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肥胖悖论作为胃癌术后并发症的新见解
Hajime Kamiya1, Shuhei Komatsu2, Keiji Nishibeppu1
1Division of Digestive Surgery (Gastric Surgery Division), Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Scientific reports
|June 21, 2023
概括
肥胖悖论,肥胖改善了结果,存在于胃癌 (GC). 然而,术后腹部传染性并发症 (PAIC) 对肥胖的GC患者产生更严重的负面影响,特别是通过腹复发.
科学领域:
- 在瘤学瘤学.
- 外科胃肠道外科手术
- 代谢综合征是代谢综合征的一种.
背景情况:
- 肥胖悖论在各种疾病中观察到,但它在胃癌 (GC) 中的作用是复杂的.
- 肥胖症在GC患者中带来了手术挑战和术后腹部传染性并发症 (PAIC) 的风险.
- 了解肥胖,PAIC和预后之间的相互作用对于GC管理至关重要.
研究的目的:
- 调查在接受治疗性胃切除术的胃癌患者中肥胖悖论的存在和影响.
- 确定肥胖和PAIC对GC长期生存的预后影响.
- 探索PAIC,肥胖和复发模式,特别是腹复发之间的关系.
主要方法:
- 在1997年至2015年间,对1536名连续接受治疗性胃切除术的患者进行了回顾性分析.
- 将患者分为肥胖和非肥胖组,并评估术后腹部感染并发症 (PAIC).
- 统计分析以评估肥胖和PAIC对5年总生存率和复发的预后意义,包括危险比率和p值.
主要成果:
- 肥胖的GC患者 (18.6%) 往往有更好的预后 (P=0.073).
- 在没有PAIC的患者中,肥胖是5年整体存活期的显著积极预后因素 (P=0.017).
- 在肥胖患者 (HR 4.22) 和非肥胖患者 (HR 1.82) 中,PAIC 是一个独立的不良预后因素.
- 与没有PAIC的患者相比,患有pStage II-III GC和PAIC的肥胖患者的5年整体存活率明显更差 (43.8%vs. 69.7%) 和腹复发率更高 (31%vs. 10%).
- 在非肥胖患者中,非PAIC和PAIC之间的预后差异较小.
结论:
- 肥胖悖论存在于胃癌中,如果没有并发症,肥胖可能会给生存带来好处.
- 术后腹部感染性并发症显著恶化了GC患者的预后,无论肥胖状况如何.
- 患有PAIC的肥胖GC患者面临更严重的负面影响,主要是由于腹膜复发增加,突出了干预的关键领域.
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