肠内营养支持治疗减轻晚期食管癌患者化疗不良反应

Enteral nutrition support reduces toxicity of chemotherapy in patients with advanced or metastatic esophageal cancer

目的:评估肠内营养支持治疗对晚期食管癌患者一线化疗疗效及不良反应的影响。方法:回顾性收集2014年7月至2016年12月于北京大学肿瘤医院接受一线化疗的118例不可手术切除的局部进展期或转移性食管癌患者资料,将患者分为两组,营养支持组(化疗同时予肠内营养支持)和对照组(单纯化疗)。比较两组患者化疗前后各营养指标[KPS功能状态评分(Karnofsky performance status)、体质量、体重指数(body mass index,BMI)、血红蛋白、淋巴细胞数、总蛋白、白蛋白、甘油三酯、总胆固醇]的变化及化疗疗效、化疗不良反应的差异。结果:(1)对照组化疗后,患者体质量、BMI和血红蛋白水平均明显下降(P<0.001);营养支持组患者化疗后,患者体质量和BMI并无明显变化,仅血红蛋白有明显下降;两组患者化疗前后其他营养指标差异均无统计学意义。(2)与对照组相比,营养支持组化疗后3级以上血液学毒性发生率显著降低(15.4%vs.42.1%,P=0.004),3级以上非血液学毒性发生率也有所降低但两组差异无统计学意义(0 vs.9.2%,P=0.123)。Logistic回归多因素分析显示,营养治疗是食管癌患者化疗后发生3级以上血液学毒性的独立影响因素(P=0.008,RR=6.048,95%CI:1.589~23.027)。(3)两组患者化疗疗效差异无统计学意义。结论:晚期食管癌患者在化疗同时予肠内营养支持治疗可改善患者营养状态,减轻化疗毒性和不良反应。

Objective:To assess the impact of enteral nutrition support on response and toxicity of the first-line chemotherapy in those patients with advanced or metastatic esophageal cancer.Methods:We collected the clinical data of 118 patients with unresectable advanced or metastatic esophageal cancer who received the first-line chemotherapy in our center from July 2014 to December 2016.All these 118 eso-phageal cancer patients were then divided into two groups:the nutrition group(received enteral nutrition support in addition to chemotherapy)and the control group(received chemotherapy only).Differences were analyzed before and after chemotherapy in each of the nutritional indicators including Karnofsky performance status(KPS),weight,body mass index(BMI),hemoglobin(Hb),number of lymphocytes(Lymph),total protein(TP),albumin(Alb),triglycerides(TG),total cholesterol(TC)in both groups.And differences of the efficacy and toxicities of the first-line chemotherapy between the two groups were also analyzed.Results:(1)Weight,BMI and Hb were all significantly decreased after chemotherapy in the control group(P<0.001),while there was no significant change of weight and BMI in the nutrition group,just with Hb decrease only.However,there was no significant change of all the other nutrition indicators after chemotherapy in both groups.(2)Compared with the control group,the nutrition group had significantly lower incidence of grade 3 to 4 hematologic toxicities after chemotherapy(15.4%vs.42.1%,P=0.004).In addition,the incidence of grade 3 to 4 nonhematologic toxicities after chemotherapy was also lower in the nutrition group but without statistical significance(0 vs.9.2%,P=0.123).Logistic regression model was then used for multivariate analysis to identify the factors that affected the toxicity of chemotherapy in these patients,and the results showed that nutrition therapy was an independent influencing factor of grade 3 or higher hematological toxicity after chemotherapy in the patients with esophageal cancer(P=0.008,RR=6.048,95%CI:1.589-23.027).(3)The response rate of chemotherapy between the control group and the nutrition group had not significant difference.Conclusion:Enteral nutrition support in addition to chemotherapy could improve nutrition status and reduce toxicity of chemotherapy in advanced or metastatic esophageal cancer patients.