Michael E DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
J Gastrointest Surg. 2010 Nov;14(11):1832-7. doi: 10.1007/s11605-010-1297-5. Epub 2010 Aug 20.
Body mass index (BMI) has proven unreliable in predicting survival following pancreaticoduodenectomy for cancer. While measures of intra-abdominal fat correlate with medical and postoperative complications of obesity, the impact of intra-abdominal fat on pancreatic cancer survival is uncertain. We hypothesized that the quantity of intra-abdominal fat would predict survival following resection of pancreatic cancer.
Preoperative CT imaging was used to measure intra-abdominal fat. Cox regression analyses were used to identify independent predictors of survival.
Sixty-one patients from 2000-2009 underwent pancreaticoduodenectomy for exocrine pancreatic adenocarcinoma. After adjusting for age and perineural invasion status, preoperative BMI did not predict overall survival (p < 0.827). Unlike BMI, quartile of intra-abdominal fat predicted survival. Relative to patients with the least intra-abdominal fat (lowest quartile), those with more intra-abdominal fat demonstrated worse overall survival, but in a non-linear fashion. Individuals in the second quartile showed a fourfold increase in likelihood of death (HR 4.018, 95% CI 1.099-14.687, p < 0.035) relative to the lowest quartile. Patients in the third (HR 2.124, 95% CI 0.278-16.222, p < 0.468) and fourth quartile (HR 1.354, 95% CI 0.296-6.190, p < 0.696) also showed greater risk of death.
Measuring intra-abdominal fat identifies a subset of patients with worse prognosis in pancreatic cancer.
体重指数（BMI）已被证明在预测胰腺癌胰十二指肠切除术后的生存方面不可靠。虽然腹内脂肪的测量与肥胖的医疗和术后并发症相关，但腹内脂肪对胰腺癌生存的影响尚不确定。我们假设腹内脂肪量将预测胰腺癌切除术后的生存。
使用术前 CT 成像来测量腹内脂肪。使用 Cox 回归分析来确定生存的独立预测因素。
2000 年至 2009 年间，有 61 名患者因外分泌胰腺腺癌接受胰十二指肠切除术。在调整年龄和神经周围侵犯状态后，术前 BMI 并未预测总体生存率（p < 0.827）。与 BMI 不同，腹内脂肪的四分位间距预测了生存。与腹内脂肪最少的患者（最低四分位数）相比，腹内脂肪较多的患者总体生存率更差，但呈非线性。与最低四分位数相比，第二四分位数的死亡可能性增加了四倍（HR 4.018，95%CI 1.099-14.687，p < 0.035）。第三（HR 2.124，95%CI 0.278-16.222，p < 0.468）和第四四分位数（HR 1.354，95%CI 0.296-6.190，p < 0.696）的患者死亡风险也更高。
测量腹内脂肪可确定胰腺癌患者预后较差的亚组。
