局部晚期鼻咽癌患者营养状况及其与预后相关性分析

Nutritional status and its relationship with prognosis in patients with locally advanced nasopharyngeal carcinoma

目的:探讨局部晚期鼻咽癌患者营养状况及其与预后相关性。方法:分析2015年8月至2017年3月湖北省肿瘤医院收治的局部晚期鼻咽癌住院患者53例,联合运用患者主观整体营养评估量表(patient-generated subjective global assessment,PGSGA)、体格测量、血液学指标和放化疗不良反应,全面评估患者营养状况;采用Kaplan-Meier法及Cox风险比例回归模型对患者生存及影响因素进行分析。结果:53例患者中,94.3%(50/53)的患者出现体质量下降,下降均值为(6.89±0.54)kg,50.9%(27/53)的患者体质量下降≥10%;PG-SGA评估的患者重度营养不良发生率为84.9%(45/53);淋巴细胞计数、红细胞、血红蛋白、白蛋白与PG-SGA评分高度负相关(P<0.05),口腔黏膜炎、吞咽困难或疼痛、厌食、体质量下降百分比与PG-SGA评分高度正相关(P<0.05);单因素及多因素分析显示,TNM分期晚、治疗期间体质量下降≥10%与局部晚期鼻咽癌患者预后不良相关,而白细胞计数增加(在正常值范围内)与局部晚期鼻咽癌患者预后良好相关,差异均具有统计学意义(P=0.036,P=0.016,P=0.024)。结论:局部晚期鼻咽癌患者营养不良发生率高;PG-SGA评分联合体格测量、血液学指标和放化疗不良反应,能够更全面地评估患者营养状况;TNM分期晚、治疗期间体质量下降≥10%是局部晚期鼻咽癌患者预后的不良因素,而白细胞计数增加(在正常值范围内)是患者预后的有利因素。

Objective:To investigate the nutritional status of patients with locally advanced nasopharyngeal carcinoma(NPC)and its relationship with prognosis.Methods:From August 2015 to March 2018,53 patients with locally advanced NPC hospitalized for treatment at the Department of Radiotherapy at Hubei Cancer Hospital,Wuhan,China,were enrolled in this study.The patient-generated subjective global assessment(PG-SGA),anthropometry measurements,hematological indexes,and side-effects of radiation and chemotherapy were used to evaluate the nutritional status.Survival and its influencing factors were further analyzed using the Kaplan-Meier estimator and a Cox proportional hazards regression model.Results:94.3%of the locally advanced NPC patients lost weight.The average weight loss was6.89±0.54 kg.Of those NPC patients who lost weight,50.94%had more than 10%weight loss.According to the PG-SGA score,84.9%of the NPC patients had severe malnutrition(PG-SGA≥9).A highly negative correlation was observed among lymphocyte count(TLC),red blood cell(RBC),hemoglobin(Hb)level,albumin(ALB)level,and PG-SGA scores(all P<0.05).A highly positive correlation was observed among oral mucositis,difficulty swallowing or pain,anorexia,rate of weight loss,and PG-SGA scores(all P<0.05).Univariate and multivariate analyses showed that a high TNM stage and more than 10%weight loss during treatment were associated with an unfavorable prognosis.A high level of white blood cells(WBC),within the normal range,was associated with a better survival rate(All P<0.05).Conclusions:Patients with locally advanced NPC had a high incidence of malnutrition in this study.PG-SGA combined with anthropometry measurements,hematological indexes,and side-effects of radiation and chemotherapy can help evaluate the nutritional status of patients with NPC more comprehensively.A high TNM stage,more than 10%weight loss during treatment,and high WBC counts were independently associated with prognosis and survival among patients with locally advanced NPC.