| 摘要: | 目的: 分析上皮性卵巢癌患者治療前的BMI與化學治療期間體重的變化對復發時間及生存期的影響。
背景: 上皮性卵巢癌是一個致命性惡性腫瘤，據推估全世界每年有超過十四萬人因此而死亡。已知肥胖是子宮內膜癌、乳癌的賀爾蒙中介危險因素和影響預後的因素，然而其對於卵巢癌的影響仍不清楚。因而有必要進一步探討兩者的關聯，以作為改善病患預後之參考。卵巢癌患者因為治療需反覆住院，而護理人員除了針對其化學治療後副作用進行評估與護理外，應發現一些可以改變的因素，以提高治療照護的成效。而身體質量指數及體重是其中一個重要而可能改變的指標，所以本研究擬釐清BMI對卵巢癌婦女的影響，以提出理想的BMI指標建議，及了解卵巢癌手術後患者在治療期間體重的增減對於疾病控制的意義。
方法:本研究採病歷回溯性研究，以中部某醫學中心卵巢癌患者首次術後化學治療者為對象，依國際疾病診斷碼，查詢西元1999至西元2012年上皮性卵巢癌患者資料。依世界衛生組織定義,將患者化療前BMI分為低於標準(BMI ≦18.5)，正常(>18.5 BMI≦24.9)，過重(≧25.0 BMI ≦29.9)，肥胖(BMI ≧30)四組類別，以化療前BMI平均值與上皮性卵巢癌患者的生理特徵與病理特徵(年齡、體重、組織學、癌症分期、體能狀態、化學治療種類)以卡方統計方式分析(Chi-square test)；並使用變異數重複測量方法(ANOVA repeated measures)分析各組BMI與六次體重的關係；體重改變的計算公式以：[（W 6/ W1）-1]×100％，由Cox比例風險回歸模式(Cox proportional hazards model)分析身體質量指數與患者人口學特徵對疾病復發與存活的影響，及化學治療期間的體重變化對復發與存活的關係；並採描述性統計Kaplan-Meier法比較治療前BMI與化學治療期間的體重變化對上皮性卵巢癌患者的復發期與存活期關係。
結果:共收集199位卵巢癌患者,其治療前的BMI於卵巢癌患者復發期及存活期無統計學上差異，所以拒絕該假設;但在相同卵巢癌患者群體中癌症期數與日常體能狀況影響病人的復發率與存活率。我們由Cox比例風險回歸模式分析化學治療期間的體重變化與患者人口學特徵對疾病復發與存活的影響中，發現化學治療時體重增加> 5％組別的病患相對於體重減少0-5%組別的病患其死亡風險比為13.45 ( 95% CI 1.03－175.5；p value＝0.04)；在第六次的化學治療時體重每增加一公斤其復發風險就增加2.4%(HR 1.024，95% CI 1.00－1.04， p value＝0.035)，所以研究結果支持卵巢癌婦女在化療期間體重的變化會對復發期及存活期影響的假設。
Purpose: To assess the impact of body mass index (BMI) before chemotherapy and body weight changes during chemotherapy in patients with epithelial ovarian cancer on the disease recurrence and survival rate.
Background: Epithelial ovarian cancer is a fatal cancer. It is esti-mated that worldwide there are more than 140,000 people have died each year. Obesity is a known endometrial cancer and breast cancer risk factor and intermediary factor on disease prognosis, however
, its effect on the ovarian cancer remains unclear.Therefore we
intended to further explore the relationship between the disease recurrence and survival rates to any exist factors, as a guide to improve the prognosis. We could pay attention to any factors during our patients’ chemotherapy hospital stay, such as on every time of their pre-chemotherapy assessment that we can manipulate it, for improving their therapeutic effect. We could expand our effort to the area beyond their chemotherapy drug side-effect. In these points of view, body mass index and body weight is one of the ideal factor we can take on, since every patient has the chance to record their weight and height before each cycles of chemotherapy. Therefore, this study was to clarify the impact of BMI for women with ovarian cancer on disease recurrence and survival rates. We supported ideal BMI index and stability of weight changes in ovarian cancer patient taking chemotherapy have significance influence for disease control.
Methods: The chart of the women who diagnosed with ovarian cancer in a medical center from 1999 through 2012 were retrospectively reviewed. We had divided all the patients according the World Health Organization classification for obesity into : under normal weight(BMI ≦18.5), normal weight(>18.5 BMI≦24.9), overweight(≧25.0 BMI ≦29.9) and obese(BMI ≧30). Chi-square test was used for testing differences between our BMI groups to clinical and pathologic features (age, body weight, histology, cancer stage, performance status, chemotherapy regiment). ANOVA repeated measure was applied for testing the differences our BMI groups to clinical and pathologic features throughout 6 courses of chemotherapy. We had intended to evaluate the relationship of our two factors: pre-chemotherapy BMI, and Change of BMI throughout 6 courses of chemotherapy, defined by ([（W 6/ W1）-1]×100％), to outcome of our patients in disease recurrence and survival rate. We used Cox proportional hazards model in our analysis. The survival curves were generated by using the Kaplan–Meier method and Differences between our BMI group curves were tested by the log-rank test.
Result: There was no association for pre-chemotherapy BMI to disease recurrence and survival in our one hundred and ninety-nine ovarian cancer patients. We therefore reject our previous assumption of significant influence of BMI to disease recurrence and survival；The cancer stage and performance status were found to affect the patient's recurrence rate and survival both in our study. Interim groups comparison between >5% body weight and the 0–5
% body weight decrease group for survival had concluded with relative hazard ratio of 13.45 ( 95% CI 1.03－175.5；p value＝0.04). With each additional one kilogram of body weight at the sixth of chemotherapy was associated with a 2.4% increases in the risk of recurrence (HR 1.024, 95% CI 1.00－1.04, p value＝0.035). Therefore the results supported the assumption that changes in body weight during chemotherapy would have impact at disease recurrence and survival of ovarian cancer patient.
Conclusions: Based on the results of this study, we recommend that nurses, who are in the care of ovarian cancer patients with chemo-
therapy, to include the body weight as an ideal factor influencing disease outcome. Consequently, every patient will have individual caring plan on weight management. We might bring out the caring strategy by assessing the contents of Individual diet and exercise situations, and giving individual health education. The change of body weight during chemotherapy might be included for disease recurrence risk assessment according to our conclusion. Nutritionist consultation might be recommended when dealing with high amplitude instability weight change during receiving chemotherapy for benefits of disease control.
結論: 依據本研究結果建議護理人員在照護接受化學治療之卵巢癌患者時，宜將體重納入評估與觀察指標，同時提供個別性護理計畫，如:評估其飲食內容與運動情形並給予衛教，將在化學治療期間的體重變化定期納入評估與追蹤要項，並依據患者的情況作適時的轉介，如:對於體重明顯改變或不穩定的病人安排會診營養師或相關門診，同時在相關醫護團隊會議中提出相對於體重明顯改變或不穩定病人化學治療的建議，以對其治療結果包括延緩復發和延長存活期及生活品質做出實質貢獻。 |
