Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, 200025, China.
Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, 200025, China.
Int J Med Sci. 2020 Aug 25;17(15):2276-2284. doi: 10.7150/ijms.46530. eCollection 2020.
The present study focused on the long-term prognostic value of dynamic body mass index (BMI) change in gastric cancer patients who underwent gastrectomy. : Clinical data from a total of 576 gastric cancer patients who underwent radical gastrectomy were collected. Univariate and multivariate analyses were performed to demonstrate the association between dynamic BMI variables (BMI before surgery, 1 month, 6 months or 12 months after surgery) and prognosis (DFS and OS). The correlation between BMI loss after surgery and survival outcomes was also evaluated. : Post-operative BMI, especially BMI at one year after surgery (<0.001), was an independent risk factor of recurrence and mortality, wherein patients with high-BMI (≥23) showed significantly better outcomes than patients with normal-BMI (18.5-23) (DFS, HR:0.49; 95% CI:0.31-0.78; OS, HR:0.30; 95% CI: 0.15-0.59). On the contrary, low-BMI (<18.5) patients presented with worse outcomes (DFS, HR: 1.34; 95% CI: 1.00-1.80; OS, HR: 1.68; 95% CI: 1.20-2.34). In addition, compared with moderate BMI loss (≤10%), severe postoperative BMI loss (>10%) at one year was independently associated with substantially worse prognosis for DFS (HR: 1.54; 95% CI: 1.15-2.08) and OS (HR: 1.45; 95% CI: 1.02-2.06). Subgroup analysis indicated that gender (=0.03), extent of resection (<0.001), tumor site (=0.001) and perineural invasion (=0.007) were associated with postoperative BMI loss at one year. The prognostic value of postoperative BMI loss at one year was consistent among most clinicopathological subgroups, except for tumor site (interaction =0.025 for OS). : In Chinese gastric cancer patients who underwent gastrectomy, higher postoperative BMI (≥ 23) was significantly associated with longer survival time, whereas severe BMI loss (>10%) at one year after surgery was associated with worse outcomes. Thus, body weight maintenance after treatment is important, and dynamic monitoring of body weight and nutritional status should be emphasized in clinical practice.
本研究旨在探讨胃癌患者接受胃切除术后动态体重指数(BMI)变化的长期预后价值。共收集了 576 例接受根治性胃切除术的胃癌患者的临床资料。采用单因素和多因素分析,探讨了手术前、术后 1 个月、6 个月和 12 个月的动态 BMI 变量(BMI)与预后(DFS 和 OS)之间的关系。还评估了术后 BMI 丢失与生存结局的相关性。术后 BMI,尤其是术后 1 年的 BMI(<0.001),是复发和死亡的独立危险因素,其中高 BMI(≥23)患者的预后明显优于正常 BMI(18.5-23)患者(DFS,HR:0.49;95%CI:0.31-0.78;OS,HR:0.30;95%CI:0.15-0.59)。相反,低 BMI(<18.5)患者的预后较差(DFS,HR:1.34;95%CI:1.00-1.80;OS,HR:1.68;95%CI:1.20-2.34)。此外,与中等 BMI 丢失(≤10%)相比,术后 1 年严重的 BMI 丢失(>10%)与 DFS(HR:1.54;95%CI:1.15-2.08)和 OS(HR:1.45;95%CI:1.02-2.06)的预后显著恶化相关。亚组分析表明,性别(=0.03)、切除范围(<0.001)、肿瘤部位(=0.001)和神经周围侵犯(=0.007)与术后 1 年的 BMI 丢失有关。术后 1 年 BMI 丢失的预后价值在大多数临床病理亚组中是一致的,但肿瘤部位除外(OS 的交互作用=0.025)。在中国接受胃切除术的胃癌患者中,较高的术后 BMI(≥23)与较长的生存时间显著相关,而术后 1 年严重的 BMI 丢失(>10%)与较差的预后相关。因此,治疗后体重维持很重要,应在临床实践中强调动态监测体重和营养状况。