全程营养支持治疗对局部晚期直肠癌新辅助同步放化疗患者营养状况、治疗耐受性和疗效的影响

Effect of whole course nutritional support on nutritional status,treatment tolerance and therapeutic efficacy in patients with locally advanced rectal cancer receiving neoadjuvant concurrent chemoradiotherapy

目的 探讨全程营养支持治疗对局部进展期直肠癌(locally advanced rectal cancer,LARC)长程术前新辅助同步放化疗(neoadjuvant concurrent chemoradiotherapy,NCCRT)患者营养状况、治疗耐受性和疗效的影响。方法 将2017年1月至2021年1月间本院收治的营养风险筛查-2002(nutritional risk screening-2002,NRS-2002)评分≥3分的88例行长程NCCRT的Ⅱ~Ⅲ期LARC患者随机分成试验组(全程营养支持治疗+NCCRT+手术)44例和对照组(NCCRT+手术)44例。主要研究终点为血清白蛋白(albumin,ALB)水平,次要研究终点为急性放射性反应和病理完全缓解率。比较两组放疗前后血清ALB、前白蛋白(prealbumin,PA)、体质量指数(body mass index,BMI)和生活质量(KPS评分)的变化情况。比较两组急性放射性反应、放疗总疗程、放疗中断情况、病理完全缓解情况、营养状况、急性放化疗不良反应、NCCRT治疗耐受性和治疗疗效。结果 试验组放疗后BMI、ALB、PA及KPS评分均较放疗前升高(均P<0.05)。放疗结束时试验组BMI、ALB、PA及KPS评分均高于对照组(均P<0.05)。试验组急性放射性直肠炎、急性上消化道反应和骨髓抑制的发生率(88.6%vs 100.0%、59.1%vs 86.4%、36.4%vs 81.8%)和发生级别均低于对照组(均P<0.05)。试验组放疗总天数[(35.57±1.68)d vs (38.16±3.42)d]及放疗中断率(11.4%vs 61.4%)均少于对照组(均P<0.05),足量足周期同步化疗完成率(95.5%vs 77.3%)高于对照组(P<0.05)。试验组治疗后T分期降期率(59.1%vs 36.4%)、N分期降期率(54.5%vs 31.8%)、保肛率(63.6%vs 40.9%)、病理完全缓解率(22.7%vs 11.4%)和肿瘤消退良好率(56.8%vs 34.1%)均高于对照组(均P<0.05),肿瘤病理消退分级低于对照组(P<0.05)。结论 全程营养支持治疗能提高NRS-2002≥3分LARC患者长程NCCRT期间的ALB水平,提高病理完全缓解率,降低急性放化疗不良反应,进而改善患者营养状况和生活质量,提高治疗耐受性和治疗疗效。

Objective To explore the effect of whole course nutritional support on the nutritional status,treatment tolerance and ther-apeutic efficacy in patients with locally advanced rectal cancer(LARC)receiving long-term neoadjuvant concurrent chemoradiotherapy(NCCRT).Methods Eighty-eight stageⅡ-ⅢLARC patients with long-term NCCRT and nutritional risk screening-2002(NRS-2002)score≥3 points admitted to our hospital from January 2017 to January 2021 were randomly assigned into two groups:the experimental group(44 cases received whole course nutritional support combined with NCCRT and surgery)and the control group(44 cases only received NCCRT and surgery).The primary endpoint was serum albumin(ALB)level,and the secondary endpoint was acute radiation response and pathological complete response rate.The change of ALB,prealbumin(PA),body mass index(BMI)and quality of life(KPS score)were ob-served and compared between the two groups before and after radiotherapy.Acute radiation response,total course and interruption of radio-therapy,pathological complete response rate,nutritional status,adverse reactions to acute radiotherapy and chemotherapy,NCCRT toler-ance and therapeutic efficacy were compared between the two groups.Results BMI,ALB,PA and KPS score were significantly increased after radiotherapy in the experimental group(all P<0.05).At the end of radiotherapy,BMI,ALB,PA and KPS score in the experimental group were significantly higher than those in the control group(all P<0.05).The incidence(88.6%vs 100.0%,59.1%vs 86.4%,36.4%vs 81.8%)and grades of acute radiation proctitis,acute gastrointestinal reaction and bone marrow suppression in the experimental group were significantly lower than those in the control group(all P<0.05).The total course[(35.57±1.68)d vs(38.16±3.42)d]and the interrup-tion rate(11.4%vs 61.4%)of radiotherapy in the experimental group was significantly lower than those in the control group(both P<0.05),and the completion rate of full dose and full cycle synchronous chemotherapy in the experimental group was higher than that in the control group(95.5%vs 77.3%,P<0.05).T-stage downgrading rate(59.1%vs 36.4%),N-stage downgrading rate(54.5%vs 31.8%),anal preser-vation rate(63.6%vs 40.9%),pathological complete response rate(22.7%vs 11.4%)and good rate of tumor regression(56.8%vs 34.1%)of patients who completed radical radiotherapy in the experimental group were all significantly higher than those in the control group(all P<0.05),and the tumor pathological regression grade was lower than that in the control group(P<0.05).Conclusions Whole course nutri-tional support can improve the ALB level,improve the pathological complete response rate,reduce the acute chemoradiotherapy response,ameliorate the nutritional status and quality of life,and improve treatment tolerance and therapeutic efficacy significantly in LARC patients with NRS-2002 score≥3 points receiving long-term NCCRT.