Impact of overweightness and critical weight loss on overall survival in patients with hepatocellular carcinoma initially treated with chemoembolization

体重过重和化疗栓塞初始治疗期间体重显著下降对肝癌患者总体生存的影响

Background:The effects of overweightness and weight loss on the development and prognosis of hepatocellular carcinoma(HCC)remain unclear.In this study,we aimed to evaluate the impact of overweightness and weight loss on the survival of patients with intermediate/advanced HCC receiving chemoembolization as initial treatment.Methods:We examined 1,170 patients who underwent chemoembolization as initial treatment for Barcelona-Clı´nic Liver Cancer stages B and C HCC at Sun Yat-sen University Cancer Center(Guangzhou,China)between December 2009 and May 2015.A baseline body mass index(BMI)of23 kg/m2 was defined as overweight,and body-weight loss of5.0%from baseline was defined as critical weight loss(CWL).Cox regression analysis was used to determine the association between overweightness or CWL and overall survival(OS).Results:The median survival time was 16.8(95%confidence interval,13.9–19.7)months and 11.1(95%confidence interval,10.0–12.2)months in the overweight and non-overweight groups(log-rank test,P<0.001),respectively.Cox multivariate analysis identified overweightness as an independent protective prognostic factor for OS(P<0.001).Subgroup stratification analysis revealed a significant association between overweightness and survival among patients receiving further treatment(P=0.005),but not in those not receiving further treatment(P=0.683).Multivariate analysis showed that both overweightness and CWL were independent prognostic factors for OS among patients receiving further treatment.Conclusion:Among patients with intermediate-or advanced-stage HCC initially treated with chemoembolization,overweightness was associated with longer OS.Furthermore,CWL was an independent adverse prognostic factor for OS in patients receiving additional treatment.

背景:体重过重和体重下降对于肝癌进展和预后的影响尚不明了。本研究旨在评估体重过重和化疗栓塞初始治疗期间体重下降对中晚期肝癌患者生存的影响。方法:2009年12月至2015年5月间,1170例在中山大学附属肿瘤医院接受化疗栓塞初始治疗的B/C期(巴塞罗那肝癌分期)肝癌患者纳入分析。基线体质指数≥23 kg/m^(2)定义为体重过重,化疗栓塞初始治疗期间体重下降≥5.0%定义为体重显著下降。采用Cox回归分析评估体重过重和体重显著下降对总体生存(OS)的影响。结果:体重过重组和非体重过重组患者中位生存时间分别为16.8(95%CI:13.9–19.7)个月和11.1(95%CI:10.0–12.2)个月(P<0.001)。Cox多因素分析证实,体重过重是OS的独立保护因素(P<0.001)。亚组分析显示,在初始化疗栓塞后接受了进一步后续治疗的患者中,体重过重对OA存在显著影响(P=0.005);但在没有接受后续治疗的患者,体重过重并不会影响OA(P=0.683)。多因素分析显示,在接受了后续治疗的肝癌患者中,体重过重和体重显著下降均为OS的独立影响因素。结论:在接受化疗栓塞初始治疗的中晚期肝癌患者中,体重过重者会有一个更长的OS;而初始治疗期间体重显著下降则是OS的一个独立危险因素。