- 期刊
The correlation between high body mass index and survival in patients with esophageal cancer after curative esophagectomy: evidence from retrospective studies
高体重指数与食管癌根治性切除术后患者生存关系的回顾性研究
摘要
目的：探讨食管癌患者术前高体重指数（high body mass index, H-BMI）对食管癌根治性切除术后长期生存的影响及其预测价值。方法：通过系统、全面的文献检索，收集已公开发表的有关食管癌患者术前H-BMI（包括超重和肥胖）对术后生存期影响的所有临床研究，按累计定量分析的要求对检索到的原始研究的质量进行评估，对符合条件的所有研究结果进行累计定量分析，计算数据合并后的H-BMI对正常BMI的危险比（hazard ratio, HR）及95%置信区间（confidence interval, CI），并根据体重指数（body massindex, BMI）及食管癌亚型进行亚组分析，评价术前H-BMI对食管癌患者根治性切除术后生存期的影响。结果：共14篇文献符合纳入标准，总样本量4823例。累计定量分析结果表明，H-BMI改善了总体食管癌患者术后无疾病生存率（disease-free survival, DFS）和总体生存率（Overall survival, OS），合并的HR分别为0.83（95% CI: 0.75-0.90）和0.79（95% CI: 0.73-0.85）；在亚组分析的超重患者中也得出了相似结果。根据肿瘤亚型进一步分层分析发现，H-BMI显著改善了食管腺癌患者术后OS，合并的HR为0.81（95% CI: 0.73-0.89），在超重和肥胖的亚组分析中也得出了相似的结果。然而在食管鳞癌中，术前H-BMI缩短了患者术后DFS，合并的HR为2.26（95% CI: 1.29-3.24）。结论：H-BMI对食管鳞癌和食管腺癌患者术后长期生存的影响完全不同。H-BMI是食管癌总体、特别是食管腺癌术后生存预后较佳的一个潜在性预测指标，而对食管鳞癌来说，H-BMI则预示着较差的术后生存。
並列摘要
Objective: To investigate the predictive value of high body mass index (H-BMI) on the survival of patients with esophageal cancer (EC) after curative esophagectomy. Methods: Studies were systematically identified to investigate the relationship between overweight and obese (H-BMI) and clinical outcomes in EC patients treated with curative esophagectomy. Measured clinical outcomes were disease-free survival (DFS) and overall survival (OS). The pooled hazard ratio (HR) with 95% confidence interval (CI) was estimated. Subgroup analyses were performed according to tumour type and body mass index (BMI). Results: Fourteen studies with 4823 cases were included in the final pooled quantitative analysis. In EC patients overall, H-BMI was associated with improved DFS (HR, 0.83; 95% CI: 0.75-0.90) and OS (HR, 0.79; 95 % CI: 0.73-0.85), as compared with normal BMI. The results were consistent with those who were overweight. Among patients with esophageal adenocarcinoma (EAC), a better prognosis, as reflected by OS, was observed with H-BMI (HR, 0.81; 95% CI: 0.73-0.89). The same results were also observed in EAC patients who were obese and overweight. In contrast, among patients with esophageal squamous cell carcinoma (ESCC), H-BMI was associated with a worse prognosis, as reflected by DFS (HR, 2.26; 95% CI: 1.29-3.24). Conclusions: H-BMI has distinctly different impacts on the postoperative survival of EAC and ESCC patients. H-BMI is a potential predictor for better prognosis in EC patients overall, and particularly in EAC patients, treated with curative esophagectomy. However, in ESCC patients, H-BMI is a potential predictor for a worse prognosis of postoperative survival.