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BMI 调整后预测接受根治性胃切除术的胃腺癌患者的印戒细胞癌预后。

BMI-adjusted prognosis of signet ring cell carcinoma in patients undergoing radical gastrectomy for gastric adenocarcinoma.

机构信息

Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.

出版信息

Asian J Surg. 2021 Jan;44(1):116-122. doi: 10.1016/j.asjsur.2020.03.023. Epub 2020 May 25.

DOI:10.1016/j.asjsur.2020.03.023

PMID:32467008

Abstract

BACKGROUND

Compared with other histologic types, signet ring cell gastric carcinoma (SRC) has unique oncological characteristics, and its implication on the prognosis of gastric cancer patients remains unclear. The purpose of this study was to evaluate the prognostic impact of body mass index (BMI) on SRC patients.

METHODS

A retrospective analysis was performed using the clinical records of 3342 patients with SRC or tubular adenocarcinoma who underwent radical gastrectomy between 2000 and 2014. Patients were divided into three groups according to histologic subtype: SRC, well-to-moderately differentiated adenocarcinoma (WMD), and poorly differentiated adenocarcinoma (PD). We compared the survival of SRC patients with that of tubular adenocarcinoma patients according to BMI.

RESULTS

The 5-year survival of SRC was significantly worse than that of WMD (P < 0.001) but superior to that of PD (P < 0.001). BMI-stratified analysis showed that in the high-BMI group, the prognosis of SRC was similar to that of WMD (P > 0.05) and better than that of PD (P < 0.001). In normal-BMI patients, SRC had a worse prognosis than WMD (P < 0.001) but a more favorable prognosis than PD (P < 0.001). SRC among low-BMI patients displayed much poorer survival than did both WMD (P < 0.001) and PD (P = 0.005). Multivariate analysis indicated that the risk of death was the lowest in SRC patients with a high BMI and highest for SRC patients with a low BMI (low-BMI hazard ratio: SRC 1 vs. WMD 0.51 and PD 0.53).

CONCLUSION

SRC has worse prognostic impact as BMI decreases. BMI leads to differing prognosis of SRC compared with tubular adenocarcinoma.

摘要

背景

与其他组织学类型相比，印戒细胞胃癌（SRC）具有独特的肿瘤学特征，但其对胃癌患者预后的影响尚不清楚。本研究旨在评估体重指数（BMI）对 SRC 患者的预后影响。

方法

对 2000 年至 2014 年间接受根治性胃切除术的 3342 例 SRC 或管状腺癌患者的临床记录进行回顾性分析。根据组织学亚型将患者分为三组：SRC、中-高分化腺癌（WMD）和低分化腺癌（PD）。我们根据 BMI 比较了 SRC 患者和管状腺癌患者的生存情况。

结果

SRC 的 5 年生存率明显差于 WMD（P<0.001），但优于 PD（P<0.001）。BMI 分层分析显示，在高 BMI 组中，SRC 的预后与 WMD 相似（P>0.05），优于 PD（P<0.001）。在正常 BMI 患者中，SRC 的预后差于 WMD（P<0.001），但优于 PD（P<0.001）。在低 BMI 患者中，SRC 的生存情况明显差于 WMD（P<0.001）和 PD（P=0.005）。多因素分析表明，BMI 较高的 SRC 患者死亡风险最低，BMI 较低的 SRC 患者死亡风险最高（低 BMI 风险比：SRC 1 比 WMD 0.51 和 PD 0.53）。