早期胃癌患者发生结核病的危险因素：胃切除术是结核病的重要危险因素吗？

Risk Factors for TB in Patients With Early Gastric Cancer: Is Gastrectomy a Significant Risk Factor for TB?

作者信息

Choi Il Ju, Kim Young-Woo, Lee Hee Seok, Ryu Keun Won, Yoon Hong Man, Eom Bang Wool, Kim Chan Gyoo, Lee Jong Yeul, Cho Soo-Jeong, Nam Byung-Ho

机构信息

Center for Gastric Cancer, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea; Center for Gastric Cancer, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea; Department of Internal Medicine, and the Cancer Biostatistics Branch, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea.

Center for Gastric Cancer, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea; Department of Internal Medicine, and the Cancer Biostatistics Branch, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea.

出版信息

Chest. 2015 Sep;148(3):774-783. doi: 10.1378/chest.15-0056.

DOI:10.1378/chest.15-0056

PMID:25811396

Abstract

BACKGROUND

Gastrectomy is known as one of the risk factors for TB. However, there is no study about the association between TB development and gastrectomy performed in patients with early gastric cancer (EGC). This study evaluated conventional risk factors, including gastrectomy, associated with TB development in patients with EGC.

METHODS

A retrospective cohort study was performed using the database of the Center for Gastric Cancer of the National Cancer Center, Korea. The patients with EGC whose T1 lesions were pathologically confirmed by gastrectomy or endoscopic resection were included.

RESULTS

A total of 1,935 patients constituted the EGC cohort. Of these, 1,495 patients were confirmed by gastrectomy and the remaining 440 by endoscopic resection. The median follow-up duration was 4.9 years, and during this period, 31 cases of TB developed (TB incidence, 334/100,000 person-years; 95% CI, 227-475). Multivariate Cox regression analysis showed that old TB lesion on chest radiograph and gastrectomy were significant risk factors (hazard ratio [HR], 5.01; 95% CI, 2.44-10.28; P < .001; and HR, 8.95; 95% CI, 1.22-65.78; P = .031; respectively). In the gastrectomy subgroup, old TB lesion and ≥ 15% reduction in weight and albumin level about 1 year after gastrectomy were significant risk factors (HR, 4.80; 95% CI, 2.26-10.18; P < .001; HR, 3.08; 95% CI, 1.47-6.48; P = .003; and HR, 5.02; 95% CI, 1.47-17.12; P = .010; respectively).

CONCLUSIONS

Old TB lesion and gastrectomy were significant risk factors in the EGC cohort. In addition, old TB lesion and ≥ 15% postoperative reductions in weight and albumin level were significant risk factors in the gastrectomy subgroup.

摘要

背景

胃切除术是已知的结核病危险因素之一。然而，尚无关于早期胃癌（EGC）患者结核病发生与胃切除术之间关联的研究。本研究评估了包括胃切除术在内的与EGC患者结核病发生相关的传统危险因素。

方法

利用韩国国立癌症中心胃癌中心的数据库进行了一项回顾性队列研究。纳入经胃切除术或内镜切除术病理确诊为T1病变的EGC患者。

结果

共有1935例患者构成EGC队列。其中，1495例患者经胃切除术确诊，其余440例经内镜切除术确诊。中位随访时间为4.9年，在此期间，发生了31例结核病（结核病发病率，334/100,000人年；95%CI，227 - 475）。多因素Cox回归分析显示，胸部X线片上的陈旧性结核病灶和胃切除术是显著的危险因素（风险比[HR]，5.01；95%CI，2.44 - 10.28；P <.001；以及HR，8.95；95%CI，1.22 - 65.78；P =.031；）。在胃切除术亚组中，陈旧性结核病灶以及胃切除术后约1年体重下降≥15%和白蛋白水平下降是显著的危险因素（HR，4.80；9%CI，2.26 - 10.18；P <.001；HR，3.08；95%CI，1.47 - 6.48；P =.003；以及HR，5.02；95%CI，1.47 - 17.12；P =.010；）。