体重指数升高并不会降低癌症患者食管癌切除术后的生存率。
An elevated body mass index does not reduce survival after esophagectomy for cancer.
机构信息
Division of Surgical Oncology, New York University School of Medicine, New York, New York, USA.
出版信息
Ann Surg Oncol. 2011 Mar;18(3):824-31. doi: 10.1245/s10434-010-1336-1. Epub 2010 Sep 24.
BACKGROUND
Incidences of esophageal cancer and obesity are both rising in the United States. The aim of this study was to determine the influence of elevated body mass index on outcomes after esophagectomy for cancer.
METHODS
Overall and disease-free survivals in obese (BMI ≥ 30), overweight (BMI 25-29), and normal-weight (BMI 20-24) patients undergoing esophagectomy constituted the study end points. Survivals were calculated by the Kaplan-Meier method, and differences were analyzed by log rank method.
RESULTS
The study included 166 obese, 176 overweight, and 148 normal-weight patients. These three groups were similar in terms of demographics and comorbidities, with the exception of younger age (62.5 vs. 66.2 vs. 65.3 years, P = 0.002), and higher incidence of diabetes (23.5 vs. 11.4 vs. 10.1%, P = 0.001) and hiatal hernia (28.3 vs. 14.8 vs. 20.3%, P = 0.01) in obese patients. Rates of adenocarcinoma histology were higher in obese patients (90.8 vs. 90.9 vs. 82.5%, P = 0.03). Despite similar preoperative stage, obese patients were less likely to receive neoadjuvant treatment (47.6 vs. 54.5 vs. 66.2%, P = 0.004). Response to neoadjuvant treatment, type of surgery performed, extent of lymphadenectomy, rate of R0 resections, perioperative complications, and administration of adjuvant chemotherapy were not influenced by BMI. At a median follow-up of 25 months, 5-year overall and disease-free survivals were longer in obese patients (respectively, 48, 41, 34%, P = 0.01 and 48, 44, 34%, P = 0.01).
CONCLUSIONS
In our experience, an elevated BMI did not reduce overall and disease-free survivals after esophagectomy for cancer.
背景
在美国，食管癌和肥胖的发病率都在上升。本研究旨在确定体重指数升高对食管癌手术后的结果的影响。
方法
接受食管癌切除术的肥胖（BMI≥30）、超重（BMI 25-29）和正常体重（BMI 20-24）患者的总生存率和无病生存率构成了研究终点。通过 Kaplan-Meier 法计算生存率，并用对数秩法分析差异。
结果
本研究纳入了 166 例肥胖患者、176 例超重患者和 148 例正常体重患者。这三组患者在人口统计学和合并症方面相似，除了年龄较小（62.5 岁比 66.2 岁比 65.3 岁，P=0.002），糖尿病发病率较高（23.5%比 11.4%比 10.1%，P=0.001）和食管裂孔疝发生率较高（28.3%比 14.8%比 20.3%，P=0.01）在肥胖患者中。肥胖患者腺癌组织学比例较高（90.8%比 90.9%比 82.5%，P=0.03）。尽管术前分期相似，但肥胖患者接受新辅助治疗的可能性较小（47.6%比 54.5%比 66.2%，P=0.004）。新辅助治疗的反应、手术类型、淋巴结清扫范围、R0 切除率、围手术期并发症和辅助化疗的应用不受 BMI 影响。在中位随访 25 个月时，肥胖患者的 5 年总生存率和无病生存率较长（分别为 48%、41%、34%，P=0.01 和 48%、44%、34%，P=0.01）。
结论
根据我们的经验，体重指数升高不会降低食管癌手术后的总生存率和无病生存率。
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