结直肠癌患者术后营养状态对放化疗耐受性的影响研究

The effect of nutritional status on tolerability of radiotherapy and chemotherapy in patients with colorectal cancer after operation

目的探讨结直肠癌患者术后营养状态对放化疗耐受性的影响。方法回顾性分析本院180例接受腹腔镜结直肠癌根治术患者的临床资料,患者术后均接受三维适形调强放疗联合化疗干预。根据营养风险筛查表(NRS 2002)记录放化疗前1 w患者营养状态,根据放化疗治疗和完成情况记录放化疗耐受性及不良反应发生情况,分析结直肠癌患者术后营养状态与放化疗耐受性的关系。结果 180例结直肠癌患者中NRS 2002评分≥3分者97例(占53.89%,为有营养风险组),83例NRS2002评分<3分(占46.11%,为无营养风险组)。129例患者顺利完成放化疗,12例延迟完成,共141例耐受性良好,39例耐受性差。NRS 2002营养状态与患者放化疗耐受性和不良反应分级呈正相关(r=0.426、0.507,P=0.023、0.000)。NRS 2002评分<3分是影响患者放化疗耐受性的独立保护因素(OR=0.487,P=0.000),不良反应分级≥Ⅲ级是影响患者放化疗耐受性的独立危险因素(OR=1.984,P=0.000)。结论结直肠癌术后患者多存在营养不良,营养不良是患者对术后放化疗耐受性的独立影响因素,营养状态监测和营养支持应是结直肠癌综合治疗的重要内容。

Objective To study the effect of postoperative nutritional status on tolerance of radiochemotherapy in patients with colorectal cancer. Methods The clinical data of 180 patients who underwent laparoscopic colorectal cancer resection were retrospectively analyzed. All patients received the intervention of three-dimensional conformal intensity modulated radiotherapy combined with chemotherapy after operation. The nutritional status assessed by the Nutritional Risk Screening 2002（NRS 2002） scale was recorded 1 week before radiochemotherapy. Tolerance of radiochemotherapy reflected by treatment and completion of chemotherapy and chemotherapy, as well as adverse reactions were recorded. The relationship between postoperative nutritional status and tolerance of radiochemotherapy in patients with colorectal cancer was analyzed. Results There were 97 out of 180 cases（53.89%） with NRS2002 score ≥ 3 and they were classified as the nutritional risk group. There were 83（46.11%） with NRS 2002 score 3 and they were classified as the no risk group. 129 patients successful completed radiotherapy and chemotherapy, and 12 had delayed completion. In total there were 141 had good tolerance and 39 poor tolerance. There were positive correlations between NRS 2002 nutritional status and patients＇ tolerance of radiochemotherapy and severity of adverse reactions（r = 0.507 and 0.426, respectively; P = 0.000 and0.023, respectively）. The NRS 2002 score 3 was an independent protective factor influencing patients＇ tolerance（OR = 0.487, P =0.000）. The severity of adverse reactions over Ⅲ was an independent risk factor influencing patients＇ tolerance（OR = 1.984, P =0.000）. Conclusion Malnutrition is common in patients with colorectal cancer. Malnutrition is an independent factor that affects the patient＇s tolerance to postoperative radiotherapy and chemotherapy. Monitoring nutritional status and nutritional support are important in the comprehensive treatment of colorectal cancer.