Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg Oncol. 2009 Dec;16(12):3245-51. doi: 10.1245/s10434-009-0645-8.
Westernization of lifestyle and diet has resulted in an increase in overweight patients in Japan. Although the adverse effects of higher body mass index (BMI) on early surgical outcomes are known, the relationship between BMI and long-term outcome is unclear.
Clinicopathological characteristics and 5-year survival rate of overweight (BMI >or= 25 kg/m2; H-BMI; n = 1126) and nonoverweight (BMI < 25 kg/m2; N-BMI; n = 6799) patients who underwent gastrectomy with curative intent at the Cancer Institute Hospital between 1970 and 2004 were compared.
Patients in the H-BMI group tended to have earlier-stage disease. The 5-year survival rate was significantly better in the H-BMI than N-BMI group (81.5% vs 74.1%, respectively; P < .001). Postoperative mortality was 1% in both groups (P = .482), whereas postoperative morbidity was 22% and 19% in the H-BMI and N-BMI groups, respectively (P = .007). Multivariate analysis indicated overweight, age, gender, surgical procedure, histology, operation year, pT, and pN as independent prognostic factors. Subset analyses of pT and pN stages revealed overweight as an independent prognostic factor in patients with pT1 and pN0.
The 5-year survival rate following curative gastrectomy is better in overweight than nonoverweight Japanese patients, especially for early-stage gastric cancer. Further studies are needed to determine whether these results apply to other countries where morbidity and mortality for gastric cancer are higher than in Asian countries.
生活方式和饮食的西化导致日本超重患者增多。虽然较高的体重指数（BMI）对早期手术结果的不良影响是已知的，但 BMI 与长期结果的关系尚不清楚。
比较了 1970 年至 2004 年间在癌症研究所医院接受根治性胃切除术的超重（BMI≥25kg/m2；H-BMI；n=1126）和非超重（BMI<25kg/m2；N-BMI；n=6799）患者的临床病理特征和 5 年生存率。
H-BMI 组患者疾病分期较早。H-BMI 组的 5 年生存率明显好于 N-BMI 组（分别为 81.5%和 74.1%；P<.001）。两组术后死亡率均为 1%（P=0.482），而 H-BMI 组和 N-BMI 组的术后发病率分别为 22%和 19%（P=0.007）。多变量分析表明超重、年龄、性别、手术方式、组织学、手术年份、pT 和 pN 是独立的预后因素。pT 和 pN 分期的亚组分析显示，超重是 pT1 和 pN0 患者的独立预后因素。
与非超重日本患者相比，接受根治性胃切除术的超重日本患者的 5 年生存率更好，尤其是早期胃癌患者。需要进一步研究确定这些结果是否适用于胃癌发病率和死亡率高于亚洲国家的其他国家。
