郭敏, 王翠, 张楠, 殷秀敏, 聂立婷, 王功朝. 应用倾向值匹配法评价体质指数对食管鳞癌患者术后并发症及生存率的影响[J]. 中国肿瘤临床, 2018, 45(11): 589-594. DOI: 10.3969/j.issn.1000-8179.2018.11.301
引用本文: 郭敏, 王翠, 张楠, 殷秀敏, 聂立婷, 王功朝. 应用倾向值匹配法评价体质指数对食管鳞癌患者术后并发症及生存率的影响[J]. 中国肿瘤临床, 2018, 45(11): 589-594. DOI: 10.3969/j.issn.1000-8179.2018.11.301
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Guo Min, Wang Cui, Zhang Nan, Yin Xiumin, Nie Liting, Wang Gongchao. Influence of body mass index on postoperative complications and survival in esophageal squamous cell carcinoma patients based on propensity score matching method[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2018, 45(11): 589-594. DOI: 10.3969/j.issn.1000-8179.2018.11.301
Citation: Guo Min, Wang Cui, Zhang Nan, Yin Xiumin, Nie Liting, Wang Gongchao. Influence of body mass index on postoperative complications and survival in esophageal squamous cell carcinoma patients based on propensity score matching method[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2018, 45(11): 589-594. DOI: 10.3969/j.issn.1000-8179.2018.11.301
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应用倾向值匹配法评价体质指数对食管鳞癌患者术后并发症及生存率的影响

Influence of body mass index on postoperative complications and survival in esophageal squamous cell carcinoma patients based on propensity score matching method

    摘要
  • 摘要:
      目的  应用倾向值匹配法评价体质指数对食管鳞癌患者术后并发症及生存率的影响。
      方法  分析2011年1月至2012年12月山东大学附属山东省立医院收治的533例接受食管鳞状细胞癌（esophageal squamous cell carcinoma，ESCC）切除术患者的临床资料。应用倾向值匹配法均衡组间协变量后，比较两组患者术后并发症的发生率及生存率。Logistic回归多因素分析确定与术后并发症相关的因素，绘制Kaplan-Meier曲线和Log-rank检验比较两组患者的生存率，Cox比例风险回归模型用于分析影响患者生存率的因素。
      结果  倾向值匹配后，N-BMI组（18.5~25.0 kg/m2）和H-BMI组（BMI≥25 kg/m2）各146例患者，分析结果显示，与NBMI组相比，H-BMI组食管鳞癌患者的术后伤口感染和呼吸系统并发症发生率显著增加（P < 0.05），其他并发症发生率的差异无统计学意义，H-BMI是伤口感染和呼吸系统并发症的独立预测因素。H-BMI组和N-BMI组患者的3年总生存率分别为54.1%和47.8%，差异未达到显著性水平（P=0.212）。两组患者5年总生存率分别为39.0%和25.0%，差异具有统计学意义（P=0.016）。亚组分析结果显示，在病理分期为Ⅰ~Ⅱ期的患者中，H-BMI组患者5生存率显著高于N-BMI组（47.3% vs. 29.0%，P=0.032），但在病理分期Ⅲ~Ⅳ期的患者中，两组生存率比较差异无统计学意义（24.5% vs. 16.7%，P=0.393）。
      结论  H-BMI不会降低食管鳞癌患者术后生存率，因此H-BMI患者可安全地行手术治疗，但应加强术中预防和术后监测。

     

    Abstract:
      Objective  To explore the influence of body mass index (BMI) on postoperative complications and survival in patients with esophageal squamous cell carcinoma (ESCC) using propensity score matched (PSM) methods.
      Methods  We retrospectively analyzed clinical data of 533 patients with ESCC who were admitted for thoracic surgery in Shandong Provincial Hospital, between January 2011 and December 2012. After conducting PSM methods to balance the covariates, the incidence of postoperative complications and survival rate were compared between the two groups. The effects of BMI on postoperative complications and survival were analyzed with multivariate Logistic regression and Cox proportional hazard analyses, respectively. Survival analysis was performed using Kaplan-Meier curves and Log-rank test.
      Results  After adjusting the PSM and confounding variables, the two groups were well matched (146 patients each) without significant differences in baseline characteristics. The incidence of wound infection and respiratory system complications in the H-BMI group (BMI≥25 kg/m2) were significantly higher than those in the N-BMI group (18.5-25 kg/m2) (P < 0.05). H-BMI was an independent risk factor for wound infection and respiratory system complications. In the present study, no significant difference was observed in the 3-year overall survival between H-BMI and N-BMI patients (54.1% vs. 47.8%, P=0.212). Patients with H-BMI had significantly better 5-year overall survival than those with N-BMI (39% vs. 25%, P=0.016). The subgroup analysis showed that patients with H-BMI had a better overall survival than those with N-BMI in stages Ⅰ-Ⅱ (47.3% vs. 29.0%, P=0.032). However, this difference was not significant when patients were stratified into stages Ⅲ and Ⅳ (24.5% vs. 16.7%, P=0.393).
      Conclusions  H-BMI appears not to decrease the overall survival of patients with ESCC. Therefore, ESCC in patients with H-BMI can receive surgical treatment safely, but proper intraoperative management and close postoperative monitoring should be performed.

     

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