increased value（ r = 0. 690,P〈0. 01）,CA242 increased value（ r =0. 591,P〈0. 01） and CA724 increased value（ r = 0. 694,P〈0. 01）. ROC analysis showed that area under the curve between BMI reduced value and prognosis（ death） was 0. 742（ P〈0. 01,95% CI 0. 602- 0. 882）,the sensitivity of death was 0. 778,the specificity was 0. 788,the best boundary value was 2. 85 kg / m^2. Patients with BMI reduced value more than or equal to 2. 85 kg / m^2 and the others with BMI reduced value less than 2. 85 kg / m^2 had statistically significant difference in pathologic differentiation（ χ^2= 12. 530,P〈0. 01）,tumor invasion depth（ χ^2= 0. 944,P〈0. 01）,lymph node metastasis（ χ^2= 6. 471,P〈0. 05） and staging（ χ^2= 6. 202,P〈0. 05）. The survival rate of BMI reduced value more than or equal to 2. 85 kg / m^2（ 33. 9%） was significantly less than those whose BMI reduced value less than 2. 85 kg / m^2（ 57. 8%）,and the difference was statistically significant（ P〈0. 05）. Conclusion The decrease of BMI variation has a highly positive correlation with CEA level in gastric cancer patients,and the patients whose BMI lower values were less than 2. 85 kg / m^2 have a better prognosis and a longer overall survival.