Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.
Department of General Surgery, No. 534 Hospital of PLA, West Lichun Road, Luoyang, Henan, 471000, China.
BMC Cancer. 2018 Feb 6;18(1):151. doi: 10.1186/s12885-018-4063-9.
The association between body mass index (BMI) and clinical outcomes of gastric cancer were still under debate. The aim of the present study was to investigate the impact of BMI on intraoperative conditions, postoperative complications and prognosis of gastric cancer.
From October 2008 to March 2015, 1210 gastric cancer patients treated with D2 gastrectomy were enrolled in the present study. Patients were divided into three groups: low BMI group (BMI < 18.5 Kg/m), normal BMI group (18.5 Kg/m ≤ BMI < 25.0 Kg/m) and high BMI group (BMI ≥ 25.0 Kg/m). Clinicopathological characteristics and prognosis of patients were recorded and analyzed. Propensity score matching was used to match patients in the three groups.
There were 107 patients in low BMI group (8.9%), 862 patients in normal BMI group (71.2%) and 241 patients in high BMI group (19.95%). Before matching, BMI was inversely associated with tumor size, tumor depth, lymph node metastasis (LNM) and tumor stage (all P < 0.05). After matching, the clinicopathological features were all comparable among the three groups (all P > 0.05). High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes (all P < 0.05). For postoperative complications, low BMI was associated with decreased rate of postoperative fever (P = 0.025). Age, BMI, tumor size, Borrmann type, pathological type, type of gastrectomy, tumor depth, LNM and tumor stage were risk factors for the prognosis of gastric cancer. Multivariate analysis showed that only BMI, tumor size, tumor depth and LNM were independent prognostic factors. The overall survival of patients with low BMI was significantly worse than patients with normal (P < 0.05) or high BMI (P < 0.05). However, the overall survival was comparable between patients with normal and high BMI (P > 0.05).
BMI was inversely associated with tumor size, tumor depth, LNM and tumor stage. High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes. Low BMI was associated with decreased rate of postoperative fever and decreased survival.
体重指数（BMI）与胃癌临床结局之间的关系仍存在争议。本研究旨在探讨 BMI 对胃癌患者术中情况、术后并发症和预后的影响。
本研究纳入了 2008 年 10 月至 2015 年 3 月期间接受 D2 胃切除术的 1210 例胃癌患者。将患者分为三组：低 BMI 组（BMI<18.5kg/m）、正常 BMI 组（18.5kg/m≤BMI<25.0kg/m）和高 BMI 组（BMI≥25.0kg/m）。记录并分析患者的临床病理特征和预后。采用倾向评分匹配法对三组患者进行匹配。
低 BMI 组 107 例（8.9%），正常 BMI 组 862 例（71.2%），高 BMI 组 241 例（19.95%）。匹配前，BMI 与肿瘤大小、肿瘤深度、淋巴结转移（LNM）和肿瘤分期呈负相关（均 P<0.05）。匹配后，三组患者的临床病理特征均具有可比性（均 P>0.05）。高 BMI 与术中出血量和手术时间增加、淋巴结清扫数目减少有关（均 P<0.05）。对于术后并发症，低 BMI 与术后发热发生率降低有关（P=0.025）。年龄、BMI、肿瘤大小、Bormann 分型、病理类型、胃切除术类型、肿瘤深度、LNM 和肿瘤分期是胃癌预后的危险因素。多因素分析显示，只有 BMI、肿瘤大小、肿瘤深度和 LNM 是独立的预后因素。低 BMI 患者的总生存率明显低于正常 BMI（P<0.05）或高 BMI（P<0.05）患者。然而，正常 BMI 和高 BMI 患者的总生存率相当（P>0.05）。
BMI 与肿瘤大小、肿瘤深度、LNM 和肿瘤分期呈负相关。高 BMI 与术中出血量和手术时间增加、淋巴结清扫数目减少有关。低 BMI 与术后发热发生率降低和生存率降低有关。
