Oh Sung Eun, Youn Ho Geun, Oh Seung Jong, Choi Min-Gew, Lee Jun Ho, Sohn Tae Sung, Bae Jae Moon, An Ji Yeong
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Surgery, VHS Medical Center, Seoul, Republic of Korea.
Clin Nutr ESPEN. 2023 Feb;53:74-79. doi: 10.1016/j.clnesp.2022.11.011. Epub 2022 Nov 30.
BACKGROUND & AIMS: Post-gastrectomy vitamin D deficiency can result in osteoporosis and fractures, which can decrease patient quality of life and increase their socioeconomic burden. However, because there is no consensus around preoperative measurement and regular postoperative monitoring of serum vitamin D [25(OH)vitD] level for gastric cancer patients, we performed a retrospective study with a single high-volume center experience.
We reviewed a database of 614 gastric cancer patients who underwent curative gastrectomy between December 2015 and December 2019. Multivariate analyses were performed to identify risk factors for 25(OH)vitD deficiency after one year postoperative (n = 546). A linear mixed model was used to evaluate changes between preoperative (n = 585) and postoperative (6 [n = 504] and 12 months [n = 572]) 25(OH)vitD values.
Preoperative 25(OH)vitD deficiency occurred in 67.7% of patients with gastric cancer. Patients who underwent postoperative chemotherapy for advanced pathologic disease were more likely to be 25(OH)vitD deficient at postoperative year one than those who did not receive chemotherapy (P = 0.005). Postoperative chemotherapy was an independent risk factor along with preoperative 25(OH)vitD level for one year postoperative 25(OH)vitD deficiency (P = 0.002). Meanwhile, there was significant change in 25(OH)vitD level after surgery according to reconstruction (increased in Billroth I group compared to gastrojejunostomy group, P = 0.016), pathologic stage (increased in stage I group, decreased in stage II and III group, P = 0.005), postoperative chemotherapy (increased in non-chemotherapy group, decreased in chemotherapy group, P = 0.001), and season of surgery (increased when the blood tests were performed at summer, decreased when tested in non-summer season, P = 0.009).
More than half of gastric cancer patients had preoperative 25(OH)vitD deficiency, and those who had postoperative chemotherapy were at risk for 25(OH)vitD deficiency one year after surgery. There was a significant change in 25(OH)vitD level after surgery according to reconstruction method and postoperative chemotherapy. Preoperative measurement and regular postoperative monitoring should be considered for high-risk patients.
胃切除术后维生素D缺乏可导致骨质疏松和骨折，这会降低患者生活质量并增加其社会经济负担。然而，由于对于胃癌患者术前血清维生素D[25(OH)vitD]水平的测量及术后定期监测尚无共识，我们进行了一项基于单一高容量中心经验的回顾性研究。
我们回顾了2015年12月至2019年12月期间接受根治性胃切除术的614例胃癌患者的数据库。进行多因素分析以确定术后一年（n = 546）25(OH)vitD缺乏的危险因素。使用线性混合模型评估术前（n = 585）与术后6个月（n = 504）和12个月（n = 572）25(OH)vitD值之间的变化。
67.7%的胃癌患者术前存在25(OH)vitD缺乏。与未接受化疗的患者相比，因晚期病理疾病接受术后化疗的患者在术后一年更易出现25(OH)vitD缺乏（P = 0.005）。术后化疗与术前25(OH)vitD水平是术后一年25(OH)vitD缺乏的独立危险因素（P = 0.002）。同时，根据重建方式（毕Ⅰ式组与胃空肠吻合术组相比升高，P = 0.016）、病理分期（Ⅰ期组升高Ⅱ期和Ⅲ期组降低，P = 0.005）、术后化疗（非化疗组升高化疗组降低，P = 0.001）以及手术季节（夏季进行血液检测时升高，非夏季检测时降低，P = 0.009），术后25(OH)vitD水平有显著变化。
超过一半的胃癌患者术前存在25(OH)vitD缺乏，接受术后化疗的患者术后一年有25(OH)vitD缺乏风险。根据重建方式和术后化疗，术后25(OH)vitD水平有显著变化。对于高危患者应考虑术前测量和术后定期监测。
