体质量指数与胃癌患者临床病理特征及预后的关系

Relationship between body mass index and clinicopathological features,prognosis of patients with gastric cancer

目的探讨体质量指数(BMI)与胃癌患者临床病理特征及预后的关系。方法收集2010年6月至2014年6月我院收治的133例胃癌患者的临床资料,根据中国成人BMI界值将其分为低BMI组(BMI<18.5 kg/m~2,37例)、正常BMI组(18.5~23.9 kg/m~2,62例)、超重或肥胖组(BMI≥24.0 kg/m2,34例)。比较三组临床病理特征、围手术期指标及术后5年生存情况。结果三组血红蛋白、白蛋白及总蛋白水平、肿瘤部位、肿瘤直径、浸润深度比较,差异具有统计学意义(P<0.05)。与正常BMI组和超重或肥胖组相比,低BMI组血红蛋白、白蛋白、总蛋白水平更低,贲门部胃癌比例更低,肿瘤直径更大,浸润更深(P<0.05)。三组性别、年龄、吸烟、TNM分期、淋巴结转移、分化程度、淋巴结清扫数目、术后住院时间、术后并发症发生率比较,差异不具有统计学意义(P>0.05)。三组手术时间、术中出血量比较,差异具有统计学意义(P<0.05)。与低BMI组和正常BMI组相比,超重或肥胖组手术时间更长,术中出血量更多(P<0.05)。三组术后5年疾病进展、死亡率比较,差异具有统计学意义(P<0.05),低BMI组术后5年疾病进展、死亡率高于正常BMI组和超重或肥胖组(P<0.05)。结论超重或肥胖对胃癌患者手术效果影响较大;低BMI胃癌患者术后5年生存情况较正常BMI和超重或肥胖患者差,围手术期应给予患者充分营养支持以改善远期预后。

Objective To investigate the relationship between body mass index(BMI)and clinicopathological features,prognosis of patients with gastric cancer.Methods The clinical data of 133 patients with gastric cancer admitted in our hospital from June 2010 to June 2014 were collected,and the patients were divided into low BMI group(BMI<18.5 kg/m~2,37 cases),normal BMI group(18.5-23.9 kg/m~2,62 cases)and overweight or obesity group(BMI≥24.0 kg/m~2,34 cases)by the Chinese abult BMI threshold.The clinicopathological features,perioperative indexes and 5-year survival after operation of the three groups were compared.Results There were significant differences in hemoglobin,albumin and total protein levels,tumor location,tumor diameter and depth of invasion among the three groups(P<0.05).Compared with the normal BMI group and the overweight or obesity group,the low BMI group had lower levels of hemoglobin,albumin and total protein,lower proportion of gastric cancer in cardia,larger tumor diameter,and deeper invasion(P<0.05).There were no significant differences in gender,age,smoking,TNM stage,lymph node metastasis,differentiation,the number of lymph node dissection,postoperative hospital stay and incidence of postoperative complications among the three groups(P>0.05).There were significant differences in operation time and intraoperative blood loss volume among the three groups(P<0.05).Compared with the low BMI group and normal BMI group,the overweight or obesity group had longer operation time and more intraoperative blood loss volume(P<0.05).There were significant differences in 5-year disease progression rate after operation and mortality rate among the three groups(P<0.05),and the 5-year disease progression rate after operation and mortality rate of the low BMI group were higher than those of the normal BMI group and the overweight or obesity group(P<0.05).Conclusion Overweight or obesity has a great influence on the operation effect of gastric cancer patients,the 5-year survival after operation of patients with low BMI gastric cancer is worse than that of patients with normal BMI and overweight or obesity.Adequate nutritional support should be given for patients in perioperative period to improve the long-term prognosis.