胃癌手术后体重变化与 2 型糖尿病风险的关系：一项全国性队列研究。
The association between weight change after gastric cancer surgery and type 2 diabetes risk: A nationwide cohort study.
机构信息
Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea.
Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea.
出版信息
J Cachexia Sarcopenia Muscle. 2023 Apr;14(2):826-834. doi: 10.1002/jcsm.13206. Epub 2023 Mar 2.
BACKGROUND
Although gastric cancer patients generally experience drastic weight decrease post-gastrectomy, the impact of weight decrease on type 2 diabetes risk remains unclear. We investigated the type 2 diabetes risk after gastric cancer surgery according to postoperative weight decrease in gastric cancer survivors in South Korea, the country with the world's highest rate of gastric cancer survival.
METHODS
This retrospective nationwide cohort study included gastric cancer surgery recipients between 2004 and 2014 who survived for ≥5 years post-surgery. We included patients without a history of diabetes at the time of surgery and those who had not received adjuvant chemotherapy before or after the surgery. Postoperative weight loss was defined as the per cent body weight loss at 3 years post-surgery compared with the baseline. The type 2 diabetes risk was evaluated using Cox regression analyses for five groups of postoperative weight decrease.
RESULTS
In 5618 included gastric cancer surgery recipients (mean age, 55.7 [standard deviation, SD, 10.9] years; 21.9% female; mean body mass index, 23.7 [SD, 2.9] kg/m ), 331 patients (5.9%) developed postoperative type 2 diabetes during follow-up duration of 8.1 years (median; interquartile range, 4.8 years; maximum, 15.2 years). Compared with those who gained weight post-surgery, patients with ≥ -15% to < -10% of postoperative weight decrease (hazard ratio, 0.65; 95% confidence interval, 0.49-0.87; P = 0.004) had the lowest type 2 diabetes risk. A non-linear association occurred between postoperative weight decrease and the type 2 diabetes risk in gastrectomy recipients (Akaike's information criterion [AIC] for non-linear model, 5423.52; AIC for linear model, 5425.61).
CONCLUSIONS
A U-shaped non-linear association occurred between the type 2 diabetes risk and postoperative weight decrease in gastric cancer survivors who underwent gastrectomy. The lowest type 2 diabetes risk occurred in patients with ≥ -15% to < -10% of postoperative weight decrease at 3 years.
背景
尽管胃癌患者在胃切除术后通常会经历明显的体重下降，但体重下降对 2 型糖尿病风险的影响尚不清楚。我们在韩国进行了这项回顾性全国性队列研究，韩国是胃癌生存率全球最高的国家，研究了胃癌患者胃切除术后体重下降与 2 型糖尿病风险的关系。
方法
本研究纳入了 2004 年至 2014 年间接受胃切除术且术后生存时间≥5 年的胃癌手术患者。我们纳入了手术时无糖尿病病史且术前或术后未接受辅助化疗的患者。术后体重减轻定义为术后 3 年与基线相比的体重百分比下降。使用 Cox 回归分析评估了 5 组术后体重减轻的 2 型糖尿病风险。
结果
在纳入的 5618 例胃癌手术患者中（平均年龄为 55.7 [标准差为 10.9] 岁，21.9%为女性，平均体重指数为 23.7 [标准差为 2.9] kg/m ），有 331 例（5.9%）在 8.1 年的随访期间发生了术后 2 型糖尿病（中位数；四分位距为 4.8 年；最长为 15.2 年）。与术后体重增加的患者相比，术后体重减轻≥-15%至<-10%的患者（风险比为 0.65；95%置信区间为 0.49-0.87；P=0.004）发生 2 型糖尿病的风险最低。在接受胃切除术的患者中，术后体重下降与 2 型糖尿病风险之间存在 U 型非线性关联（非线性模型的赤池信息量准则 [AIC] 为 5423.52，线性模型的 AIC 为 5425.61）。
结论
接受胃切除术的胃癌幸存者中，2 型糖尿病风险与术后体重下降呈 U 型非线性关联。术后 3 年体重下降≥-15%至<-10%的患者发生 2 型糖尿病的风险最低。
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