Weight Loss Following Radical Cystectomy for Bladder Cancer: Characterization and Effect on Survival
Weight Loss Following Radical Cystectomy for Bladder Cancer: Characterization and Effect on Survival
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DOI：
10.1016/j.clgc.2016.06.009
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发表时间：
2017-02-01
影响因子：
3.2
通讯作者：
Kader, A. Karim
中科院分区：
文献类型：
--
作者：
McDonald, Michelle L.;Liss, Michael A.;Kader, A. Karim
膀胱癌根治性膀胱切除术后体重减轻是常见的现象，但特征不明确。目前的研究调查了一组接受膀胱癌根治性膀胱切除术的患者术后体重减轻的发生率及其与死亡率的关系。特别注意营养状况指标和营养不良对术后结果的潜在影响。本研究的目的是评估根治性膀胱切除术（RC）后体重减轻（WL）的发生率及其与死亡率的关系。营养状况被认为是膀胱癌RC术后并发症的潜在可改变危险因素。美国肠外和肠内营养学会和营养与饮食学会承认WL是营养不良的诊断指标。方法：2008年7月至2013年7月期间，71例膀胱癌患者接受了RC，并定期记录其手术体重。主要预测变量为术后第1个月的实质WL，定义为>= 10% WL。采用Kaplan-Meier分析估计生存率；多因素分析采用Logistic回归。结果：术后2周平均WL为9.5磅（-5.2%），1个月时14.3磅（-7.8%），2个月时16.9磅（-9.0%），3个月时12.6磅（-6.9%），4个月时8.9磅（-4.6%）。42%的患者符合严重WL的标准。在19个月的中位随访中，总死亡率为31%（71例中有22例），在经历严重WL的患者中，总死亡率上升至64%（22例中有14例）（P < 0.05）。在多变量分析中，大量WL趋于显著（P =.07）。>= 10% WL患者的5年生存率显著降低（log rank P < 0.05）。结论：患者在RC后出现WL，这可能是营养不良的指示。大量WL可能预示较差的总生存率。需要前瞻性研究来确定营养优化是否可以预防明显的白癜风并改善预后。
Weight loss following radical cystectomy for bladder cancer is commonly observed although poorly characterized. The current study investigates the prevalence of postoperative weight loss and its association with mortality in a cohort of patients undergoing radical cystectomy for bladder cancer. Special attention was given to indicators of nutritional status and the potential effect of malnutrition on postoperative outcomes. Introduction: The purpose of this study was to evaluate the prevalence of postoperative weight loss (WL) following radical cystectomy (RC) and its association with mortality. Nutritional status is recognized as a potential modifiable risk factor for postoperative complications following RC for bladder cancer. The American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics recognize WL as a diagnostic measure for malnutrition. Methods: Seventy-one patients underwent RC for bladder cancer between July 2008 and July 2013, in whom pert-operative weights were documented regularly. The primary predictor variable was substantial WL defined as >= 10% WL by postoperative month 1. Survival was estimated using Kaplan-Meier analysis; logistic regression was used for multivariate analyses. Results: Mean postoperative WL at 2 weeks was 9.5 lbs (-5.2%), 14.3 lbs (-7.8%) at 1 month, 16.9 lbs (-9.0%) at 2 months, 12.6 lbs (-6.9%) at 3 months, and 8.9 lbs (-4.6%) at 4 months. Forty-two percent of patients met criteria for substantial WL. At 19 months median follow-up, the overall mortality rate was 31% (22 of 71), which rose to 64% (14 of 22) in patients who experienced substantial WL (P < .05). Substantial WL trended towards significance on multivariate analysis (P =.07). There was a significant decrease in 5-year survival in patients with >= 10% WL (log rank P < .05). Conclusions: Patients experience WL following RC, which may be indicative of malnutrition. Substantial WL may predict for poor overall survival. Prospective studies are needed to determine whether nutritional optimization can prevent significant WL and improve outcomes.