The Influence Of BMI On Postoperative Complications And Long-term Prognosis In NSCLC Is Analyed Based On Propensity Score Matching Method

Objective:The patients who are with high body mass index are subjected to more basic diseases than others.The purpose of this paper is to study the influfence of preoperative body mass index on perioperative complications,clinical curative effect and the effect of long-term prognosis of patients with non-small cell lung cancer through the Propensity Score Matching method to exclude the interference of confounding factors.Methods:Collecting the clinical datas of patients who received radical resection of lung cancer in the department of Thoracic surgery depantment of the first hospital of lanzhou university from January 2013 to June 2016 retrospectively.The long-term prognosis and survival rate of patients were followed up by telephone,outpatient service and WeChat group.According to BMI,the patients were divided into two groups.High BMI group was consisted of 126 cases whose BMI are over 24 kg/m~2,263 cases were in the normal BMI whose BMI range from 18.5 kg/m~2 to BMI 24 kg/m~2.T test,?~2 test or Fisher's exact test were used to compare the postoperative clinical efficacy and the postoperative complications between the two groups.Survival rate was calculated by kaplan-meier method and survival curves were plotted.Univariate and multivariate Cox regression models were used to analyze the factors that influence the long-term prognosis of lung cancer.Results:531 clinical datas of patients were collected together and 389 patients were included in this study,including 126 patients in High BMI group and 263 patients in Normal BMI group respectively.There were statistical differences in the surgical methods and hyperlipidemia between the two groups.After the two groups were dealed with through PSM,there was no significant difference in the general baseline datas between the two groups(P<0.05).Firstly,the incidence of postoperative pulmonary infection(17.1%vs.7.2%,P=0.024),poor incision healing(6.3%vs.0.9%,P=0.031)and overall postoperative complications(40.5%vs.21.6%,P=0.002)in High BMI group were significantly higher than that Normal BMI group,with statistical difference(P<0.05).The incidence of atelectasis(7.8%VS 5.4%,P=0.581),pleural effusion(7.8%VS 6.3%,P=0.789)and pulmonary embolism(2.7%VS 1.8%,P=0.651)was not significantly different between the two groups(P>0.05).Secondly,the operation time[(182.5±20.4)min VS(190.5±23.6)min,P=0.007]and the postoperative recovery time[(6.6±1.2)d VS(7.2±1.5)d,P<0.001]in Normal BMI group were longer than those in High BMI group,with statistical difference(P<0.05).Factors such as,intraoperative hemorrhage[(246.3±34.8)ml VS(248.0±38.3)ml,P=0.728],lymph node dissection[(23.2±8.8)VS(25.6±10.0),P=0.083],postoperative thoracic drainage[(269.8±74.6)ml VS(278.1±95.4)ml,P=0.472],and catheter duration[(3.8±0.9)d VS(3.7±1.2)d,P=0.806]were no statistical difference in the two groups(P>.05).Thirdly,univariate COX regression analysis showes that age[P=0.001,OR=1.053,95%CI(1.020-1.086)],male[P=0.05,OR=1.586,95%CI(1.0-2.515)],smoking history[P=0.002,OR=1.982,95%CI(1.295-3.033)],hypertension[P=0.036,OR=1.564,95%CI(1.054-3.108)],Normal BMI group[P=0.032,OR=1.810,95%CI(1.029-2.378)],Stage I lung cancer[P<0.001,OR=0.145,95%CI(0.076-0.276)]and stage II lung cancer[P=0.002,OR=0.452,95%CI(0.274-0.744)]were the factors that influences the long-term prognosis of patients with lung cancer after surgery.Diabetes,hyperlipidemia,surgical methods and pathological types do not have close correlation with the postoperative prognosis of patients with lung cancer.Multivariate COX regression analysis suggests that advanced age[P<0.001,OR=1.067,95%CI(1.033-1.101)],hypertension[P=0.032,OR=1.811,95%CI(1.051-3.120)],Normal BMI group[P=0.002,OR=2.048,95%CI(1.309-3.206)],smoking history[P=0.009,OR=1.956,95%CI(1.183-3.233)],Stage I lung cancer[P<0.001,OR=0.124,95%CI(0.063-0.244)]and stage II lung cancer[P=0.003,OR=0.446,95%CI(0.260-0.764)]with the stage III lung cancer as a reference index were risk factors.Conclusion:The poor perioperative clinical efficacy and the high incidence of perioperative complications are believed to occur more commonly in those paitients with a high BMI who were subjected to NSCLC.However,the long-term prognosis of patients with higher BMI after NSCLC is better than that of patients with normal BMI.