[术前体重减轻对胃癌患者胃切除术后的影响]

[The impact of preoperative weight loss for gastric cancer patients after gastrectomy].

作者信息

Cui Jingli, Liang Han, Deng Jingyu, Ding Xuewei, Pan Yuan, Wang Xiaona, Wang Baogui, Wu Liangliang, Jiang Nan

机构信息

Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2014 Jun;52(6):409-14.

PMID:25219554

Abstract

OBJECTIVE

To elucidate the prognostic influence of preoperative weight loss for gastric cancer.

METHODS

A total of 672 gastric cancer patients who underwent gastrectomy between January 2003 and December 2007 were enrolled. The patients were categorized into three groups according to the percentage of weight loss before surgery: no weight loss group (0%), limited group ( < 10%), and severe group ( ≥ 10%). Compared the clinicopathologic characteristics and analyzed the prognostic influence of preoperative weight loss. The survival was analyzed by Kaplan-Meier survival cure and the prognostic factors were analyzed univariately and multivariately by Cox comparative hazard modal.

RESULTS

Among the 672 cases gastric cancer, no weight loss group had 275 cases, limited group 294 cases, severe group 103 cases. Tumor size (F = 4.386) , tumor location (χ² = 15.864), depth of invasion (χ² = 22.245) , the number of lymph node metastasis (χ² = 23.803), Surgical approach (χ² = 18.423) , extent of lymphadenectomy (χ² = 8.172) , curability (χ² = 15.650) were discrepant among the three groups (all P < 0.05) . The 5-year survival rate of the patients with severe group was 28.0%, limited group was 37.7%, while the no weight loss group was 40.3% (χ² = 20.148, P < 0.05). Age (95% CI: 0.480 - 0.744, P = 0.000), weight loss before surgery (95% CI: 0.371 - 0.687, P = 0.000), depth invasion (95% CI: 0.289 - 0.564, P = 0.000), lymph node metastasis (95% CI: 0.451 - 0.783, P = 0.000), extent of lymphadenectomy (95% CI: 0.647 - 0.990, P = 0.000), curability (95% CI: 0.291 - 0.486, P = 0.000), postoperative adjuvant chemotherapy (95% CI: 0.511 - 0.846, P = 0.000) were associated with survival of this group. In multivariate analysis, age (HR = 1.618, 95% CI: 1.298 - 2.016, P = 0.000), weight loss before surgery (HR = 1.258, 95%CI: 1.077 - 1.469, P = 0.004), depth of invasion (HR = 1.810, 95% CI: 1.287 - 2.545, P = 0.000), N stage (HR = 1.555, 95% CI: 1.413 - 1.172, P = 0.000) were independent prognostic factors for survival.

CONCLUSIONS

Patients with weight loss above 10% have poor prognosis. Weight loss before surgery may be an important independent prognostic factor for gastric cancer.

摘要

目的

阐明术前体重减轻对胃癌预后的影响。

方法

纳入2003年1月至2007年12月期间接受胃切除术的672例胃癌患者。根据术前体重减轻的百分比将患者分为三组：无体重减轻组（0%）、有限组（<10%）和严重组（≥10%）。比较临床病理特征并分析术前体重减轻对预后的影响。采用Kaplan-Meier生存曲线分析生存率，并通过Cox比较风险模型对预后因素进行单因素和多因素分析。

结果

672例胃癌患者中，无体重减轻组275例，有限组294例，严重组103例。三组间肿瘤大小（F = 4.386）、肿瘤位置（χ² = 15.864）、浸润深度（χ² = 22.245）、淋巴结转移数（χ² = 23.803）、手术方式（χ² = 18.423）、淋巴结清扫范围（χ² = 8.172）、根治性（χ² = 15.650）均存在差异（均P < 0.05）。严重组患者的5年生存率为28.0%，有限组为37.7%，无体重减轻组为40.3%（χ² = 20.148，P < 0.05）。年龄（95%CI：0.480 - 0.744，P = 0.000）、术前体重减轻（95%CI：0.371 - 0.687，P = 0.000）、浸润深度（95%CI：0.289 - 0.564，P = 0.000）、淋巴结转移（95%CI：0.451 - 0.783，P = 0.000）、淋巴结清扫范围（95%CI：0.647 - 0.990，P = 0.000）、根治性（95%CI：0.291 - 0.486，P = 0.000）、术后辅助化疗（95%CI：0.511 - 0.846，P = 0.000）与该组患者的生存相关。多因素分析中，年龄（HR = 1.618，95%CI：1.298 - 2.016，P = 0.000）、术前体重减轻（HR = 1.258，95%CI：1.077 - 1.469，P = 0.004）浸润深度（HR = 1.810，95%CI：1.287 - 2.545，P = 0.000）、N分期（HR = 1.555，95%CI：1.413 - 1.172，P = 0.000）是生存的独立预后因素。