营养风险对老年早期食管癌患者放疗的预后的影响

Prognostic Significance of Nutritional Risk Before Radiotherapy in Elderly Patients with Early Stage Esophageal Cancer

[目的]探讨营养风险及身体质量指数（BMI）与老年早期食管癌放疗患者预后的关系。[方法]收集2011年7月至2014年12月于连云港市第二人民医院接受根治性放疗的41例≥70岁、Ⅰ/Ⅱ,N0期食管鳞癌患者临床资料。应用营养风险筛查工具2002（NRS-2002）行营养风险评估,营养风险定义为NRS-2002评分≥3分。分析NRS-2002评分与食管癌患者临床资料的关系,Kaplan-Meier法计算生存率并Log-rank检验差异,Cox比例风险模型进行多因素分析。[结果]27例患者（65.85%）放疗前存在营养风险。营养风险患者营养支持治疗前后血清白蛋白水平有统计学差异（P=0.0127）。NRS-2002评分与血清白蛋白水平及BMI有关（P〈0.05）。单因素分析显示肿瘤长度≥6cm、BMI〈18.5kg/m^2、NRS-2002评分≥3分是食管癌放疗患者预后不良因素（P〈0.05）。多因素生存分析显示NRS-2002评分及BMI是食管癌放疗患者总生存时间的独立预后因素（P〈0.05）。[结论]营养风险及消瘦可作为预测老年早期食管癌放疗患者的预后不良指标。

[Objective] To analyze the association of nutritional risk and body mass index（BMI） with the prognosis of elderly patients with early stage esophageal cancer undergoing radiotherapy. [Methods] The medical records of 41 patients aged ≥70 with stage Ⅰ/Ⅱ,NO esophageal cancer treated in our hospital between July 2011 and December 2014 were enrolled. Nutritional risk was defined as a NRS score≥3 according to nutritional risk screening-2002 （NRS-2002）. Survival curves were generated by Kaplan-Meier method and compared by Log-rank test. The multivariate analysis was performed with the Cox proportional hazard model to identify the prognostic factors. [ Results] Among 41 patients there were 27 cases（65.9%） with malnutrition risk before radiotherapy. The serum albumin level in patients with malnutrition risk was increased after nutritional support（P=-0.0127）. NRS-2002 score was correlated with serum albumin level and BMI of patients. Univariate analysis showed that length of tumor≥6cm,BMI〈18.5kg/m^2 and NRS-2002 score ≥3 were associated with poorer overall survival（OS）. Multivariate analysis showed that BMI and NRS- 2002 score were independent predicting factors for OS. [Conclusion] NRS-2002 score and BMI can be used as potential prognostic indicators for elderly patients with early stage esophageal cancer.