Division of Transplantation, Department of Surgery, University of Michigan, 2226 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0331, USA.
J Gastrointest Surg. 2010 May;14(5):849-57. doi: 10.1007/s11605-010-1163-5. Epub 2010 Feb 6.
Following hepatectomy for malignancy, the effect of body mass index (BMI) on hepatic and oncologic outcomes is unknown.
Two hundred seventy-nine post-hepatectomy patients with malignancy from our center were included in the cohort (1996-2006). BMI was categorized using World Health Organization criteria. The effect of BMI was evaluated using risk-adjusted Cox models for time to recurrence and overall survival.
Seventy-nine patients (28.3%) had primary hepatobiliary cancers, 134 (48.0%) had colorectal metastases, and 66 (25.3%) had other metastases. Thirty-five percent of patients were obese (BMI > 30). Obese patients had more hepatic-specific perioperative complications (27.8% vs. 15.9%, p = 0.018), bile leaks (18.6% vs. 9.9%, p = 0.030), post-operative pneumonia (9.3% vs. 2.2%, p = 0.0074), intra-abdominal abscesses (7.2% vs. 1.7%, p = 0.017), acute renal failure (7.2% vs. 1.7%, p = 0.017), urinary tract infections (16.4% vs. 7.7%, p = 0.024), and longer lengths of stay (10.5 vs.8.6 days, p = 0.029). Obese and non-obese patients had similar perioperative mortality, time to recurrence, and overall survival on univariate analysis. However, after adjusting for demographic, tumor, and operative characteristics, and complications, increasing BMI displayed improved recurrence-free (HR 0.90, 95% CI 0.86-0.95) and overall survival (HR 0.96, 95% CI 0.92-0.99).
High BMI patients may have better oncologic outcomes despite higher perioperative morbidity and hepatic complications following hepatectomy. These findings have important clinical and biological implications.
肝切除术治疗恶性肿瘤后，体重指数（BMI）对肝脏和肿瘤学结果的影响尚不清楚。
纳入本中心 279 例恶性肿瘤肝切除术后患者的队列（1996-2006 年）。采用世界卫生组织标准对 BMI 进行分类。使用风险调整 Cox 模型评估 BMI 对复发时间和总生存的影响。
79 例（28.3%）患者患有原发性肝胆癌，134 例（48.0%）患有结直肠癌转移，66 例（25.3%）患有其他转移。35%的患者肥胖（BMI>30）。肥胖患者肝特异性围手术期并发症更多（27.8% vs. 15.9%，p=0.018），胆漏（18.6% vs. 9.9%，p=0.030），术后肺炎（9.3% vs. 2.2%，p=0.0074），腹腔脓肿（7.2% vs. 1.7%，p=0.017），急性肾衰竭（7.2% vs. 1.7%，p=0.017），尿路感染（16.4% vs. 7.7%，p=0.024），住院时间更长（10.5 天 vs. 8.6 天，p=0.029）。肥胖和非肥胖患者在单因素分析中具有相似的围手术期死亡率、复发时间和总生存率。然而，在校正人口统计学、肿瘤和手术特征以及并发症后，BMI 增加显示出无复发生存率的改善（HR 0.90，95%CI 0.86-0.95）和总生存率（HR 0.96，95%CI 0.92-0.99）。
尽管肝切除术后围手术期发病率和肝脏并发症较高，但高 BMI 患者可能具有更好的肿瘤学结果。这些发现具有重要的临床和生物学意义。
