术前癌症恶病质与手术后短期结局
Preoperative cancer cachexia and short-term outcomes following surgery.
作者信息
Mason Meredith C, Garcia Jose M, Sansgiry Shubhada, Walder Annette, Berger David H, Anaya Daniel A
机构信息
Department of Medicine, Houston VA Center for Innovations in Quality, Effectiveness and Safety (IQUEST), Michael E. DeBakey VA Medical Center, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Department of Medicine, Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Department of Medicine, Center for Translational Research on Inflammatory Diseases, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas.
出版信息
J Surg Res. 2016 Oct;205(2):398-406. doi: 10.1016/j.jss.2016.06.076. Epub 2016 Jul 4.
BACKGROUND
Cancer cachexia is an important measure of physiologic reserve associated with worse survival and represents an actionable factor for the cancer population. However, the incidence of cachexia in surgical cancer patients and its impact on postoperative outcomes are currently unknown.
METHODS
A prospective cohort study enrolling patients having elective cancer surgery (2012-2014) at a Veterans Affairs tertiary referral center. Preoperative cancer cachexia (weight loss ≥5% over 6-mo period before surgery) was the predictor of interest. The primary outcome was 60-d postoperative complications (VA Surgical Quality Improvement Program). Patients were grouped by body mass index (BMI) category (<25, 25-29.9, ≥30), and interaction between cachexia and BMI was tested for the primary outcome. Multivariate logistic regression was used to examine the association between preoperative cachexia and postoperative complications.
RESULTS
Of 253 patients, 16.6% had preoperative cachexia, and 51.8% developed ≥ 1 postoperative complications. Complications were more common in cachectic patients (64.3% versus 49.3%, P = 0.07). This association varied by BMI category, and interaction analysis was significant for those with normal or underweight BMI (BMI < 25, P = 0.03). After multivariate modeling, in patients with normal or underweight BMI, preoperative cachexia was associated with higher odds of postoperative complications (odds ratios, 5.08 [95% confidence intervals, 1.18-21.88]; P = 0.029). Additional predictors of complications included major surgery (3.19 [1.24-8.21], P = 0.01), ostomy (4.43 [1.68-11.72], P = 0.003), and poor baseline performance status (2.31 [1.05-5.08], P = 0.03).
CONCLUSIONS
Cancer cachexia is common in surgical patients, and is an important predictor of postoperative complications, though its effect varies by BMI. As a modifiable predictor of worse outcomes, future studies should examine the role of cachexia treatment before cancer surgery.
背景
癌症恶病质是与较差生存率相关的生理储备的重要指标，是癌症患者的一个可干预因素。然而，手术癌症患者中恶病质的发生率及其对术后结局的影响目前尚不清楚。
方法
一项前瞻性队列研究，纳入在退伍军人事务部三级转诊中心接受择期癌症手术的患者（2012 - 2014年）。术前癌症恶病质（术前6个月内体重减轻≥5%）是感兴趣的预测因素。主要结局是术后60天并发症（退伍军人事务部外科质量改进计划）。患者按体重指数（BMI）类别（<25、25 - 29.9、≥30）分组，并对恶病质与BMI之间的相互作用进行主要结局测试。采用多因素逻辑回归分析术前恶病质与术后并发症之间的关联。
结果
253例患者中，16.6%有术前恶病质，51.8%发生≥1种术后并发症。恶病质患者并发症更常见（64.3%对49.3%，P = 0.07）。这种关联因BMI类别而异，对于BMI正常或体重过低的患者（BMI < 25，P = 0.03），相互作用分析具有显著性。多因素建模后，在BMI正常或体重过低的患者中，术前恶病质与术后并发症几率较高相关（比值比，5.08 [95%置信区间，1.18 - 21.88]；P = 0.029）。并发症的其他预测因素包括大手术（3.19 [1.24 - 8.21]，P = 0.01）、造口术（4.43 [1.68 - 11.72]，P = 0.003）和基线表现状态差（2.31 [1.05 - 5.08]，P = 0.03）。
结论
癌症恶病质在手术患者中很常见，是术后并发症的重要预测因素，但其影响因BMI而异。作为预后较差的一个可改变的预测因素，未来研究应探讨癌症手术前恶病质治疗的作用。
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