体重指数对食管癌切除术后并发症和生存的影响：基于临床的队列研究和荟萃分析。
The impact of body mass index on complication and survival in resected oesophageal cancer: a clinical-based cohort and meta-analysis.
机构信息
1] Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China [2] Guangdong Esophageal Cancer Research Institute, Guangzhou, People's Republic of China [3] Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.
出版信息
Br J Cancer. 2013 Nov 26;109(11):2894-903. doi: 10.1038/bjc.2013.666. Epub 2013 Nov 7.
BACKGROUND
Body mass index (BMI) has been associated with the risk of oesophageal cancer. But the influence of BMI on postoperative complication and prognosis has always been controversial.
METHODS
In total, 2031 consecutive patients who underwent oesophagectomy between 1998 and 2008 were classified according to Asian-specific BMI (kg m(-2)) cutoff values. The impact of BMI on overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazard models. We performed a meta-analysis to examine the association of BMI with OS and postoperative complication.
RESULTS
Patients with higher BMI had more postoperative complication (P=0.002), such as anastomotic leakage (P=0.016) and cardiovascular diseases (P<0.001), but less incidence of chylous leakage (P=0.010). Logistic regression analysis showed that BMI (P=0.005) was a confounding factor associated with postoperative complication. Multivariate analysis showed that overweight and obese patients had a more favourable survival than normal weight patients (HR (hazard ratio) = 0.80, 95% CI (confidence interval): 0.70-0.92, P=0.001). Subgroup analysis showed that the association with higher BMI and increased OS was observed in patients with oesophageal squamous cell carcinoma (ESCC) (P<0.001), oesophageal adenocarcinoma (EA) (P=0.034), never-smoking (P=0.035), ever-smoking (P=0.035), never alcohol consumption (P=0.005), weight loss (P=0.003) and advanced pathological stage (P<0.001). The meta-analysis further corroborated that higher BMI was associated with increased complication of anastomotic leakage (RR (risk ratio)=1.04, 95% CI: 1.02-1.06, P=0.001), wound infection (RR=1.03, 95% CI: 1.00-1.05, P=0.031) and cardiovascular diseases (RR=1.02, 95% CI: 1.00-1.05, P=0.039), but decreased incidence of chylous leakage (RR=0.98, 95% CI: 0.96-0.99, P<0.001). In addition, high BMI could significantly improved OS (HR=0.78, 95% CI: 0.71-0.85, P<0.001).
CONCLUSION
Preoperative BMI was an independent prognostic factor for survival, and strongly associated with postoperative complications in oesophageal cancer.
背景
体重指数（BMI）与食管癌风险相关。但 BMI 对术后并发症和预后的影响一直存在争议。
方法
共纳入 1998 年至 2008 年间接受食管癌切除术的 2031 例连续患者，根据亚洲特定 BMI（kg/m²）截断值进行分类。使用 Kaplan-Meier 方法和 Cox 比例风险模型估计 BMI 对总生存（OS）的影响。我们进行了荟萃分析，以检查 BMI 与 OS 和术后并发症的关系。
结果
BMI 较高的患者术后并发症发生率更高（P=0.002），如吻合口漏（P=0.016）和心血管疾病（P<0.001），但乳糜漏发生率较低（P=0.010）。逻辑回归分析显示 BMI（P=0.005）是与术后并发症相关的混杂因素。多变量分析显示，超重和肥胖患者的生存预后优于正常体重患者（HR=0.80，95%CI：0.70-0.92，P=0.001）。亚组分析显示，BMI 较高与 OS 增加的关联在食管鳞癌（ESCC）（P<0.001）、食管腺癌（EA）（P=0.034）、从不吸烟（P=0.035）、吸烟（P=0.035）、从不饮酒（P=0.005）、体重减轻（P=0.003）和晚期病理分期（P<0.001）患者中更为明显。荟萃分析进一步证实，较高的 BMI 与吻合口漏（RR=1.04，95%CI：1.02-1.06，P=0.001）、伤口感染（RR=1.03，95%CI：1.00-1.05，P=0.031）和心血管疾病（RR=1.02，95%CI：1.00-1.05，P=0.039）的并发症发生率增加相关，但乳糜漏发生率降低（RR=0.98，95%CI：0.96-0.99，P<0.001）。此外，高 BMI 可显著改善 OS（HR=0.78，95%CI：0.71-0.85，P<0.001）。
结论
术前 BMI 是生存的独立预后因素，与食管癌术后并发症密切相关。
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