摘要
目的探讨体重指数与胆囊癌患者临床病理特征和预后的关系。方法回顾性研究2008年1月1日—2013年12月31日第二军医大学东方肝胆外科医院收治的386例胆囊癌患者的临床和随访资料。根据《中国成人超重和肥胖症预防控制指南》,将患者分为正常体重组(BMI<23.5 kg/m2,239例,占61.9%)、超重组(23.5 kg/m2≤BMI<27.5 kg/m2,127例,占32.9%)、肥胖组(BMI≥27.5 kg/m2,20例,占5.18%),比较3组临床病理因素(性别、年龄、糖尿病、高血压、胆囊相关疾病、黄疸、肿瘤位置、TMN、手术方式、术后天数、组织分化、肝侵犯、术中输血例数、并发症),并分析BMI和5年生存率的关系。正态分布的计量资料采用均数±标准差(Mean±SD)表示,偏态分布的计量资料采用M(P25,P75)表示,组间比较采用非参数秩和检验。计数资料采用χ2检验或Fisher确切概率法。Kaplan-Meier法计算生存率,单因素分析采用Log-rank检验,多因素采用COX回归比例风险模型。结果386例胆囊癌患者中位生存时间为12.1个月,1、3、5年的总生存率分别为51.8%、25.2%、16.8%。单因素生存分析显示,年龄、黄疸、意外胆囊癌、肿瘤位置、TMN、手术方式、组织分化、肝侵犯、术中输血例数、并发症对5年生存率有影响(χ2=12.24、30.87、37.01、7.92、104.23、118.76、12.05、49.12、6.85、12.24,P<0.05)。BMI与高血压有关,对5年生存率无显著影响,但随着BMI的增加,5年生存率呈上升趋势(16.3%比16.7%比23.3%,P=0.774)。多因素生存分析显示,手术方式(OR=1.441,95%CI:1.219~1.705)、肝脏侵犯(OR=1.625,95%CI:1.264~2.091)、M分期(OR=1.664,95%CI:1.070~2.587)、N分期(OR=1.511,95%CI:1.218~1.875)是本组患者预后的独立危险因素(P<0.05),BMI是非独立危险因素(P=0.901)。结论BMI对胆囊癌患者的预后无显著影响,肥胖胆囊癌患者无需等减肥后再行外科手术治疗。
Objective To explore the relationship between body mass index(BMI)and clinicopathological features and prognosis of gallbladder cancer.Methods The clinical and follow-up data of three hundred and eighty-six patients of gallbladder carcinoma were retrospectively,who were treated from January 2008 to December 2013 in the Department of Hepatobiliary Surgery,Eastern Hepatobiliary Hospital,Second Military Medical University.According to the guidelines for prevention and control of overweight and obesity in Chinese adults,the patients were divided into three groups:normal weight group(BMI<23.5 kg/m2,239 cases,accounting for 61.9%),overweight group(23.5 kg/m2≤BMI<27.5 kg/m2,127 cases,accounting for 32.9%)and obesity group(BMI≥27.5 kg/m2,20 cases,accounting for 5.18%).The clinicopathological factors(gender,age,diabetes mellitus,hypertension,gallbladder related diseases,jaundice,tumor location,TMN,postoperative days,tissue differentiation,liver invasion,intraoperative blood transfusion,complications)of the three groups were compared,and the relationship between BMI and 5-year survival rate was analyzed.Measurement data with normal distribution were indicated as mean±standard deviation(Mean±SD),measurement data with skewed distribution were represented as M(P25,P75).Nonparametric rank sum test was used for measurement data.Categorical variables were compared by the chi-square test or Fisher probability method.The survival curve was drawn by the Kaplan-Meier method.The univariate analysis and multivariate analysis of prognosis were respectively done using the Log-rank test and COX regression model.Results The median survival time of 386 patients with gallbladder cancer was 12.1 months.The overall survival rates of 1,3 and 5 years were 51.8%,25.2%and 16.8%,respectively.Univariate survival analysis showed that age,jaundice,accidental gallbladder cancer,tumor location,TMN,surgical method,tissue differentiation,liver invasion,intraoperative blood transfusion,and complications affected the 5-year survival rate(χ2=12.24,30
作者
温志坚
陈战
林茜
刘斌
肖林峰
闫兴洲
张宝华
Wen Zhijian;Chen Zhan;Lin Qian;Liu Bin;Xiao Linfeng;Yan Xingzhou;Zhang Baohua(Department of General Surgery,No.73 Army Hospital of the Chinese People's Liberation Army,Key Laboratory of Biliary Tract,Xiamen 361003,China;Department of Hepatobiliary Surgery,the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai 200438,China)
出处
《国际外科学杂志》
2020年第10期666-672,F0003,共8页
International Journal of Surgery
基金
上海市级医院新兴前沿技术联合攻关项目(SHDC12016127)。
关键词
胆囊肿瘤
预后
体重指数
Gallbladder neoplasms
Prognosis
Body mass index
