体质量指数对食管鳞癌患者术后并发症和长期预后的影响

Influence of body mass index on postoperative complications and long-term prognosis in patients with esophageal squamous cell carcinoma

目的探讨体质量指数(BMI)对食管鳞癌患者术后并发症和长期预后的影响。方法选取行食管癌根治术的1479例食管鳞癌患者,根据BMI分为低BMI组(BMI<18.5 kg/m^(2))100例、正常BMI组(18.5 kg/m^(2)≤BMI<24 kg/m^(2))850例及高BMI组(BMI≥24 kg/m^(2))529例。比较3组患者术后并发症的差异。采用Kaplan-Meier生存曲线比较3组患者总生存率的差异,Cox比例风险模型分析患者BMI对预后的影响。结果与正常BMI组比较,高BMI组切口感染发生率增加,低BMI组肺部感染和心律失常发生率增加(P<0.05);与低BMI组比较,高BMI组心律失常发生率降低(P<0.05)。而3组吻合口瘘、呼吸衰竭、乳糜胸和声带麻痹发生率差异无统计学意义(P>0.05)。Kaplan-Meier生存分析显示,低BMI组患者的5年累积总生存率低于正常BMI组(Log-rankχ^(2)=16.857,P<0.01)和高BMI组(Log-rankχ^(2)=18.802,P<0.01),而高BMI组和正常BMI组患者的5年累积总生存率差异无统计学意义(Log-rankχ^(2)=0.324,P=0.569)。多因素Cox回归分析显示,低BMI是食管鳞癌患者预后的独立危险因素(HR=1.449,95%CI:1.084~1.938,P<0.05)。结论高BMI增加食管鳞癌患者术后切口感染的发生率;低BMI增加患者肺部感染和心律失常的发生率,并且是患者预后不良的独立预测因素。

Objective To investigate the influence of body mass index(BMI)on postoperative complications and long term prognosis in patients with esophageal squamous cell carcinoma(ESCC).Methods A total of 1479 patients with ESCC who underwent radical resection were included in this study.According to BMI,100 patients were divided into the low BMI group(BMI<18.5 kg/m^(2)),850 cases were divided into the normal BMI group(18.5 kg/m^(2)≤BMI<24 kg/m^(2))and 529 cases were divided into the high BMI group(BMI≥24 kg/m^(2)).Postoperative complications of patients were compared between the three BMI groups.Kaplan-Meier survival curve was used to compare the overall survival of the three groups,and Cox proportional risk model was used to analyze the influence of BMI on prognosis of patients.Results Compared with the normal BMI group,the incidence of incision infection was increased in the high BMI group,and the incidence rates of pulmonary infection and arrhythmia were increased in the low BMI group(P<0.05).Compared with the low BMI group,the incidence of arrhythmia was lower in the high BMI group(P<0.05).There were no significant differences in the incidence of anastomotic leakage,respiratory failure,chylothorax and vocal cord paralysis between the three groups(P>0.05).Kaplan Meier survival curve showed that the 5-year cumulative overall survival rate of patients was significantly lower in the low BMI group than that in the normal BMI group(Log-rankχ^(2)=16.857,P<0.01)and the high BMI group(Log-rankχ^(2)=18.802,P<0.01),while there was no significant difference in 5-year cumulative overall survival rate between the high BMI group and the normal BMI group(Log-rankχ^(2)=0.324,P=0.569).Multivariate Cox regression analysis showed that low BMI was an independent risk factor for the prognosis of patients with esophageal squamous cell carcinoma(HR=1.449,95%CI:1.084-1.938,P<0.05).Conclusion High BMI increases the incidence of incision infection after esophagectomy in patients with ESCC.Low BMI increases the incidence of pulmonary infections and arrhythmia,and is an independent predictor for poor overall survival.