无脂肪质量指数与食管癌患者围手术期结局的关系

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摘要目的探索无脂肪质量指数(FFMI)与食管癌患者术后并发症及死亡率的关系,以阐明 FFMI 对围手术期结局的预测价值。方法选取 2017 年 1 月至 2021 年 12 月于南通大学附属海安医院胸外科接受根治性手术治疗的 152 例食管癌患者作为研究对象,通过生物电阻抗分析仪测量并计算患者的 FFMI。根据 FFMI 的截止点(男性<17 kg / m 2 ,女性<15 kg / m 2 ),将所有患者分为低 FFMI 组(103 例)与正常 FFMI 组(49 例),比较两组患者的基线特征与围手术期结局。通过 Logistic 回归模型进行单变量与多变量分析,用以确定食管癌术后并发症的独立风险因素。结果除体质指数外,低 FFMI 组与正常 FFMI 组患者在年龄、性别、基础疾病史、肿瘤病理特征及实验室检查等方面无显著差异(P> 0. 05),具有可比性。与正常 FFMI 组相比,低 FFMI 组患者具有更高的术后并发症发生率 (40. 8% 比 21. 4%,χ 2 = 6. 286, P = 0. 012),特别是吻合口漏 (40. 8% 比 21. 4%,χ 2 = 5. 191, P= 0. 032)与肺炎(28. 6%比 12. 6%,χ 2 = 5. 783, P= 0. 016),差异有统计学意义。此外,低 FFMI 组患者的住院时间较正常 FFMI 组明显延长[IQR: 14. 0 (12. 0,18. 0)d 比 12. 0(11. 0,16. 0)d,Z= -1. 985, P= 0. 047]。然而,两组患者在术后院内死亡率方面未见显著差异 (4. 1% 比 1. 9%,χ 2 = 0. 593, P = 0. 388)。单、多因素 Logistic 回归分析展示术前 FFMI (OR= 2. 502, 95%CI = 1. 181~ 5. 301, P= 0. 017)与低蛋白血症(OR= 2. 570, 95%CI = 1. 115~ 5. 926, P= 0. 027)是食管癌术后并发症的独立风险因素。结论 FFMI 是预测食管癌围手术期结局的一项有效参数,这一发现强调了身体成分测量在食管癌患者临床管理中的价值。

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	夏倩倩
	王薇
	陈海生

关键词 ：食管癌, 无脂肪质量指数, 营养不良, 术后并发症

Abstract：Objective To explore the effects of fat-free mass index FFMI on postoperative complications and in-hospital mortality and clarify its predictive value for perioperative outcomes of esophageal cancer patients. Method This analysis included 152 esophageal cancer patients who underwent curative esophagectomy at the Department of Thoracic Surgery in Haian Hospital Affiliated to Nantong University from January 2017 to December 2021. The FFMI was measured and calculated by bioelectrical impedance analysis and then all patients were divided into low FFMI 103 and normal FFMI 49 group based on the cutoff value of FFMI male <17 kg / m 2 female < 15 kg / m 2 . The baseline characteristics and perioperative outcomes of the two groups were compared. In addition the Logistic regression model was used for univariate and multivariate analysis to determine the independent risk factors of postoperative complications for esophageal cancer patients. Result Except for body mass index there were no significant differences between low FFMI and normal FFMI group for age gender comorbidities clinicopathological features and laboratory tests P>0. 05 . The baseline characteristics between the two patient groups were comparable. Compared with the normal FFMI group low FFMI group had a higher rate of postoperative complications 40. 8% vs 21. 4% χ 2 = 6. 286 P = 0. 012 especially anastomotic leakage 40. 8% vs 21. 4% χ 2 = 5. 191 P= 0. 032 and pneumonia 28. 6% vs 12. 6% χ 2 = 5. 783 P = 0. 016 . In addition the length of hospital stays was longer in low FFMI group than in the normal FFMI group IQR 14. 0 12. 0 18. 0 d vs 12. 0 11. 0 16. 0 d Z = - 1. 985 P = 0. 047 . However there was no significant difference between the two groups for postoperative in-hospital mortality 4. 1% vs 1. 9% χ 2 = 0. 593 P= 0. 388 . The results of univariate and multivariate logistic regression analysis revealed that preoperative FFMI OR = 2. 502 95%CI = 1. 181 - 5. 301 P = 0. 017 and hypoalbuminemia OR = 2. 570 95% CI = 1. 115 - 5. 926 P = 0. 027 were independent risk factors of postoperative complications for esophageal cancer patients who underwent curative esophagectomy. Conclusion FFMI was an effective parameter to predict the perioperative outcome and this finding further emphasized the value of body composition measurement in the clinical management of esophageal cancer patients.

收稿日期: 2022-09-07

基金资助:2022 年度南通市基础科学研究和社会民生科技计划项目(JCZ2022018)

通讯作者: 陈海生,电子邮箱:ffj8099lzx@ 163. com

引用本文:

夏倩倩,王薇,陈海生. 无脂肪质量指数与食管癌患者围手术期结局的关系[J]. 肿瘤代谢与营养电子杂志, 2023, 10(1): 107-112.
Xia Qianqian, Wang Wei, Chen Haisheng. Relationship between fat-free mass index and perioperative outcomes in esophageal cancer patients. Electron J Metab Nutr Cancer, 2023, 10(1): 107-112.