营养不良和内脏肥胖预测了接受直肠癌直肠切除术的患者的短期和长期不良结局。
Malnutrition and visceral obesity predicted adverse short-term and long-term outcomes in patients undergoing proctectomy for rectal cancer.
机构信息
Department of Anorectal Surgery, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, No.109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China.
Department of Endocrinology, The Wenzhou Third Clinical Institute, The Third Affiliated Hospital of Shanghai University, Wenzhou Medical University, Wenzhou People's Hospital, No. 57 Canghou Street, Wenzhou, 325000, Zhejiang, China.
出版信息
BMC Cancer. 2023 Jun 22;23(1):576. doi: 10.1186/s12885-023-11083-y.
BACKGROUND
To the best of our knowledge, no previous studies have explored the relationship between visceral obesity and malnutrition. Therefore, this study has aimed to investigate the association between them in patients with rectal cancer.
METHODS
Patients with rectal cancer who underwent proctectomy were included. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM). Visceral obesity was measured using computed tomography (CT). The patients were classified into four groups according to the presence of malnutrition or visceral obesity. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors for postoperative complications. Univariate and multivariate cox regression analyses were performed to evaluate the risk factors for overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier survival curves and log-rank tests were performed for the four groups.
RESULTS
This study enrolled 624 patients. 204 (32.7%) patients were included in the well-nourished non-visceral obesity (WN) group, 264 (42.3%) patients were included in the well-nourished visceral obesity (WO) group, 114 (18.3%) patients were included in the malnourished non-visceral obesity (MN) group, and 42 (6.7%) patients were included in the malnourished visceral obesity (MO) group. In the multivariate logistic regression analysis, the Charlson comorbidity index (CCI), MN, and MO were associated with postoperative complications. In the multivariate cox regression analysis, age, American Society of Anesthesiologists (ASA) score, tumor differentiation, tumor node metastasis (TNM), and MO were associated with worsened OS and CSS.
CONCLUSIONS
This study demonstrated that the combination of visceral obesity and malnutrition resulted in higher postoperative complication and mortality rates and was a good indicator of poor prognosis in patients with rectal cancer.
背景
据我们所知，以前没有研究探讨过内脏肥胖与营养不良之间的关系。因此，本研究旨在调查直肠癌患者中两者之间的关系。
方法
纳入接受直肠切除术的直肠癌患者。根据全球营养不良倡议（GLIM）定义营养不良。使用计算机断层扫描（CT）测量内脏肥胖。根据是否存在营养不良或内脏肥胖，将患者分为四组。进行单因素和多因素逻辑回归分析，以评估术后并发症的危险因素。进行单因素和多因素 Cox 回归分析，以评估总生存（OS）和癌症特异性生存（CSS）的危险因素。进行 Kaplan-Meier 生存曲线和对数秩检验。
结果
本研究纳入 624 例患者。204 例（32.7%）患者纳入营养良好非内脏肥胖（WN）组，264 例（42.3%）患者纳入营养良好内脏肥胖（WO）组，114 例（18.3%）患者纳入营养不良非内脏肥胖（MN）组，42 例（6.7%）患者纳入营养不良内脏肥胖（MO）组。多因素逻辑回归分析显示，Charlson 合并症指数（CCI）、MN 和 MO 与术后并发症相关。多因素 Cox 回归分析显示，年龄、美国麻醉医师协会（ASA）评分、肿瘤分化、肿瘤淋巴结转移（TNM）和 MO 与 OS 和 CSS 恶化相关。
结论
本研究表明，内脏肥胖和营养不良的结合导致术后并发症和死亡率更高，是直肠癌患者预后不良的良好指标。
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