质子重离子放疗对恶性肿瘤患者营养状况及不良事件的影响

Effects of proton and heavy ion radiotherapy on nutritional status and adverse events in patients with malignant tumor

目的了解质子重离子放疗对恶性肿瘤患者营养状况的影响, 分析不良事件的影响因素。方法回顾性研究自2016年10月至2021年9月期间接受质子重离子治疗的恶性肿瘤患者2 390例。收集基本信息、诊疗方案和营养指标等。采用配对t检验分析质子重离子治疗前后患者营养状况的变化, Logistic回归分析不良事件的影响因素。结果放疗患者入院和出院时营养风险的发生率分别为17.5%和27.8%, 其中光子加重离子治疗以及质子加重离子治疗患者出院时营养风险的发生率分别达到了73.9%和30.8%(χ^(2)=237.149, P<0.01;χ^(2)=36.925, P<0.01)。患者出院时严重体重丢失的发生率为14.1%, 光子加重离子治疗和质子加重离子治疗的体重丢失分别为4.84 kg和1.52 kg(t=11.716, P<0.01;t=29.530, P<0.01)。四种放疗方案对血清白蛋白和总淋巴细胞计数均有影响(P<0.01), 且以光子加重离子和质子加重离子治疗对血清白蛋白和总淋巴细胞计数的影响较大, 降幅分别为2.88 g/L和2.18 g/L、1.06×10^(9)/L和0.80×10^(9)/L(P<0.01)。多变量Logistic回归分析显示, 入院营养风险、同期化疗是质子重离子治疗不良事件的独立影响因素(OR=1.404, 95%CI:1.039~1.898;OR=2.370, 95%CI:1.781~3.154);与重离子治疗比较, 质子、质子加重离子以及光子加重离子治疗不良事件的发生增加(OR=3.982, 95%CI:2.533~6.259;OR=4.995, 95%CI:3.688~6.766;OR=7.716, 95%CI:5.079~11.720)。结论质子重离子治疗期间肿瘤患者的营养状况变差, 其中光子加重离子治疗对营养状况的影响最大, 入院营养风险和同期化疗是质子重离子治疗期间不良事件的独立影响因素。

Objective:To understand the effects of proton and heavy ion radiotherapy on nutritional status in patients with malignant tumors and to analyze the influencing factors of adverse events.Methods:Patients with malignant tumors who received proton and heavy ion therapy between October 2016 and September 2021were retrospectively included. The demographic characteristics, clinical diagnosis, radiotherapy regimen, nutritional indicators and adverse events were collected. Paired t test was used to analyze the changes in nutritional status before and after treatment and logistic regression was used to analyze the influencing factors of adverse events. Results:A total of 2,390 patients were enrolled and were stratified into 4 groups according to different radiotherapy regimen, namely proton, heavy ion, proton + heavy ion and photon + heavy ion radiotherapies. The prevalence of nutritional risk were 17.5% and 27.8% at admission and discharge, respectively. The prevalence of nutritional risk at discharge were 73.9% ( χ^(2) = 237.149, P < 0.01) in patients who received photon + heavy ion radiotherapy and 30.8% ( χ^(2) = 36.925, P < 0.01) in those who received proton + heavy ion radiotherapy. The prevalence of critical weight loss at discharge was 14.1%, with the absolute weight loss of 4.84 kg ( t = 11.716, P < 0.01) and 1.52 kg ( t = 29.530, P < 0.01) in photon + heavy ion radiotherapy and proton + heavy ion radiotherapy groups, respectively. All groups showed significant changes in serum albumin (ALB) and total lymphocyte count (TLC). Specifically, photon + heavy ion and proton + heavy ion therapy had a greater effect on serum ALB and TLC, with a decrease of 2.88 g/L and 2.18 g/L for ALB as well as a decrease of (1.06×10^(9)) /L and (0.80×10^(9)) /L for TLC ( P < 0.01). Multivariate logistic regression analysis showed that nutritional risk at admission and concurrent chemotherapy were independent factors for adverse events of proton and heavy ion radiotherapy ( OR = 1.404, 95% CI: 1.039 to 1.898;OR = 2.370, 95% CI: 1.781 to 3.154). Compared with heavy ion radiotherapy, the other 3 groups had more adverse events (proton, OR = 3.982, 95% CI: 2.533 to 6.259;proton + heavy ion, OR = 4.995, 95% CI: 3.688 to 6.766;photon + heavy ion, OR = 7.716, 95% CI: 5.079 to 11.720). Conclusions:Patients receiving proton and heavy ion therapy showed poorer nutritional status. Photon + heavy ion therapy had the greatest impact on nutritional status. Nutritional risk at admission and concurrent chemotherapy were independent factors for adverse events in patients receiving proton and heavy ion therapy.