营养状态与鼻咽癌患者同步放化疗预后的关系

Relationship between nutritional status and prognosis of patients with nasopharyngeal carcinoma with concurrent chemoradiotherapy

目的探讨营养状态与鼻咽癌患者同步放化疗预后的关系。方法回顾性分析2010年8月至2011年12月于广西医科大学附属肿瘤医院进行同步放化疗的134例初治鼻咽癌患者的临床资料。分别于放疗前1周(治疗前),放疗第4周(治疗中期)和放疗结束时采用营养风险筛查工具(nutritional risk screening 2002,NRS2002)以及患者提供的主观整体营养状况评估(patient-generated subjective global assessment,PG-SGA)量表评估患者营养状况,并分析PG-SGA评分与患者临床病理特征及总生存期(OS)、远处无转移生存期(DMFS)的关系。结果治疗前,治疗中期和治疗结束时NRS2002评分≥3分的患者所占比例分别为30.60%(41/134),75.37%(101/134)和85.82%(115/134),PG-SGA量表定性C级和B级的患者均逐渐增加,且放疗中期以及放疗结束时PG-SGA评分均较治疗前明显变差(P<0.001)。T分期、N分期、肿瘤体积以及各侵犯部位与PG-SGA评分呈正相关(均P<0.05)。治疗前中后PG-SGA不同评分组患者的5年OS和DMFS差异有统计学意义(P<0.001)。结论同步放化疗前鼻咽癌患者的营养不良风险较高,并在同步放化疗过程中营养状况持续恶化且与不良预后有关。

Objective To investigate the relationship between nutritional status and the prognosis of nasopharyngeal carcinoma patients with concurrent chemoradiotherapy.Methods The clinical data of 134 initial treatment patients with nasopharyngeal carcinoma who received concurrent chemoradiotherapy in Guangxi Medical University Cancer Hospital from August 2010 to December 2011 was retrospective analysis.The nutritional status of patients was assessed by nutritional risk screening 2002(NRS2002)scale and patientgenerated subjective global assessment(PG-SGA)scale in 3 stages,respectively,i.e.,1 week before radiotherapy(pre-treatment),4 weeks after radiotherapy(mid-treatment)and at the end of radiotherapy.The relationship between PG-SGA score and the clinicopathological characteristics,overall survival(OS)and distant metastasis-free survival(DMFS)of the patients were analyzed.Results The proportion of patients with NRS2002 score≥3 in 3 stages(pre-treatment,mid-treatment and at the end of treatment)was 30.60%(41/134),75.37%(101/134),and 85.82%(115/134),respectively.The number of the qualitative grade C and B patients of PG-SGA scale gradually increased,and the PG-SGA scores in the mid-treatment and at the end of treatment were significantly worse than the pretreatment(P<0.001).T stage,N stage,tumor volume and each site of invasion were positively correlated with PG-SGA score(all P<0.05).Before,during,and after treatment,the 5-year OS and DMFS of patients with different PG-SGA scores were significantly different(P<0.001).Conclusions Patients with nasopharyngeal carcinoma are at higher risk of malnutrition before concurrent chemoradiotherapy,and their nutritional status continues to deteriorate during concurrent chemoradiotherapy,which is related to poor prognosis.