Obesity portends increased morbidity and earlier recurrence following liver transplantation for hepatocellular carcinoma
Obesity portends increased morbidity and earlier recurrence following liver transplantation for hepatocellular carcinoma
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DOI：
10.1111/j.1477-2574.2012.00602.x
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发表时间：
2013-07-01
期刊：
影响因子：
2.9
通讯作者：
Alsina, Angel E.
中科院分区：
文献类型：
--
作者：
Mathur, Abhishek;Franco, Edson S.;Alsina, Angel E.
背景：肥胖与胰腺癌行胰管切除术后肿瘤学预后不良有关。然而，有一个缺乏证据的影响，肥胖对术后并发症，肿瘤学结果和生存的肝细胞癌（HCC）患者接受原位肝移植（奥尔特）。方法从1996-2008年1000多例奥尔特患者中筛选出159例诊断为肝癌的患者。获得人口统计学数据、体重指数（BMI）、围手术期参数、复发率和生存率。根据Clavien-Dindo分级（I-V级）对并发症进行分组。结果超重组和肥胖组患者危及生命的并发症发生率分别为58%和70%，明显高于非肥胖组的41%（P < 0.05）。超重和肥胖者肝癌复发率分别为15%和15%，非肥胖者肝癌复发率为7%，两组比较差异有统计学意义（P < 0.05）。复发时间也显著缩短。与非肥胖组（58 +/- 6个月）相比，超重组（45 +/- 3个月）和肥胖组（41 +/- 4个月）的平均+/-标准差生存率差异未达到统计学显著性。结论这些发现表明BMI是肥胖的一个重要的替代指标，预示着肝细胞癌奥尔特后并发症的风险增加和肿瘤学结局较差。
Background Obesity has been associated with poor oncologic outcomes following pancreatoduodenectomy for pancreatic cancer. However, there is a paucity of evidence on the impact of obesity on postoperative complications, oncologic outcome and survival in patients with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT). Methods From a database of over 1000 patients who underwent OLT during 1996-2008, 159 patients with a diagnosis of HCC were identified. Demographic data, body mass index (BMI), perioperative parameters, recurrence and survival were obtained. Complications were grouped according to Clavien-Dindo grading (Grades I-V). Results There were increased incidences of life-threatening complications in overweight (58%) and obese (70%) patients compared with the non-obese patient group (41%) (P < 0.05). Furthermore, the incidence of recurrence of HCC was doubled in the presence of overweight (15%) and obesity (15%) compared with non-obesity (7%) (P < 0.05). Time to recurrence also decreased significantly. Differences in mean +/- standard deviation survival in the overweight (45 +/- 3 months) and obese (41 +/- 4 months) groups compared with the non-obese group (58 +/- 6 months) did not reach statistical significance. Conclusions These findings indicate that BMI is an important surrogate marker for obesity and portends an increased risk for complications and a poorer oncologic outcome following OLT for HCC.