个体化营养干预对局部晚期鼻咽癌患者生活质量及生存预后的影响

Influence of individualized nutrition intervention on quality of life and survival prognosis of patients with locally advanced nasopharyngeal carcinoma

背景与目的:同步放化疗是局部晚期鼻咽癌的首选治疗方法,但放化疗会使患者营养状况持续恶化,进而影响患者的生活质量及生存预后。探讨基于营养风险评估的个体化营养干预对局部晚期鼻咽癌同步放化疗患者生活质量及生存预后的影响。方法:选取2017年1月—2019年3月海南医学院第二附属医院耳鼻咽喉头颈外科收治的局部晚期鼻咽癌患者116例,随机分为干预组和对照组,每组58例,所有患者均接受同步放化疗,对照组放化疗期间行常规饮食指导,干预组患者根据营养风险评估行个体化营养干预。比较两组患者的营养状况变化、生活质量,并分析两组患者的2年和3年总生存率(overall survival,OS),无局部复发生存率(local recurrence-free survival,LRFS),无远处转移生存率(distant metastasis-free survival,DMFS)。结果:干预组放疗2周、放疗4周及放疗结束时营养不良发生率分别为27.59%、46.55%和51.72%,均低于对照组的48.28%、75.86%和81.03%,差异有统计学意义(P<0.05)。治疗后干预组躯体功能、角色功能、认知功能、情绪功能、社会功能等生活质量评分均高于对照组,差异有统计学意义(P<0.05)。干预组2年和3年OS、LRFS、DMFS均高于对照组,差异有统计学意义(P<0.05)。结论:个体化营养干预能有效地改善局部晚期鼻咽癌患者放化疗期间的营养状况,提高患者生活质量,改善生存预后。

Background and purpose:Concurrent chemoradiotherapy is the preferred treatment for locally advanced nasopharyngeal carcinoma.However,concurrent chemoradiotherapy will worsen the nutritional status of patients,thus affecting the quality of life and survival prognosis of patients.This study aimed to investigate the effect of individualized nutritional intervention based on nutritional risk assessment on quality of life and survival prognosis of patients with locally advanced nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy.Methods:A total of 116 patients with locally advanced nasopharyngeal carcinoma treated in the Second Affiliated Hospital of Hainan Medical College from January 2017 to March 2019 were enrolled and randomly divided into the intervention group(58 cases)and the control group(58 cases).The patients in both groups were treated with the same concurrent chemoradiotherapy.The control group received routine dietary guidance,and the intervention group received individualized nutritional intervention based on nutritional risk assessment during concurrent chemoradiotherapy.The nutritional status and life quality of the two groups were compared,and the 2-year and 3-year overall survival(OS),local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)of the two groups were analyzed.Results:The incidence of malnutrition in the intervention group at 2 weeks,4 weeks and the end of radiotherapy was 27.59%,46.55% and 51.72% respectively,which were lower than 48.28%,75.86% and 81.03% of the control group(P<0.05).After treatment,scores of life quality including psychological function,role function,cognitive function,emotional function,social function were significantly higher in the intervention group than in the control group(P<0.05).The 2-year and 3-year OS,LRFS and DMFS were higher in the intervention group than in the control group(P<0.05).Conclusion:Individualized nutrition intervention can effectively improve the nutritional status,life quality and the survival prognosis of locally advanced nasopharyngeal carcinoma patients during concurrent chemoradiotherapy.