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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2015, Vol. 04 ›› Issue (03) : 289 -295. doi: 10.3877/cma.j.issn.2095-3224.2015.03.14

所属专题： 文献；

论著

体重指数与结直肠癌预后的相关性研究
邹振玉1, 宁宁1, 刘海亮2, 李松岩1(), 杜晓辉1,†(), 李荣1   
  1. 1. 100853　北京，解放军总医院普通外科
    2. 100853　北京，解放军总医院肿瘤外科
  • 收稿日期:2015-03-21 出版日期:2015-06-25
  • 通信作者: 李松岩, 杜晓辉
  • 基金资助:
    国家自然科学基金(61170123); 海南省自然科学基金(813226)

Association between body mass index and prognosis of colorectal cancer

Zhen-yu ZOU1, Ning NING1, Song-yan LI2, Xiao-hui DU1,†(), Rong LI1()   

  1. 1. Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2015-03-21 Published:2015-06-25
  • Corresponding author: Xiao-hui DU, Rong LI
  • About author:
    Corresponding author: DU Xiao-hui, Email:
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引用本文：

邹振玉, 宁宁, 刘海亮, 李松岩, 杜晓辉, 李荣. 体重指数与结直肠癌预后的相关性研究[J/OL]. 中华结直肠疾病电子杂志, 2015, 04(03): 289-295.

Zhen-yu ZOU, Ning NING, Song-yan LI, Xiao-hui DU, Rong LI. Association between body mass index and prognosis of colorectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2015, 04(03): 289-295.

目的

探讨体重指数(body mass index，BMI)与结直肠癌患者临床病理特征和预后的关系。

方法

回顾性分析2005年7月至2011年6月解放军总医院收治的107例结直肠癌患者的临床和随访资料。将患者分为正常体重组(BMI<23.0kg/m2)、超重组(23.0 kg/m2≤BMI<27.5 kg/m2)和肥胖组(BMI≥27.5 kg/m2)，比较三组临床病理因素，并分析BMI与5年生存率的关系。

结果

正常体重组37例(34.6%)，超重组54例(50.5%)，肥胖组16例(14.9%)。中位生存时间为37个月，1、3、5年的总生存率分别为95.3%、81.9%、74.0%。单因素生存分析显示，肿瘤位置、浸润程度、淋巴结转移和临床分期对5年生存率有影响(均P<0.05)。BMI与肿瘤浸润程度有关(P＝0.039)，对5年生存率无显著影响，但随着BMI增加，5年生存率呈上升趋势(69.2% vs 72.0% vs 93.8%，P＝0.239)。多因素生存分析显示，肿瘤位置和临床分期是本组患者预后的独立危险因素(均P<0.05)，BMI非独立危险因素(P＝0.343)。

结论

BMI对结直肠癌患者的预后无显著影响。

关键词: 结直肠肿瘤, 体重, 预后
Objective

To explore the association between body mass index(BMI), clinicopathological characteristics, and prognosis of colorectal cancer patients.

Methods

Medical records and follow-up data of 107 patients with colorectal cancertreated in Chinese PLA General Hospital from July 2005 to June 2011 were analyzed retrospectively.The patients were divided into normal weight group(BMI<23.0kg/m2), overweight group(23.0 kg/m2≤BMI<27.5 kg/m2), and obese group(BMI≥27.5 kg/m2). The clinicopathological factors were compared among these three groups and the association between BMI and 5-year overall survival rate was analyzed.

Results

There were 37 patients(34.6%)in the normal weight group, 54 patients(50.5%)in the overweight group, and 16 patients(14.9%)in the obese group.The median survival time was 37 months.The 1-, 3-and 5-year overall survival rates were 95.3%, 81.9%, and 74.0%, respectively.According to the Kaplan-Meier method, tumor site, infiltrating degree, lymph metastasis, and clinical stage had significant effects on 5-year overall survival rate(P<0.05, respectively). BMI was significantly relevant to tumor infiltrating degree(P=0.039). No statistically significant correlation was found between BMI and 5-year overall survival rate, but the elevated BMI showed a trend toward increased 5-year overall survival rate(69.2% vs 72.0% vs 93.8%, P=0.239). Cox proportional hazards model indicated that the tumor site and clinical stage were significant independent risk factors(P<0.05, respectively), but BMI was not(P=0.343).

Conclusions

There is no significant association between BMI and prognosis of patients with colorectal cancer.

Key words: Colorectal neoplasms, Body weight, Prognosis
表1 107例直肠癌患者不同BMI组基线特征比较表
临床资料 正常体重组n＝37(%) 超重组n＝54(%) 肥胖组n＝16(%) P值
性别 ? ? ? 0.143
? 男 17(45.9%) 36(66.7%) 9(56.2%) ?
? 女 20(54.1%) 18(33.3%) 7(43.8%) ?
年龄 53.7±14.5 55.0±10.6 51.9±7.8 0.635
肿瘤直径 ? ? ? 0.202
? <4.5cm 22(59.5%) 22(40.7%) 7(43.8%) ?
? ≥4.5cm 15(40.5%) 32(59.3%) 9(56.2%) ?
肿瘤位置 ? ? ? 0.524
? 直肠 15(40.5%) 32(59.3%) 9(56.2%) ?
? 远端结肠 13(35.1%) 13(24.1%) 4(25.0%) ?
? 近端结肠 9(24.3%) 9(16.7%) 3(18.8%) ?
肿瘤分化程度 ? ? ? 0.665
? 高分化 7(18.9%) 9(16.7%) 1(6.2%) ?
? 中分化 23(62.2%) 31(57.4%) 12(75.0%) ?
? 低分化 7(18.9%) 14(25.9%) 3(18.8%) ?
浸润程度 ? ? ? 0.039
? T1＋T2 7(18.9%) 6(11.1%) 2(12.5%) ?
? T3 15(40.5%) 39(72.2%) 8(50.0%) ?
? T4 15(40.5%) 9(16.7%) 6(37.5%) ?
淋巴结转移 ? ? ? 0.887
? 1～3个 14(37.8%) 20(37.0%) 7(43.8%) ?
? >3个 6(16.2%) 9(16.7%) 1(6.2%) ?
? 有远处转移 5(13.5%) 6(11.1%) 4(25.0%) 0.370
临床分期 ? ? ? 0.345
? I期 6(16.2%) 3(5.6%) 0(0.0%) ?
? II期 10(27.0%) 22(40.7%) 7(43.8%) ?
? III期 15(40.5%) 23(42.6%) 6(37.5%) ?
? IV期 6(16.2%) 6(11.1%) 3(18.8%) ?
图2 不同BMI组的总体生存曲线图
表2 107例结直肠癌患者临床资料及术后5年生存率的单因素预后分析表
临床病理因素 例数 5年生存率(%) P值
性别 ? ? 0.599
? 男 62 75.6 ?
? 女 45 71.5 ?
年龄 ? ? 0.419
? <50岁 38 80.7 ?
? ≥50岁 69 70.1 ?
BMI ? ? 0.239
? <23.0 kg/m2 37 69.2 ?
? 23.0～27.5 kg/m2 54 72.0 ?
? ≥27.5 kg/m2 16 93.8 ?
肿瘤直径 ? ? 0.904
? <4.5 cm 51 74.1 ?
? ≥4.5 cm 56 73.4 ?
肿瘤位置 ? ? 0.027
? 直肠 56 79.9 ?
? 远端结肠 30 72.2 ?
? 近端结肠 21 60.2 ?
肿瘤分化程度 ? ? 0.782
? 高分化 17 78.1 ?
? 中分化 66 75.5 ?
? 低分化 24 69.1 ?
浸润程度 ? ? 0.000
? T1＋T2 15 82.1 ?
? T3 62 86.9 ?
? T4 30 41.2 ?
淋巴结转移 ? ? 0.000
? 无 50 92.2 ?
? 1～3个 41 64.0 ?
? >3个 16 45.1 ?
远处转移 ? ? 0.202
? 无 92 77.4 ?
? 有 15 50.3 ?
临床分期 ? ? 0.000
? I期 9 83.3 ?
? II期 39 97.4 ?
? III期 44 73.3 ?
? IV期 15 0 ?
表3 107例结直肠癌患者术后总体生存的多因素预后分析表
因素 P值 RR值(95%CI)
BMI 0.343 0.719(0.363～1.424)
肿瘤位置 0.045 1.734(1.013～2.967)
浸润程度 0.134 1.815(0.832～3.960)
淋巴结转移 0.237 1.525(0.757～3.069)
临床分期 0.000 3.980(1.881～8.422)
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