胃癌患者术后体重变化与生活质量的相关性研究

Factors Related to Weight Loss After Gastrectomy and Its Impact on Quality of Life in Gastric Cancer Patients

[目的]探讨胃癌患者术后1年体重的变化规律,分析影响体重变化的相关因素。[方法]纳入2018年10月至2019年8月住院收治的行胃癌根治性手术患者共259例,术后第1、3、6、12个月问卷随访患者体重,术后1年应用EORTC-QLQ-C30和EORTC-QLQ-STO22量表评估患者生活质量。采用Logistic回归分析影响患者术后体重变化的因素,采用非参数检验比较不同体重下降比例对患者生活质量的影响。[结果]术后1年患者平均体重[(57.64±11.10)kg]显著低于术前[(66.28±11.59)kg](P<0.001)。体重下降超过10%患者有130例(55.01%),超过15%患者89例(37.71%)。多因素Logistic回归分析显示,手术术式(OR=4.17,95%CI:2.34~7.45)和BMI≥24 kg/m^(2)(OR=2.13,95%CI:1.20~3.79)与术后体重下降≥15%相关。体重纵向变化规律显示,术后0~6个月处于持续下降状态,其中0~1个月下降最快。远端胃癌根治术后0~6个月下降幅度小于全胃/近端组(P<0.001),6~12个月回升幅度大于全胃/近端组(P=0.005)。对于接受全胃/近端胃癌根治术患者而言,体质指数(BMI)≥24 kg/m^(2)组患者于术后6个月内BMI下降幅度最大(26.10 kg/m^(2)下降至20.43 kg/m^(2));BMI<24 kg/m^(2)组患者在术后3~6个月内低于正常BMI水平。术前BMI≥24 kg/m^(2)患者术后1年BMI仍高于BMI<24 kg/m^(2)患者(P<0.001)。术后1年生活质量评分显示,体重下降超过10%对患者总体健康状况存在影响。[结论]胃癌患者术后体重下降较多,行近端/全胃根治术患者下降更加显著。体重下降超过10%严重影响患者生活质量。亟需针对不同术式,动态筛查胃癌术后患者营养风险,进行饮食营养干预,提高患者营养状态和生活质量。

[Purpose]To investigate longitudinal weight changes and associated factors in gastric cancer patients after gastrectomy and to explore its impacts on quality of life of patients.[Methods]In this prospective longitudinal survey 259 gastric cancer patients who received radical gastrectomy from October 2018 to August 2019 were included.Postoperative body weight was followed through questionnaire in 1,3,6 and 12 months after surgery.EORTC-QLQ-C30 and EORTC-QLQ-STO22 were used to assess the quality of life(QOL)1 year after surgery.Logistic regression was used to analyze the factors influencing postoperative weight change.Nonparametric test was used to compare the influence of different weight loss ratios on quality of life of patients.[Results]The average weight one year after surgery was significantly lower than that before surgery(57.64±11.10 kg vs 66.28±11.59 kg,P<0.001).Among all patients,130 lost over 10%weight(55.01%)and 89 lost over 15%(37.71%).Multivariable Logistic regression analysis showed that surgical methods(OR=4.19,95%CI:2.29~7.68)and body mass index(BMI)≥24 kg/m^(2)(OR=2.14,95%CI:1.20~3.80)were associated with weight loss>15%.The longitudinal body weight changes showed a continuous decrease from 0 to 6 months after surgery,and the decrease was the fastest from 0 to 1month[(3.08±2.73)kg].The weight loss in patients from 0 to 6 months after surgery in distal gastrectomy group was less than that in total and proximal gastrectomy group(P<0.001)and weight rebound was larger than that in total and proximal gastrectomy group(P=0.005).For patients who received total and proximal gastrectomy,those with BMI≥24 kg/m^(2)at diagnosis showed significantly BMI decrease from 26.10 to 20.43 kg/m^(2),while the BMI for patients with BMI<24 kg/m^(2)at diagnosis was lower than normal level(18.5 kg/m^(2))within 3~6 months after surgery.The QOL scores indicated that the body weight loss over 10%had impact on the general health of patients.There were statistically differences in physical function,role function,emotional function,as well as loss of appetite,nausea and vomiting,stomach pain,regurgitation,eating restriction,anxiety and taste symptoms(P<0.05).Weight loss of more than 15%,in addition to the above domains,also had effects on fatigue,pain,shortness of breath,insomnia,dysphagia,and social function.[Conclusion]Postoperative weight loss is common in patients with gastric cancer,and the decrease is more significant in patients undergoing proximal and total gastrectomy.Weight loss of more than 10%may seriously affect the quality of life of patients.It is necessary to dynamically screen the nutritional risk of postoperative gastric cancer patients and conduct dietary nutritional intervention to improve the nutritional status and quality of life of patients.