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目的明确食管鳞状细胞癌患者术前的体重指数对围手术期及预后的影响。方法回顾性分析2001年1月至2009年12我院手术治疗503例食管癌患者的临床资料,其中男268例、女235例,中位年龄57(32~88)岁。术前的体重指数和临床病理学特征分析采用χ2检验或者Fisher确切概率算法,生存分析采用Kaplan-Meier曲线获取并进行log-rank检验比较各组生存率差异。结果总体患者的1年、3年、5年和10年的总生存率分别为64.0%、49.0%、43.0%和41.0%;体重下降、淋巴结转移、肿瘤低分化发生率在BMI≤18.5 kg/m~2患者中明显高于BMI>18.5 kg/m~2患者(P=0.026,P=0.006,P=0.048)。Kaplan-Meier生存分析表明:消瘦的食管癌患者术后有生存期缩短的趋势(P=0.001);不同BMI患者的总并发症、吻合口瘘及肺部并发症发生率差异无统计学意义(P=0.162,P=0.590,P=0.376);单变量及多变量分析表明:消瘦、饮酒史及肿瘤分化程度是影响患者预后的独立因素。结论食管癌切除术后的并发症发生率与术前体重指数无关,而低体重患者因确诊时病情较晚,致使预后较正常体重及超重患者差。
Objective To determine the effect of preoperative body mass index on perioperative and prognosis in patients with esophageal squamous cell carcinoma. Methods The clinical data of 503 patients with esophageal cancer who underwent surgery in our hospital from January 2001 to December 2009 were retrospectively analyzed. There were 268 males and 235 females, with a median age of 57 (32 to 88) years. The preoperative body mass index and clinicopathological features were analyzed by Chi-square test or Fisher’s exact probability algorithm. Survival analysis was performed by Kaplan-Meier curve and log-rank test was used to compare the survival rates. Results The overall survival rates of patients in one year, three years, five years and ten years were 64.0%, 49.0%, 43.0% and 41.0% respectively. The incidence of body weight loss, lymph node metastasis and tumor differentiation were lower in BMI ≤18.5 kg / Patients with m ~ 2 were significantly higher than those with BMI> 18.5 kg / m ~ 2 (P = 0.026, P = 0.006, P = 0.048). Kaplan-Meier survival analysis showed that patients with emasculated esophageal cancer had a shorter survival time after surgery (P = 0.001). There was no significant difference in the total complication, anastomotic fistula and pulmonary complication between different BMI patients (P < P = 0.162, P = 0.590, P = 0.376). Univariate and multivariate analyzes showed that the history of emaciation, alcohol consumption and the degree of tumor differentiation were independent prognostic factors. Conclusions The incidence of complications after resection of esophageal cancer has nothing to do with preoperative body mass index, while patients with low weight have a later prognosis than normal body weight and overweight patients.