术前体重指数对肝细胞癌合并2型糖尿病患者根治性切除术后预后的预测价值

Prognostic predictive value of preoperative body mass index in patients with hepatocellular carcinoma complicated with type 2 diabetes mellitus after radical resection

目的探讨术前BMI对肝细胞癌(HCC)合并2型糖尿病患者根治性切除术后生存预后的影响。方法回顾性分析2013年1月至2014年12月在海军军医大学(第二军医大学)第三附属医院行根治性切除术的140例HCC合并2型糖尿病患者的临床资料。患者术前BMI为18.8~31.8 kg/m^(2),根据术前BMI分为正常BMI(18.8~24.9 kg/m^(2))组和较高BMI(25.0~31.8 kg/m^(2))组。对两组患者的基本临床资料及BMI对预后的影响进行分析。结果140例患者中,正常BMI组94例(67.1%)、较高BMI组46例(32.9%)。两组患者在年龄、性别、实验室检查指标、病理学参数、抗病毒治疗、糖尿病治疗方式、术后预防性经导管动脉化疗栓塞治疗等方面差异均无统计学意义(P均>0.05)。较高BMI组的3年总生存率(86.0%)高于正常BMI组(64.8%),两组总生存期差异有统计学意义(P=0.011)。多因素Cox比例风险回归分析显示,较高BMI是HCC合并2型糖尿病患者根治性切除术后总生存期的独立保护因素(HR=0.379,95%CI 0.156~0.917,P=0.031)。结论对于HCC合并2型糖尿病患者,术前BMI较高者总生存期更长。

Objective To investigate the impact of preoperative body mass index(BMI)on the survival and prognosis of patients with hepatocellular carcinoma(HCC)complicated with type 2 diabetes mellitus after radical resection.Methods The clinical data of 140 HCC patients with type 2 diabetes mellitus who underwent radical resection in The Third Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.2013 to Dec.2014 were retrospectively analyzed.These patients were divided into 2 groups based on preoperative BMI(ranged 18.8-31.8 kg/m^(2)):normal-BMI(18.8-24.9 kg/m^(2))group and high-BMI(25.0-31.8 kg/m^(2))group.The basic clinical data and prognostic factors of the 2 groups of patients were summarized and analyzed.Results Among the 140 patients,94(67.1%)and 46(32.9%)were in the normal-BMI and high-BMI groups,respectively.There was no significant difference between the 2 groups in age,gender,laboratory examination indicators,pathological parameters,antiviral treatment,diabetes treatment,or postoperative preventive transcatheter arterial chemoembolization(all P>0.05).The 3-year overall survival rate of the high-BMI group(86.0%)was higher than that of the normal-BMI group(64.8%),and there was a significant difference in the overall survival between the 2 groups(P=0.011).Multivariate Cox proportional hazard regression analysis showed that high-BMI was an independent protective factor for the overall survival of HCC patients with type 2 diabetes after radical resection(hazard ratio=0.379,95%confidence interval 0.156-0.917,P=0.031).Conclusion HCC patients complicated with type 2 diabetes mellitus with high preoperative BMI have significantly better overall survival.