BMI与新辅助治疗后食管癌肿瘤消退之间的关联：来自德国全国性注册研究的见解
Association Between BMI and Tumour Regression After Neoadjuvant Therapy in Oesophageal Cancers: Insights From a German Nationwide Registry.
文献信息
| PMID | 42760794 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Susanne D Otto |
| 作者单位 | Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Germany. |
| 期刊 | Cancer medicine |
| SCI 分区 | Q2 |
| IF | 3.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 对于局部晚期食管癌，多模式治疗是标准治疗方案，但预后仍然较差。过去几十年中肥胖率显著上升。肥胖对新辅助治疗反应的影响仍不明确。本研究评估食管癌新辅助治疗后体重指数（BMI）与组织病理学肿瘤消退之间的关联。
材料与方法： 我们使用由德国普通与内脏外科学会（Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie，DGAV）提供的DGAV|registry食管手术前瞻性数据库进行分析。主要结局为Becker分类的组织病理学肿瘤消退分级。主要解释变量为BMI。在描述性统计之后，进行单因素和多因素回归分析，并针对肿瘤组织学、新辅助治疗方案、年龄、性别、ECOG状态、合并症、吞咽困难和体重减轻进行调整。关联使用多因素回归（部分比例优势）模型进行评估。
结果： 共纳入647例患者，包括432例腺癌（包括AEG I/II）和215例鳞状细胞癌（SCC）。在调整临床和肿瘤相关协变量后，较高的BMI与有利的组织病理学反应独立相关：未观察到与向Becker分级≥1b转变的关联；然而，较高的BMI与Becker分级≥2（OR 0.97，95% CI 0.94-1.00，p = 0.04）和Becker分级≥3（OR 0.93，95% CI 0.90-0.96，p < 0.001）的比值降低相关。此外，SCC、无吞咽困难、放化疗和低ECOG评分与有利消退独立相关，而年龄、性别、糖尿病状态、合并症或治疗前体重减轻未观察到独立关联。
结论： 对德国DGAV|registry的分析显示，较高的BMI与食管癌多模式治疗后组织病理学肿瘤消退改善显著相关。这些发现提示BMI升高患者之间可能存在肿瘤生物学差异，强调需要进一步的机制研究。
英文摘要
BACKGROUND: For locally advanced oesophageal carcinoma, multimodal therapy is the standard of care, but prognosis remains poor. Obesity has risen markedly in the last decades. The impact of obesity on response to neoadjuvant treatment remains unclear. This study evaluates the association between body mass index (BMI) and histopathological tumour regression following neoadjuvant therapy in oesophageal cancer.
MATERIALS AND METHODS: We performed an analysis using the prospective database from the DGAV|registry oesophageal surgery provided by the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV). The primary outcome was histopathological tumour regression grade by the Becker classification. The primary explanatory variable was BMI. Descriptive statistics were followed by uni- and multivariate regression analyses adjusted for tumour histology, neoadjuvant regimen, age, sex, ECOG status, comorbidities, dysphagia and weight loss. Associations were evaluated using a multivariate regression (partial proportional odds) model.
RESULTS: Six hundred and forty-seven patients were included, comprising 432 adenocarcinomas (including AEG I/II) and 215 squamous cell carcinomas (SCC). After adjustment for clinical and tumour-related covariates, higher BMI was independently associated with a favourable histopathological response: No association was observed for the transition to Becker grade ≥ 1b; however, higher BMI was associated with reduced odds of Becker grade ≥ 2 (OR 0.97, 95% CI 0.94-1.00, p = 0.04) and Becker grade ≥ 3 (OR 0.93, 95% CI 0.90-0.96, p < 0.001). In addition, SCC, absence of dysphagia, radiochemotherapy and low ECOG score were independently associated with favourable regression, whereas no independent associations were observed for age, sex, diabetes status, comorbidities or pretherapeutic weight loss.
CONCLUSION: Analysis of the German DGAV|registry revealed that higher BMI was significantly associated with improved histopathological tumour regression following multimodal therapy for oesophageal cancer. These findings suggest potential differences in tumour biology among patients with elevated BMI, underscoring the need for further mechanistic investigation.