摘要： 目的 分析胃癌根治手术前患者营养状态的特点,探讨术前高危营养状态(体质量指数<24 kg/m²、贫血、低蛋白血症)对不同浆膜类型胃癌患者预后的影响及对预判胃癌分期的辅助评估。方法 回顾性分析641例行胃癌根治性手术患者的临床病历资料,并按照浆膜类型分为正常和反应型、结节型、健状型、多彩弥漫型4组,比较4组患者的术前营养指标和术后5年生存情况。结果 术前存在任意2个及2个以上危险营养因素的正常和反应型高危营养状态患者的5年生存率低于存在1个及1个以下危险营养因素的正常和反应型低危营养状态患者(分别为89.3%和76.0%,P<0.05)。正常和反应型高危营养状态患者与结节型患者相比,5年生存率无统计学差异。结节型、腱状型和多彩弥漫型3组中,高危营养状态与低危营养状态患者相比,5年生存率均无统计学差异。结论 在胃癌浆膜类型为正常和反应型的患者中,低危营养状态患者的预后情况明显好于高危营养状态患者,在预判胃癌分期时可重新将低危营养状态独立划分,将正常和反应型中的高危营养状态患者与结节型患者合并。

术前营养状态对不同浆膜类型胃癌患者预后的影响及对胃癌分期的预判

张博¹, 李凯², 邵伊宁³, 欧凤荣¹

1. 中国医科大学 附属第一医院临床营养科, 沈阳 110001;
2. 中国医科大学 附属第一医院肿瘤外科, 沈阳 110001;
3. 中国医科大学 2015级(101期)临床医学专业, 沈阳 110122

收稿日期:2019-08-23出版日期:2020-06-30发布日期:2020-06-15
通讯作者:欧凤荣E-mail:ofrcmu@163.com
作者简介:张博(1986-),男,医师,硕士研究生.
基金资助:辽宁省高等学校创新人才支持计划项目（LR2016043）


关键词: 胃癌, 浆膜类型, 营养状态, 分期, 预后
Abstract: Objective To analyze the nutritional status of patients with gastric cancer before they undergo gastrectomy and to investigate the effect of a high-risk preoperative nutritional status (body mass index <24 kg/m²,anemia,and hypoproteinemia) on the prognosis of gastric cancer of different serous membrane types as well as the application of preoperative nutritional status in predicting the gastric cancer stage. Methods In this study,we reviewed the medical records of 641 patients with gastric cancer who underwent gastrectomy. The patients were divided into 4 groups according to their serosal membrane types,as follows:normal and reactive,nodular,tendonoid,and color-diffused types. Preoperative nutritional indicators and postoperative survival were analyzed and compared among the 4 groups. Results The 5-year survival rates of the normal and reactive group with a high-risk nutritional status were lower than those of the normal and reactive group with a low-risk nutritional status. No significant difference in 5-year survival was found between the normal and reactive group with a high-risk nutritional status and the nodular group. Further,no significant difference in the 5-year survival rate was found between the patients with high- and low-risk nutritional statuses in the nodular,tendonoid,and color-diffused groups. Conclusion Among the patients with gastric cancer of the normal and reactive types,patients with a low-risk nutritional status had a significantly better prognosis than those with a high-risk nutritional status. In the prediction of cancer stage,low-risk nutritional status can be reclassified independently,and high-risk nutritional status can be combined with the nodule type.
Key words: gastric cancer, serous membrane type, nutrition status, staging, prognosis
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