| ObjectiveWe aim to compare the effect of body mass index(BMI)on the perioperative complications and on the disease-free survival rate(DFSR)after hepatectomy for liver cancer patients,and to explore the role of BMI in surgical decision making,by taking retrospective cohort study as the primary research method,to provide a rationale for treatment decision making and for prognosis judgment.Methods1.Based on the inclusion and exclusion criteria and sticking to a retrospective study design,we collected the clinical data about 858 liver cancer patients who received hepatectomy from January 2008 to December 2012 in the Department of Hepatobiliary Surgery of Southwest Hospital Affiliated to the Third Military Medical University.Among them,there were 766 males and 92 females,with a mean age of 48 years.Based on the preoperative BMI of the patients and the criteria of China,the patients with the BMI between 18.5 kg/m2 and 24.0 kg/m2 were put into the normal body weight group(602 cases),and those with the BMI of ? 24 kg/m2 into the overweight and obesity group(256 cases).2.We investigated the distribution of BMI of the patients receiving hepatectomy.3.We studied the basic information of the two groups before the operation,including the gender,age,HBV-DNA,total bilrubin(TBIL),albumin(Alb)and Child-Pugh class of liver function.4.We studied the intraoperative,pathologic and postoperative data of the two groups,including the amount of bleeding,the time for blocking the blood flow through the first porta hepatis,and the time for operation;whether there is liver cirrhosis or tumor thrombus in the large blood vessel;the number and diameter of tumors;hospitalization time;whether there is perioperative complications;and disease-free survival(DFS)time.5.We compared the postoperative complications in terms of its number and type of the two groups,and carried out univariate and multivariate analysis of risk factors for these complications.6.We compared the 3-year DFSR(including DFS time)of the two groups,and conducted univariate and multivariate analysis of risk factors for DFS.7.T-test or U-test was used to compare the clinical data,and ?2 test or Fisher's exact test was used to compare the categorical variables of the two groups.DFS refers to the length of time from the day for performing the operation to the diagnosis of reoccurrence.For risk factors for complications,the logistic regression model was used for univariate analysis,and those with a P value <0.05 received multivariate analysis.For risk factors for DFSR,Cox proportional hazard model was used for univariate analysis,and those with a P value <0.05 received multivariate analysis.DFSR was calculated by Kaplan-Meier method.Log-Rank Test was used to conduct comparison between the groups.The difference between the two groups is judged to be statistically significant when p = 0.05 or less.Statistical analysis was performed using SPSS(SPSS for Windows,version 19.0).Results1.The general comparison between the overweight and obesity group and the normal body weight group The median HBV-DNA load was significantly higher in the normal body weight group(7970;0,52800000)than in the overweight and obesity group(1890;0,5690000)(P<0.05).The median Alb was significantly higher in the overweight and obesity group(42.9;28.1,52.5)than in the normal body weight group(39.3;26.6,50.4)(P<0.05).The median intraoperative bleeding amount was significantly higher in the overweight and obesity group(450;80,5500)than in the normal body weight group(400;30,8000)(P<0.05).The time for operation and blockage of blood flow through the first porta hepatis was significantly longer in the overweight and obesity group than in the normal body weight group(P<0.05).The median DFS was significantly higher in the overweight and obesity group(482;13,2222)than in the normal body weight group(240;5,2330)(P<0.05).No significant difference was found in the age,gender,preoperative TBIL,Child-Pugh class,the presence of liver cirrhosis,the presence of tumor thrombus in the large blood vessel,the number and diameter of tumors,postoperative hospitalization time and incidence rate of complication of the two groups(P>0.05).2.The condition of complication The incidence rate of perioperative complications was 28.5% in the overweight and obesity group,and 25.9% in the normal body weight group,with no significant difference between the two groups(P>0.05).The incidence of pleural effusion was significantly lower in the overweight and obesity group(2.3%)than in the normal body weight group(11.0%)(P<0.05).The incidence of delayed incision healing was significantly higher in the overweight and obesity group(4.2%)than in the normal body weight group(2.2%)(P<0.05).There was no significant difference in the incidence of bleeding(1.0% vs.0.3%,P>0.05),bile leakage(5.5% vs.3.5%,P>0.05),postoperative ascites(2.3% vs.0.7%,P>0.05),pulmonary infection(5.1% vs.1.5%,P>0.05),liver failure(3.3% vs.1.3%,P>0.05)and mortality(2.2% vs.0.8%,P>0.05)between the two groups.3.Analysis of risk factors for postoperative complications The univariate analysis of the risk factors for complications in all patients(n=858)showed that HBV-DNA,TBIL,Alb,Child-Pugh class,and the amount of bleeding and operation time all affected the complications after hepatectomy(P<0.05).Other factors,including somatotype,age,gender,the presence of liver cirrhosis,tumor thrombus in the large blood vessel,the number and diameter of tumors,and blockage of the first porta hepatis blood flow,did not affect the occurrence of postoperative complications(P>0.05).The multivariate logistic regression analysis showed that TBIL of >21 ?mol/L(RR=1.332,95%CI: 1.027-2.328,P<0.05),Alb of <35 g/L(RR=1.899,95%CI: 1.004-3.595,P<0.05)and operation time of >240 min(RR=1.874,95%CI: 1.320-2.660,P<0.05)were the independent risk factors that influenced the incidence of postoperative complications,while obesity was not a risk factor.4.The comparison of DFSR and analysis of risk factors Kaplan-Meier analysis showed that the 3-year DFSR was significant higher in the overweight and obesity group(40.6%)than in the normal body weight group(30.1%)(P<0.05).The univariate analysis of the risk factors for 3-year DFS in all patients(n=858)showed that the somatotype,liver cirrhosis,tumor thrombus in the large blood vessel,the number and diameter of tumors,intraoperative bleeding and operation time were associated with the 3-year DFSR after hepatectomy(P<0.05).However,the age,gender,HBV-DNA,TBIL,Alb,Child-Pugh class and the blockage of the first porta hepatis blood flow were not associated with the 3-year DFSR after hepatectomy(P>0.05).Multivariate logistic regression analysis showed that the presence of tumor thrombus in the large blood vessel(RR=2.185,95%CI: 1.812-2.634,P<0.05),a large number of tumors(RR=1.240,95%CI: 1.021-1.507,P<0.05),the diameter of tumor of ?5 cm(RR=1.514,95%CI: 1.240-1.848,P<0.05)and the operation time of >240 min(RR=1.260,95%CI: 1.036-1.532,P<0.05)were independent risk factors that influenced the 3-year DFSR after hepatectomy,while obesity was a protective factor(RR=0.754,P<0.05).The curve of DFS shows that DFSR was higher in the overweight and obesity group than in the normal body weight group in the patients receiving hepatectomy.Conclusion:1.Overweight and obese patients had more amount of blood loss,longer first hepatic portal occlusion time and longer operation time,but the total incidence rate of postoperative complications had no difference between two groups.Hepatectomy is safe for overweight and obesity of HCC patients.2.The 3-year DFSR was significant higher in the overweight and obesity group than in the normal body weight group,so it is important to improve the preoperative nutritional status,which has important clinical significance for improving the long-term prognosis of patients;The study of defects:1.The study was a retrospective study.There are deviations caused by human factors inevitably in the process of establishment and collecting data.BMI is a classification method for assessing the degree of obesity worldwide,but with the progress of science and technology.The BMI value is only a reference value,the body fat ratio is more accurate than BMI and to measure whether patients with obesity.But due to lack of equipment,the clinical work can only measure the preoperative height and weight,resulting the actual degree of obesity of some patients and BMI values do not match;2.Through this study we found that the 3-year DFSR was significant higher in the overweight and obesity group.However,there are many other factors that affect the prognosis of HCC in clinical work.Whether there is interaction between BMI and those factors,and the mechanism needs to be further studied. |
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