Nutritional status and its relationship with prognosis in patients with locally advanced nasopharyngeal carcinoma
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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. -
Key words:
- locally advanced /
- nasopharyngeal carcinoma /
- malnutrition /
- prognosis
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表 1 53例局部晚期鼻咽癌患者基本特征
表 2 53例局部晚期鼻咽癌患者治疗前后各项指标及营养评分变化
（x±s） 
表 3 53例局部晚期鼻咽癌患者不良反应
例（%） 
表 4 53例局部晚期鼻咽癌患者PG-SGA评分与各项指标相关性分析
表 5 影响局部晚期鼻咽癌患者总生存的单因素及多因素分析
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[1] Wong CH, Ma BB, Cheong HT, et al. Preclinical evaluation of PI3K inhibitor BYL719 as a single agent and its synergism in combination with cisplatin or MEK inhibitor in nasopharyngeal carcinoma (NPC)[J]. Am J Cancer Res, 2015, 5(4):1496-1506. http://cn.bing.com/academic/profile?id=a0cb099d3e8625c954eb8f7023399bc6&encoded=0&v=paper_preview&mkt=zh-cn [2] Lin YH, Huang TL, Chien CY, et al. Pretreatment prognostic factors of survival and late toxicities for patients with nasopharyngeal carcinoma treated by simultaneous integrated boost intensity-modulated radiotherapy[J]. Radiat Oncol, 2018, 13(1):45. doi: 10.1186/s13014-018-0990-5 [3] Xiao W, Chan CWH, Fan Y, et al. Symptom clusters in patients with nasopharyngeal carcinoma duringradiotherapy[J]. Eur J Oncol Nurs, 2017, 28:7-13. doi: 10.1016/j.ejon.2017.02.004 [4] 陈梦微, 林少俊.鼻咽癌的营养治疗[J].中国癌症防治杂志, 2017, 9(4):255-259. doi: 10.3969/j.issn.1674-5671.2017.04.03 [5] 张力.鼻咽癌的综合治疗进展[J].肿瘤防治研究, 2019, 46(8):667-670. doi: 10.3971/j.issn.1000-8578.2019.19.0636 [6] 郭尔钢, 吴成, 胡国清.鼻咽癌患者病程中的营养状况[J].中国肿瘤临床, 2018, 45(10):492-496. doi: 10.3969/j.issn.1000-8179.2018.10.103 [7] 李涛, 吕家华, 郎锦义, 等.恶性肿瘤放疗患者营养治疗专家共识[J].肿瘤代谢与营养电子杂志, 2018, 5(4):358-365. http://d.old.wanfangdata.com.cn/Periodical/zldxyyy201804009 [8] Via MA, Mechanick JI. Malnutrition, dehydration, and ancillary feeding options in dysphagia patients[J]. Otolaryngol Clin North Am, 2013, 46(6):1059-1071. doi: 10.1016/j.otc.2013.08.002 [9] He Y, Chen L, Chen L, et al. Relationship between the comprehensive nutritional index and the EORTC QLQ-H & N35 in nasopharyngeal carcinoma patients treated with intensitymodulated radiation therapy[J]. Nutr Cancer, 2017, 69(3):436-443. doi: 10.1080/01635581.2017.1283422 [10] 黄素宁, 王仁生, 梁菲菲, 等.局部晚期鼻咽癌诱导化疗联合同期放化疗的临床观察[J].中华肿瘤防治志, 2013, 20(8):614-617. http://d.old.wanfangdata.com.cn/Periodical/qlzlzz201308013 [11] Li G, Gao J, Liu ZG, et al. Influence of pretreatment ideal body weight percentile and albumin on prognosis of nasopharyngeal carcinoma:Long-term outcomes of 512 patients from a single institution[J]. Head Neck, 2014, 36(5):660-666. doi: 10.1002/hed.23357 [12] 韩东景, 杨峥, 赵楠, 等.鼻咽癌放疗患者营养状况及营养干预的临床观察[J].中华肿瘤防治杂志, 2013, 20(10):786-789. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=qlzlzz201310018 [13] 李厨荣, 李涛, 李昉, 等.营养治疗对头颈部肿瘤放化疗营养状况影响的前瞻性研究[J].肿瘤代谢与营养电子杂志, 2017, 6(4):168-172. http://d.old.wanfangdata.com.cn/Periodical/zldxyyy201702008 [14] 中国抗癌协会, 中国抗癌协会肿瘤营养与支持治疗专业委员会, 中国抗癌协会肿瘤康复与姑息治疗专业委员会, 等.鼻咽癌营养治疗专家共识[J].肿瘤代谢与营养电子杂志, 2018, 5(1):30-32. http://d.old.wanfangdata.com.cn/Periodical/zldxyyy201801006 [15] 程金建, 杨华, 陆合明, 等.鼻咽癌患者调强放疗过程中体质量变化及影响因素分析[J].肿瘤防治研究, 2013, 40(8):767-771. doi: 10.3971/j.issn.1000-8578.2013.08.010 [16] 林仙煌, 关秀碧, 吴庆彩, 等.鼻咽癌同期放化疗期间体质量变化相关研究[J].现代医院, 2015, 15(7):41-45. doi: 10.3969/j.issn.1671-332X.2015.07.016 [17] 邱晨, 杨宁, 田光亮, 等.鼻咽癌患者放疗前后营养状况的前瞻性研究[J].山东大学学报(医学版), 2011, 49(6):130-133. http://d.old.wanfangdata.com.cn/Periodical/shandykdxxb201106029t [18] 童桂兰, 杨沛华, 刘春文, 等.血清前白蛋白的临床应用价值[J].中国中西医结合消化杂志, 2012, 20(5):232-234. http://d.old.wanfangdata.com.cn/Periodical/zgzxyjhpwzz201205015 [19] 王佳, 洪忠新.评价住院患者营养缺乏性营养不良敏感性指标的研究[J].中国全科医学, 2011, 14(7):2156-2158. http://d.old.wanfangdata.com.cn/Periodical/zgqkyx201119013 [20] Egestad H, Nieder C. Differences in quality of life in obese and normal weight head and neck cancer patients undergoing radiation therapy[J]. Support Care Cancer, 2015, 23(4):1081-1090. doi: 10.1007/s00520-014-2463-1 [21] 李欣, 孙明贺, 高媛.鼻咽癌患者发生营养不良相关危险因素的研究[J].哈尔滨医科大学学报, 2018, 52(5):465-468. doi: 10.3969/j.issn.1000-1905.2018.05.016 [22] 郝洁, 韩加.头颈部肿瘤患者放疗期间放疗反应与体质量变化分析[J].今日健康, 2016, 15(1):61. [23] 沈梅竹, 龙国贤, 孙伟, 等.鼻咽癌患者营养状态变化调查[J].内科急危重症杂志, 2015, 21(5):348-351. http://d.old.wanfangdata.com.cn/Periodical/nkjwzzzz201505010 [24] 黎娜, 刘洁, 林欣, 等.鼻咽癌住院患者营养状况及与PG-SGA评分相关性研究[J].肿瘤代谢与营养电子杂志, 2019, 6(9):200-205. http://d.old.wanfangdata.com.cn/Periodical/zldxyyy201902014 [25] Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival:a systematic review of the epidemiological literature[J]. Nutr J, 2010, 22(9):69. http://d.old.wanfangdata.com.cn/OAPaper/oai_doaj-articles_b23d98eecaecc2afdfb51cef8beefc31 [26] Liu LT, Chen QY, Tang LQ, et al. The Prognostic Value of treatmentrelated lymphopenia innasopharyngeal carcinoma patients[J]. Cancer Res Treat, 2018, 50(1):19-20. doi: 10.4143/crt.2016.595 [27] 贺巧, 陈琳, 黄叶才, 等.鼻咽癌患者放化疗前预后营养指数与预后的相关性[J].临床检验杂志, 2018, 3(36):182-185. http://d.old.wanfangdata.com.cn/Periodical/lcjyzz201803006 -
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