体重指数、四肢骨骼肌指数及血脂水平对高危肾透明细胞癌患者肿瘤进展风险的影响

Effects of body mass index,appendicular skeletal muscle mass index and serum lipid levels on the risk of tumor progression in patients with high-risk renal clear cell carcinoma

目的评估体重指数(body mass index,BMI)及其动态变化、四肢骨骼肌指数(appendicular skeletal muscle mass index,ASMI)和血脂水平对肿瘤进展的可能影响,为患者体重管理提供参考依据。方法采用前瞻性队列研究设计,检测100例高危肾透明细胞癌患者的血脂水平,采用多频生物电阻抗法测定ASMI、BMI并追踪BMI动态变化,探讨BMI、ASMI及血脂水平对研究对象2年内肿瘤进展的影响。结果正常BMI且伴低ASMI的患者肿瘤进展风险是超重及肥胖患者的5.248倍(95%CI:1.946~14.153,P=0.001)。术前高密度脂蛋白胆固醇每增加0.1个单位,进展风险降低0.771倍(95%CI:0.631~0.942,P=0.011)。治疗期间BMI下降超过基线5%的患者的肿瘤进展风险是BMI维持在基线+5%患者的5.165倍(95%CI:1.735~15.370,P=0.003)。结论肥胖肾透明细胞癌患者相较于正常体重患者在肿瘤无进展生存中的优势可能因受ASMI、患病前非自愿性体重下降及血脂水平等的影响,因此临床中对于患者体重的管理,不能仅限于BMI值,更需结合患者的癌症分期、人体成分及代谢状态进行个体化设置。

Objective To evaluate the potential effects of serum lipid levels,appendicular skeletal muscle mass index(ASMI)and body mass index(BMI),together with its dynamic changes,on tumor progression in renal clear cell carcinoma patients,so as to inform body weight management.Methods This prospective cohort study included a total of 100 patients with high-risk clear cell renal cell carcinoma.Serum lipid levels were detected,ASMI and BMI were measured using bioelectrical impedance analysis and the dynamic changes of BMI were tracked.The effects of BMI,ASMI and serum lipid levels on tumor progression within 2 years were explored.Results Patients with normal BMI and low ASMI had 5.248(95%CI:1.946 to 14.153,P=0.001)times higher risk of tumor progression than those who were overweight or obese.For every 0.1-unit increase in pre-operative HDL-C,the risk of tumor progression decreased by 0.771(95%CI:0.631 to 0.942,P=0.011)times.Patients who experienced more than 5%decrease in BMI compared with baseline had 5.165(95%CI:1.735 to 15.370,P=0.003)times the progression risk of patients whose BMI changed within±5%from baseline.Conclusions The advantage of obese clear cell carcinoma patients over normal-weight patients in tumor progression-free survival may be influenced by ASMI,pre-onset involuntary weight loss and lipid levels.Therefore,patient weight management should not merely focus on absolute BMI but tailor to individual characteristics,including cancer stage,body composition and metabolic status.