术前营养状况作为腹部肿瘤手术术后总生存的预测因素：一项系统评价和Meta分析

Preoperative nutritional status as a predictor of postoperative overall survival in abdominal tumor surgery: a systematic review and meta-analysis.

作者信息

Su Zhaoyin, Lin Yifeng, Li Molan, Yang Yanyan, Chen Xiaohan, Zhu Yifu, Mo Yifan, Huang Zhirui, Liu Yatao, Michael Nerlich

机构信息

The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.

School of Philosophy and Sociology, Lanzhou University, Lanzhou, China.

出版信息

Front Surg. 2025 Aug 18;12:1645392. doi: 10.3389/fsurg.2025.1645392. eCollection 2025.

DOI:10.3389/fsurg.2025.1645392

PMID:40901012

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12399654/

Abstract

BACKGROUND

Abdominal tumors, including those in the stomach, colon, pancreas, and gallbladder, significantly impact global morbidity and mortality. Surgical resection is the primary treatment, but postoperative outcomes and long-term survival are often affected by factors such as preoperative nutritional status. Malnutrition is common in these patients, making its management crucial for improving outcomes. This systematic review and meta-analysis aim to consolidate evidence on the role of preoperative nutritional status in postoperative survival for patients undergoing abdominal tumor surgery, offering insight into its prognostic value.

METHODS

A systematic literature search was conducted using electronic databases to report the impact of the preoperative nutritional status on OS (overall survival) of patients with abdominal tumor surgery as of January 1st, 2025. The hazard ratio (HR) with a 95% confidence interval (CI) was used to evaluate the impact of the preoperative nutritional status on OS.

RESULTS

A total of 32 studies involving 10352 patients were included in the meta-analysis. The results (pooled HR: 1.61, 95% CI: 1.49-1.73, ² = 43.0%, < 0.001) indicated that preoperative malnutrition is significantly associated with poorer OS. Subgroup and meta-regression analyses based on methods of nutritional status assessment, country, sample size, study design, follow-up duration, analytical model, and tumor type all showed a consistent association between preoperative malnutrition and worse OS. The robustness of these pooled results was further verified through sensitivity analysis. Additionally, the heterogeneity of pooled HR of OS was attributed to differences in study designs, as indicated by meta-regression analysis ( = 0.005). Funnel plots did not show significant publication bias.

CONCLUSION

Based on existing evidence, the preoperative nutritional status is a valuable predictor of postoperative OS in patients with abdominal tumor surgery.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD420251008979.

摘要

背景

腹部肿瘤，包括胃癌、结肠癌、胰腺癌和胆囊癌，对全球发病率和死亡率有重大影响。手术切除是主要治疗方法，但术后结果和长期生存往往受到术前营养状况等因素的影响。营养不良在这些患者中很常见，因此对其进行管理对于改善预后至关重要。本系统评价和荟萃分析旨在整合术前营养状况对腹部肿瘤手术患者术后生存作用的证据，深入了解其预后价值。

方法

使用电子数据库进行系统文献检索，以报告截至2025年1月1日术前营养状况对腹部肿瘤手术患者总生存期（OS）的影响。采用风险比（HR）及95%置信区间（CI）评估术前营养状况对OS的影响。

结果

荟萃分析共纳入32项研究，涉及10352例患者。结果（合并HR：1.61，95%CI：1.49 - 1.73，I² = 43.0%，P < 0.001）表明术前营养不良与较差的OS显著相关。基于营养状况评估方法、国家、样本量、研究设计、随访时间、分析模型和肿瘤类型的亚组分析和荟萃回归分析均显示术前营养不良与较差的OS之间存在一致关联。通过敏感性分析进一步验证了这些合并结果的稳健性。此外，荟萃回归分析表明，OS合并HR的异质性归因于研究设计的差异（P = 0.005）。漏斗图未显示明显的发表偏倚。