局部晚期鼻咽癌患者营养状况及其与预后相关性分析

Nutritional status and its relationship with prognosis in patients with locally advanced nasopharyngeal carcinoma

    摘要
  • 摘要:
      目的  探讨局部晚期鼻咽癌患者营养状况及其与预后相关性。
      方法  分析2015年8月至2017年3月湖北省肿瘤医院收治的局部晚期鼻咽癌住院患者53例，联合运用患者主观整体营养评估量表（patient-generated subjective global assessment，PGSGA）、体格测量、血液学指标和放化疗不良反应，全面评估患者营养状况；采用Kaplan-Meier法及Cox风险比例回归模型对患者生存及影响因素进行分析。
      结果  53例患者中，94.3%（50/53）的患者出现体质量下降，下降均值为（6.89±0.54）kg，50.9%（27/53）的患者体质量下降≥10%；PG-SGA评估的患者重度营养不良发生率为84.9%（45/53）；淋巴细胞计数、红细胞、血红蛋白、白蛋白与PG-SGA评分高度负相关（P < 0.05），口腔黏膜炎、吞咽困难或疼痛、厌食、体质量下降百分比与PG-SGA评分高度正相关（P < 0.05）；单因素及多因素分析显示，TNM分期晚、治疗期间体质量下降≥10%与局部晚期鼻咽癌患者预后不良相关，而白细胞计数增加（在正常值范围内）与局部晚期鼻咽癌患者预后良好相关，差异均具有统计学意义（P=0.036，P=0.016，P=0.024）。
      结论  局部晚期鼻咽癌患者营养不良发生率高；PG-SGA评分联合体格测量、血液学指标和放化疗不良反应，能够更全面地评估患者营养状况；TNM分期晚、治疗期间体质量下降≥10%是局部晚期鼻咽癌患者预后的不良因素，而白细胞计数增加（在正常值范围内）是患者预后的有利因素。

     

    Abstract:
      Objective  To investigate the nutritional status of patients with locally advanced nasopharyngeal carcinoma (NPC) and its relationship with prognosis.
      Methods  From August 2015 to March 2018, 53 patients with locally advanced NPC hospitalized for treatment at the Department of Radiotherapy at Hubei Cancer Hospital, Wuhan, China, were enrolled in this study. The patient-generated subjective global assessment (PG-SGA), anthropometry measurements, hematological indexes, and side-effects of radiation and chemotherapy were used to evaluate the nutritional status. Survival and its influencing factors were further analyzed using the Kaplan-Meier estimator and a Cox proportional hazards regression model.
      Results  94.3% of the locally advanced NPC patients lost weight. The average weight loss was 6.89 ±0.54 kg. Of those NPC patients who lost weight, 50.94% had more than 10% weight loss. According to the PG-SGA score, 84.9% of the NPC patients had severe malnutrition (PG-SGA ≥ 9). A highly negative correlation was observed among lymphocyte count (TLC), red blood cell (RBC), hemoglobin (Hb) level, albumin (ALB) level, and PG-SGA scores (all P < 0.05). A highly positive correlation was observed among oral mucositis, difficulty swallowing or pain, anorexia, rate of weight loss, and PG-SGA scores (all P < 0.05). Univariate and multivariate analyses showed that a high TNM stage and more than 10% weight loss during treatment were associated with an unfavorable prognosis. A high level of white blood cells (WBC), within the normal range, was associated with a better survival rate (All P < 0.05).
      Conclusions  Patients with locally advanced NPC had a high incidence of malnutrition in this study. PG-SGA combined with anthropometry measurements, hematological indexes, and side-effects of radiation and chemotherapy can help evaluate the nutritional status of patients with NPC more comprehensively. A high TNM stage, more than 10% weight loss during treatment, and high WBC counts were independently associated with prognosis and survival among patients with locally advanced NPC.

     

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