高体质指数对胃癌切除术患者预后影响的Meta分析

目的 系统评价高体质指数（body mass index，BMI）对胃癌切除术患者预后的影响。方法　计算机检索PubMed、EMBASE、Scopus、Cochrane Library、万方和中国知网等数据库，搜集关于BMI与胃癌切除术患者预后的相关研究，检索期限为建库至2018年12月31日。按照纳入和排除标准筛选文献，提取相关数据并评价纳入文献的质量。采用Review Manager 5.3软件进行Meta分析。结果 共纳入35篇文献，包括32 113例原发性胃癌患者，其中女性11 356例，男性20 757例。Meta分析结果显示，无论是开腹还是腹腔镜手术，高BMI组胃癌患者术后并发症的发生风险均高于低BMI 组患者（RR=1.29，95%CI：1.14~1.46，P<0.001；RR=1.24，95%CI：1.04~1.47，P=0.01）。高BMI组患者的5年总生存率较低BMI组患者差（RR=0.87，95%CI：0.79~0.96，P=0.006），但高BMI对胃癌患者的围手术期死亡率无显著影响（RR=0.79，95%CI：0.51~1.22，P=0.29）。结论 相对低BMI患者，高BMI胃癌患者术后并发症发生率较高，5年生存率较低，但不增加围手术期死亡率。

Prognostic impact of high body mass index on gastric cancer patients undergoing gastrectomy

Objective To evaluate the effect of high body mass index（BMI） on the prognosis of gastric cancer patients undergoing gastrectomy. Methods　PubMed，EMBASE，Scopus，Cochrane Library，WanFang and CNKI databases were searched to find related studies on the effect of high BMI on the prognosis of patients that undergoing gastrectomy for gastric cancer from inception to December 31，2018. According to the inclusion and exclusion criteria，screened the literature，extracted data and evaluated the quality. Meta-analysis was performed using Review Manager 5.3 software. Results A total of 35 literatures were included in the study，including 32 113 patients（11 356 females and 20 757 males） with primary gastric cancer. Meta-analysis showed that the risk of postoperative complications in patients with high BMI was significantly higher than that in patients with low BMI，whether it was open or laparoscopic gastrectomy（RR=1.29，95%CI：1.14-1.46，P<0.001；RR=1.24，95%CI：1.04-1.47，P=0.01）. The 5-year overall survival rate of patients with high BMI gastric cancer was lower than that in patients with low BMI gastric cancer（RR=0.87，95%CI：0.79-0.96，P=0.006），but high BMI had no significant effect on perioperative mortality in patients with gastric cancer（RR=0.79，95%CI：0.51-1.22，P=0.29）. Conclusions Patients with high BMI gastric cancer have a higher incidence of postoperative complications and a lower 5-year survival rate than those patients with low BMI gastric cancer，but no increase perioperative mortality.