Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2022 Jul 8;17(7):e0270460. doi: 10.1371/journal.pone.0270460. eCollection 2022.
Despite an association between obesity and increased mortality in the general population, obesity has been paradoxically reported with improved mortality of surgery and some types of cancer. However, this has not been fully investigated in patients undergoing cancer surgery. Using a cohort consisting of mostly Asian population, we enrolled 87,567 adult patients who underwent cancer surgery from March 2010 to December 2019. They were divided into three groups according to body mass index (BMI): 53,980 (61.6%) in the normal (18.5-25 kg/m2), 2,787 (3.2%) in the low BMI (<18.5 kg/m2), and 30,800 (35.2%) in the high BMI (≥25 kg/m2) groups. The high BMI group was further stratified into overweight (25-30 kg/m2) and obese (≥30 kg/m2) groups. The primary outcome was mortality during three years after surgery. Following adjustment by inverse probability weighting, mortality during three years after surgery was significantly lower in the high BMI group than the normal (4.8% vs. 7.0%; hazard ratio [HR], 0.69; confidence interval [CI], 0.64-0.77; p < 0.001) and low BMI (4.8% vs. 13.0%; HR: 0.38; CI: 0.35-0.42; p < 0.001) groups. The mortalities of the overweight and obese groups were lower than that of the normal group (7.0% vs. 5.0%; HR: 0.72; CI: 0.67-0.77; p < 0.001 and 7.0% vs. 3.3%; HR: 0.57; CI: 0.50-0.65; p < 0.001, respectively). This association was not observed in female patients and those undergoing surgery for breast and gynecological cancers. High BMI may be associated with decreased mortality after cancer surgery. Further investigations are needed for clinical application of our finding.
尽管肥胖与普通人群的死亡率增加有关，但肥胖与手术和某些类型癌症的死亡率改善有关，这一现象令人费解。然而，这在接受癌症手术的患者中尚未得到充分研究。本研究使用了一个主要由亚洲人群组成的队列，纳入了 2010 年 3 月至 2019 年 12 月期间接受癌症手术的 87567 名成年患者。根据体重指数（BMI）将他们分为三组：正常组（18.5-25kg/m2）53980 例（61.6%），低 BMI 组（<18.5kg/m2）2787 例（3.2%），高 BMI 组（≥25kg/m2）30800 例（35.2%）。高 BMI 组进一步分为超重（25-30kg/m2）和肥胖（≥30kg/m2）组。主要结局是手术后 3 年内的死亡率。通过逆概率加权调整后，与正常组（7.0%）和低 BMI 组（13.0%）相比，高 BMI 组术后 3 年内的死亡率显著降低（4.8%vs.7.0%，风险比[HR]，0.69；95%置信区间[CI]，0.64-0.77；p<0.001 和 4.8%vs.13.0%，HR：0.38；95%CI：0.35-0.42；p<0.001）。超重组和肥胖组的死亡率均低于正常组（7.0%vs.5.0%，HR：0.72；95%CI：0.67-0.77；p<0.001 和 7.0%vs.3.3%，HR：0.57；95%CI：0.50-0.65；p<0.001）。这一关联在女性患者和接受乳腺癌和妇科癌症手术的患者中并未观察到。高 BMI 可能与癌症手术后死亡率降低有关。为了将我们的发现应用于临床，还需要进一步的研究。
