Oh Hyun Jin, Lim Chul-Hyun, Yoon Byung-Ho, Yoon Seung Bae, Baeg Myong Ki, Kim Won Chul, Cho Yu Kyung, Park Jae Myung, Choi Myung-Gyu, Yoo Han Mo, Song Kyo Young, Jeon Hae Myung, Park Cho Hyun
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea.
Eur J Cancer. 2017 Feb;72:28-36. doi: 10.1016/j.ejca.2016.11.023. Epub 2016 Dec 23.
Gastrectomy is a known risk factor for decreased bone mass. We aimed to evaluate the cumulative incidence and predictive factors of fracture in gastric cancer patients who underwent gastrectomy.
We retrospectively reviewed the records of 1687 patients who underwent gastrectomy for gastric cancer at our hospital between September 1991 and December 2008. The exclusion criteria were stage IV gastric cancer, history of cancer recurrence, medical conditions that cause osteoporosis and high-energy injury. Fractures at sites considered to be associated with osteoporosis were diagnosed radiologically.
In total, our analysis included the records of 1131 patients. The incidence of postgastrectomy fracture was 42.1 cases per 1000 person-years. Fractures typically occurred within 3.7 ± 0.5 years postoperatively. The cumulative incidence of fracture was 9.1%, 19.7%, and 37.3% by postoperative year 2, 4, and 6, respectively. During the following years, the cumulative incidence increased slowly, up to a final 40.6%. Multivariate analysis showed that older age (hazard ratio, 1.03; 95% confidence interval, 1.01-1.04) and smoking (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73) were significantly associated with fracture, whereas sex, body mass index, percent weight loss, diabetes mellitus, tumour stage, and type of gastrectomy were not.
The cumulative incidence of fracture is high in gastric cancer patients who have undergone gastrectomy, and fracture rate is higher during the early postoperative period. Old age and smoking are independent risk factors for postgastrectomy fracture in these patients. More detailed postoperative surveillance and pharmacological intervention should be considered to prevent fracture.
胃切除术是已知的骨量减少风险因素。我们旨在评估接受胃切除术的胃癌患者骨折的累积发生率及预测因素。
我们回顾性分析了1991年9月至2008年12月期间在我院因胃癌接受胃切除术的1687例患者的病历。排除标准为IV期胃癌、癌症复发史、导致骨质疏松的内科疾病及高能损伤。通过放射学诊断与骨质疏松相关部位的骨折。
我们的分析共纳入1131例患者的病历。胃切除术后骨折发生率为每1000人年42.1例。骨折通常发生在术后3.7±0.5年。术后第2年、第4年和第6年骨折的累积发生率分别为9.1%、19.7%和37.3%。在随后几年中，累积发生率缓慢上升，最终达到40.6%。多因素分析显示，年龄较大（风险比，1.03；95%置信区间，1.01 - 1.04）和吸烟（风险比，1.35；95%置信区间，1.05 - 1.73）与骨折显著相关，而性别、体重指数、体重减轻百分比、糖尿病、肿瘤分期和胃切除术类型则无相关性。
接受胃切除术的胃癌患者骨折累积发生率较高，且术后早期骨折率更高。年龄较大和吸烟是这些患者胃切除术后骨折的独立风险因素。应考虑更详细的术后监测和药物干预以预防骨折。
