Gastric cancer,Surgery,Lipids,Survival prognosis,Retrospective cohort study  ,"/> 胃癌手术患者血脂水平与生存预后的相关性：一项回顾性队列研究

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中国癌症防治杂志

中国癌症防治杂志 ›› 2024, Vol. 16 ›› Issue (6): 687-693.doi: 10.3969/j.issn.1674-5671.2024.06.08

• 消化道肿瘤诊疗专栏 • 上一篇    下一篇

胃癌手术患者血脂水平与生存预后的相关性：一项回顾性队列研究

  

  1. 中国人民解放军空军军医大学西京医院消化外科;中国人民解放军空军军医大学西京医院,国家消化系统疾病临床医学研究中心和消化系肿瘤整合防治全国重点实验室
  • 出版日期:2024-12-25 发布日期:2025-01-03
  • 通讯作者: 季刚 E-mail：jigangfmmu@163.com; 赵晓迪 E-mail：leedyzhao@fmmu.edu.cn
  • 基金资助:
    国家自然科学基金面上项目（81871913；82273142）

Correlation between blood lipid levels and survival prognosis of gastric cancer patients under operation: A retrospective cohort study

  • Online:2024-12-25 Published:2025-01-03

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摘要： 目的 探讨胃癌手术患者血脂水平与生存预后的相关性。方法 选择2020年5月至2021年5月在空军军医大学西京医院消化外科行手术治疗的837例胃癌患者为研究对象。采用Cox回归、限制性立方样条法分析胃癌患者血清中总胆固醇（total cholesterol，TC）、甘油三酯（triglyceride，TG）、高密度脂蛋白胆固醇（high⁃density lipoprotein cholesterol，HDL⁃C）及低密度脂蛋白胆固醇（low⁃density lipoprotein cholesterol，LDL⁃C）水平与总生存期（overall survival，OS）之间的关系。结果 生存分析显示，TC≥5.2 mmol/L患者的死亡风险较TC<5.2 mmol/L患者高56.8%（HR=1.568，95%CI：1.159~2.121），LDL⁃C≥3.4 mmol/L患者的死亡风险较LDL⁃C<3.4 mmol/L患者高95.7%（HR=1.957，95%CI：1.440~2.660），但未发现TG、HDL⁃C与OS有关（均P>0.05）。限制性立方样条分析显示，TC与OS之间具有“U型”关系，当TC水平<4.36 mmol/L时患者死亡风险随着TC水平增高而降低，并在TC=4.36 mmol/L达到最低风险，当TC>4.36 mmol/L时患者死亡风险随TC水平增高而增高（非线性P=0.006）。LDL⁃C与OS之间具有“J型”关系，LDL⁃C水平在较低范围内时风险较平稳，直到LDL⁃C=2.57 mmol/L时，风险迅速增加（非线性P=0.024），未发现TG、HDL⁃C水平与OS存在关联（均P>0.05）。亚组分析显示，在男性、年龄>50岁、身体质量指数<18.5 kg/m2、有吸烟史、无冠心病史和有饮酒史的患者中，TC、LDL⁃C与OS关联更为明显（均P<0.05），除具有吸烟史的胃癌患者中观察到TG与OS存在关联外，其余各亚组患者TG、HDL⁃C水平与OS无明显关联（均P>0.05）。结论 胃癌患者血清LDL⁃C及TC水平升高与生存预后不良相关，可作为评估胃癌患者术后预后的重要指标。

关键词: 胃癌, 手术, 血脂, 生存预后, 回顾性队列研究

Abstract: Objective To investigate the correlation between blood lipid levels and survival prognosis for the gastric cancer patients undergoing operation. Methods A total of 837 gastric cancer patients who underwent gastrointestinal surgery in department of Xijing Hospital, Air Force Medical University from May 2020 to May 2021 were selected as the study objects. The relationship between Serum levels of total cholesterol (TC), triglycerides (TG), high⁃density lipoprotein cholesterol (HDL⁃C), low⁃density lipoprotein cholesterol (LDL⁃C) and overall survival (OS) in patients with gastric cancer were analyzed by the Cox regression and the restricted cubic spine analysis. Results The survival analysis showed that the patients with TC≥5.2 mmol/L had a risk of death 56.8% higher than the patients with TC<5.2 mmol/L (HR=1.568, 95% CI:1.159~2.121), and the risk of death in patients with LDL⁃C≥3.4 mmol/L was 95.7% higher than that in patients with LDL⁃C<3.4 mmol/L (HR=1.957, 95% CI: 1.440~2.660). However, TG and HDL⁃C were not associated with OS (P>0.05). The restricted cubic spine analysis showed that there was a U⁃shaped relationship between TC and OS. When TC level was less than 4.36 mmol/L, the survival risk of patients decreased with the increase of TC level, and the lowest risk was reached at TC=4.36 mmol/L. The risk increased with the increase of TC level at > 4.36 mmol/L (P for nonlinear=0.006). There was a J⁃shaped relationship between LDL⁃C and OS. When LDL⁃C level was in the low range, the risk was relatively stable, and the risk increased rapidly until LDL⁃C=2.57 mmol/L (P for nonlinear=0.024), and no correlation was found between TG and HDL⁃C level and OS (P>0.05 for both). Subgroup analysis showed that TC and LDL⁃C were more significantly associated with OS in male patients, age>50 years old, BMI<18.5 kg/m2, smoking history, no history of coronary heart disease and alcohol consumption (all P<0.05), except for the association between TG and OS observed in gastric cancer patients with a smoking history, there was no significant correlation between TG and HDL⁃C levels and OS in other subgroups (all P>0.05). Conclusions High levels of LDL⁃C and TC are closely associated with poor clinical prognosis in gastric cancer patients, which can be used as an important indicator for postoperative prognostic assessment of patients with gastric cancer.

Key words: Gastric cancer')">Gastric cancer, Surgery, Lipids, Survival prognosis, Retrospective cohort study  

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  • 引用本文

    郭芝妤, 曹田宇, 王伟东, 郭星娴, 马婉琪, 卢瑗瑗, 赵晓迪, 季刚. 胃癌手术患者血脂水平与生存预后的相关性：一项回顾性队列研究[J]. 中国癌症防治杂志, 2024, 16(6): 687-693.

    GUO Zhiyu, CAO Tianyu, WANG Weidong, GUO Xingxian, MA Wanqi, LU Yuanyuan, ZHAO Xiaodi, JI Gang. Correlation between blood lipid levels and survival prognosis of gastric cancer patients under operation: A retrospective cohort study[J]. Chinese Journal of Oncology Prevention and Treatment, 2024, 16(6): 687-693.