肥胖不影响肝细胞癌患者根治性肝切除术后的预后。
Obesity Does Not Influence Outcomes in Hepatocellular Carcinoma Patients following Curative Hepatectomy.
作者信息
Guo Zhe, Zhang Jun, Jiang Jing-Hang, Li Le-Qun, Xiang Bang-De
机构信息
Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China; Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Wuhan, P.R. China.
Department of Ultrasound, Wuhan NO. 1 Hospital, Wuhan, P.R. China.
出版信息
PLoS One. 2015 May 12;10(5):e0125649. doi: 10.1371/journal.pone.0125649. eCollection 2015.
BACKGROUND
Whether obesity affects surgical outcomes in patients with hepatocellular carcinoma (HCC) is controversial. Here we retrospectively evaluated the impact of obesity on outcomes in HCC patients after curative hepatectomy.
METHODS
Patients with Child-Pugh A liver function who underwent curative hepatectomy between 2006 and 2010 were categorized as obese (BMI ≥25 kg/m2, n = 68) and non-obese (<25 kg/m2, n = 242). To reduce interference from baseline differences between the two groups, propensity score-matched analysis was performed in the ratio 1:2 using a caliper width of 0.1. Surgical outcomes were compared for 61 obese and 115 non-obese patients.
RESULTS
Obese patients had higher levels of albumin and aspartate aminotransferase, and more solitary tumors compared to the non-obese patients (all P<0.05). In the propensity-matched cohort, baseline characteristics did not differ between the two groups (all P>0.05). Obese and non-obese patients had comparable 30-day mortality (1.6% vs. 2.6%, P = 1.000), 90-day mortality (3.3% vs. 4.3%, P = 1.000), and incidence of postoperative complications (19.7% vs. 18.3%, P = 0.819). Overall survival at 1, 3, and 5 years was similar for obese patients (83.6%, 63.6%, 41.6%) as for non-obese patients (80.9%, 65.9%, 49.1%; P = 0.358). Disease-free survival at 1, 3, and 5 years was also similar for obese patients (71.5%, 36.3%, 24.3%) as for non-obese ones (60.2%, 43.7%, 27.7%; P = 0.969).
CONCLUSION
Our propensity score-matched analysis strengthens the case that obesity does not adversely affect surgical outcomes of HCC patients undergoing curative hepatectomy.
背景
肥胖是否会影响肝细胞癌（HCC）患者的手术疗效存在争议。在此，我们回顾性评估了肥胖对接受根治性肝切除术后的HCC患者预后的影响。
方法
将2006年至2010年间接受根治性肝切除术且肝功能为Child-Pugh A级的患者分为肥胖组（BMI≥25 kg/m2，n = 68）和非肥胖组（<25 kg/m2，n = 242）。为减少两组间基线差异的干扰，采用倾向评分匹配分析，以1:2的比例、卡尺宽度为0.1进行。比较了61例肥胖患者和115例非肥胖患者的手术结果。
结果
与非肥胖患者相比，肥胖患者的白蛋白和天冬氨酸转氨酶水平更高，且孤立肿瘤更多（均P<0.05）。在倾向评分匹配队列中，两组间基线特征无差异（均P>0.05）。肥胖和非肥胖患者的30天死亡率（1.6%对2.6%，P = 1.000）、90天死亡率（3.3%对4.3%，P = 1.000）及术后并发症发生率（19.7%对18.3%，P = 0.819）相当。肥胖患者1年、3年和5年的总生存率（83.6%、63.6%、41.6%）与非肥胖患者（80.9%、65.9%、49.1%；P = 0.358）相似。肥胖患者1年、3年和5年的无病生存率（71.5%、36.3%、24.3%）与非肥胖患者（60.2%、43.7%、27.7%；P = 0.969）也相似。
结论
我们的倾向评分匹配分析进一步证明，肥胖不会对接受根治性肝切除术的HCC患者的手术疗效产生不利影响。
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