The Ohio State University Wexner Medical Center, Columbus, OH, USA.
The Ohio State University Wexner Medical Center, Columbus, OH, USA; University of Verona, Verona, Italy.
Eur J Surg Oncol. 2019 Jun;45(6):1084-1091. doi: 10.1016/j.ejso.2019.03.004. Epub 2019 Mar 7.
The association between body mass index (BMI) and long-term outcomes of patients with ICC has not been well defined. We sought to define the presentation and oncologic outcomes of patients with ICC undergoing curative-intent resection, according to their BMI category.
Patients who underwent resection of ICC were identified in a multi-institutional database. Patients were categorized as normal weight (BMI 18.5-24.9 kg/m), overweight (BMI 25.0-29.9 kg/m) and obese (BMI≥30 kg/m) according to the World Health Organization (WHO) definition. Impact of clinico-pathological factors on recurrence-free survival (RFS) was assessed using Cox proportional hazards model among patients in the three BMI categories.
Among a total of 790 patients undergoing curative-intent resection of ICC in the analytic cohort, 399 (50.5%) had normal weight, 274 (34.7%) were overweight and 117 (14.8%) were obese. Caucasian patients were more likely to be obese (66.7%, n = 78) and overweight (47.1%, n = 129) compared with Asian (obese: 18.8%, n = 22; overweight: 46%, n = 126) and other races (obese: 14.5%, n = 17; overweight: 6.9%, n = 19)(p < 0.001). There were no differences in the presence of cirrhosis (10.9%, vs. 12.8%, vs. 12.9%), preoperative jaundice (8.6% vs. 9.5% vs. 12.0%), or levels of CA 19-9 (75, IQR 24.6-280 vs. 50.9, IQR 17.9-232 vs. 43, IQR 16.9-192.7) among the BMI groups (all p > 0.05). On multivariable analysis, increased BMI was an independent risk factor for tumor recurrence (OR 1.16, 95% CI 1.02-1.32, for every 5 unit increase).
Increasing BMI was associated with incremental increases in the risk of recurrence following curative-intent resection of ICC. Future studies should aim to achieve a better understanding of BMI-related factors relative to prognosis of patients with ICC.
体重指数（BMI）与 ICC 患者的长期预后之间的关系尚未明确。我们旨在根据 BMI 类别，确定接受根治性切除术的 ICC 患者的表现和肿瘤学结局。
在一个多机构数据库中确定接受 ICC 切除术的患者。根据世界卫生组织（WHO）的定义，患者被分为正常体重（BMI 18.5-24.9 kg/m）、超重（BMI 25.0-29.9 kg/m）和肥胖（BMI≥30 kg/m）。在这三个 BMI 类别中的患者中，使用 Cox 比例风险模型评估临床病理因素对无复发生存率（RFS）的影响。
在分析队列中，总共 790 例接受 ICC 根治性切除术的患者中，399 例（50.5%）体重正常，274 例（34.7%）超重，117 例（14.8%）肥胖。与亚洲人（肥胖：18.8%，n=22；超重：46%，n=126）和其他种族（肥胖：14.5%，n=17；超重：6.9%，n=19）相比，白人患者更有可能肥胖（66.7%，n=78）和超重（47.1%，n=129）（p<0.001）。各组在肝硬化（10.9%，12.8%，12.9%）、术前黄疸（8.6%，9.5%，12.0%）或 CA 19-9 水平（75，IQR 24.6-280 vs. 50.9，IQR 17.9-232 vs. 43，IQR 16.9-192.7）方面无差异（均 p>0.05）。在多变量分析中，BMI 增加是肿瘤复发的独立危险因素（OR 1.16，95%CI 1.02-1.32，每增加 5 个单位）。
在接受 ICC 根治性切除术的患者中，BMI 的增加与复发风险的增加相关。未来的研究应旨在更好地了解与 ICC 患者预后相关的 BMI 相关因素。
