Nakagawa Tatsuo, Toyazaki Toshiya, Chiba Naohisa, Ueda Yuichiro, Gotoh Masashi
Department of Thoracic Surgery, Tenri Hospital, Tenri, Nara, Japan
Department of Thoracic Surgery, Tenri Hospital, Tenri, Nara, Japan.
Interact Cardiovasc Thorac Surg. 2016 Oct;23(4):560-6. doi: 10.1093/icvts/ivw175. Epub 2016 May 31.
Nutritional status is associated with an effect on oncological outcomes. However, the effect of nutritional status on postoperative survival in lung cancer has not been well studied. We retrospectively analysed and evaluated the effect of preoperative body mass index (BMI) and changes in body weight on postoperative outcomes of lung cancer surgery.
A total of 1311 patients with non-small-cell lung cancer who underwent surgery between January 2001 and December 2011 were included in this study. Preoperative body weight at 4-12 weeks prior to surgery was obtained in 737 patients and the ratio of change in body weight was calculated.
The patients were classified into four groups as follows: underweight (BMI < 18.5), normal weight (BMI from ≥18.5 to <25), overweight (BMI from ≥25 to <30) and obese (BMI ≥ 30). Postoperative survival curves of the BMI groups showed that the underweight group had a poorer prognosis than the other groups, especially for disease-free survival (DFS) (P = 0.03). Univariate and adjusted survival analyses using Cox's proportional hazards regression model showed that low BMI was a significantly poor prognostic factor in overall survival (OS) (P = 0.03 and P = 0.02, respectively) and DFS (P < 0.01 and P < 0.01, respectively). Among the BMI groups, the underweight group had a significant worse prognosis than the other groups for DFS in univariate and adjusted analyses (P = 0.04 and P < 0.01, respectively). With regard to changes in body weight, patients with a body weight loss of 3.7% or greater had a significantly poorer prognosis for OS and DFS in univariate analysis and for DFS in adjusted analyses compared with the other patients. Regarding short-term outcomes, the weight loss group had a significantly longer postoperative hospital stay than the non-weight loss group (P = 0.02) and postoperative 90-day mortality was significantly lower in the normal weight group than in the underweight group (P = 0.03).
Low BMI and significant body weight loss before surgery have a negative effect on surgical outcomes for patients with non-small-cell lung cancer.
营养状况与肿瘤学结局相关。然而，营养状况对肺癌术后生存的影响尚未得到充分研究。我们回顾性分析并评估了术前体重指数（BMI）和体重变化对肺癌手术术后结局的影响。
本研究纳入了2001年1月至2011年12月期间接受手术的1311例非小细胞肺癌患者。737例患者获取了术前4 - 12周的体重，并计算体重变化率。
患者分为以下四组：体重过轻（BMI < 18.5）、正常体重（BMI≥18.5至<25）、超重（BMI≥25至<30）和肥胖（BMI≥30）。BMI分组的术后生存曲线显示，体重过轻组的预后比其他组差，尤其是无病生存期（DFS）（P = 0.03）。使用Cox比例风险回归模型进行的单因素和校正生存分析表明，低BMI是总生存期（OS）（分别为P = 0.03和P = 0.02）和DFS（分别为P < 0.01和P < 0.01）的显著不良预后因素。在BMI分组中，单因素和校正分析显示体重过轻组的DFS预后明显比其他组差（分别为P = 0.04和P < 0.01）。关于体重变化，体重减轻3.7%或更多的患者在单因素分析中的OS和DFS以及校正分析中的DFS预后明显比其他患者差。关于短期结局，体重减轻组的术后住院时间明显长于非体重减轻组（P = 0.02），正常体重组的术后90天死亡率明显低于体重过轻组（P = 0.03）。
术前低BMI和显著体重减轻对非小细胞肺癌患者的手术结局有负面影响。
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