Chen Zhen-Xin, Jian Zhi-Wei, Wu Xi-Wen, Wang Jun-Cheng, Peng Jing-Yuan, Huang Chun-Yu, Lao Xiang-Ming
Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China.
Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China.
Gastroenterol Rep (Oxf). 2019 Aug 28;8(2):125-133. doi: 10.1093/gastro/goz040. eCollection 2020 Apr.
The effects of overweightness and weight loss on the development and prognosis of hepatocellular carcinoma (HCC) remain unclear. In this study, we aimed to evaluate the impact of overweightness and weight loss on the survival of patients with intermediate/advanced HCC receiving chemoembolization as initial treatment.
We examined 1,170 patients who underwent chemoembolization as initial treatment for Barcelona-Clínic Liver Cancer stages B and C HCC at Sun Yat-sen University Cancer Center (Guangzhou, China) between December 2009 and May 2015. A baseline body mass index (BMI) of ≥23 kg/m was defined as overweight, and body-weight loss of ≥5.0% from baseline was defined as critical weight loss (CWL). Cox regression analysis was used to determine the association between overweightness or CWL and overall survival (OS).
The median survival time was 16.8 (95% confidence interval, 13.9-19.7) months and 11.1 (95% confidence interval, 10.0-12.2) months in the overweight and non-overweight groups (log-rank test, <0.001), respectively. Cox multivariate analysis identified overweightness as an independent protective prognostic factor for OS (<0.001). Subgroup stratification analysis revealed a significant association between overweightness and survival among patients receiving further treatment (=0.005), but not in those not receiving further treatment (=0.683). Multivariate analysis showed that both overweightness and CWL were independent prognostic factors for OS among patients receiving further treatment.
Among patients with intermediate- or advanced-stage HCC initially treated with chemoembolization, overweightness was associated with longer OS. Furthermore, CWL was an independent adverse prognostic factor for OS in patients receiving additional treatment.
超重和体重减轻对肝细胞癌（HCC）发生发展及预后的影响尚不清楚。本研究旨在评估超重和体重减轻对接受化疗栓塞作为初始治疗的中晚期HCC患者生存的影响。
我们研究了2009年12月至2015年5月期间在中山大学肿瘤防治中心（中国广州）因巴塞罗那临床肝癌分期B和C期HCC接受化疗栓塞作为初始治疗的1170例患者。基线体重指数（BMI）≥23kg/m²定义为超重，体重较基线下降≥5.0%定义为临界体重减轻（CWL）。采用Cox回归分析确定超重或CWL与总生存期（OS）之间的关联。
超重组和非超重组的中位生存时间分别为16.8（95%置信区间，13.9 - 19.7）个月和11.1（95%置信区间，10.0 - 12.2）个月（对数秩检验，<0.001）。Cox多因素分析确定超重是OS的独立保护性预后因素（<0.001）。亚组分层分析显示，接受进一步治疗的患者中超重与生存之间存在显著关联（P = 0.005），但未接受进一步治疗的患者中无此关联（P = 0.683）。多因素分析表明，超重和CWL都是接受进一步治疗患者OS的独立预后因素。
在接受化疗栓塞初始治疗的中晚期HCC患者中，超重与较长的OS相关。此外，CWL是接受额外治疗患者OS的独立不良预后因素。
