局部晚期口咽鳞癌诱导化疗序贯放化疗后小野寺预后营养指数对预后的影响

Effects of Onodera′s prognostic nutritional index on the prognosis of locally advanced oropharyngeal squamous cell carcinoma after induction chemotherapy followed by sequential chemoradiotherapy

目的探讨局部晚期口咽鳞癌诱导化疗序贯放化疗后小野寺预后营养指数对预后的影响。方法回顾分析2014年至2018年在贵州医科大学附属肿瘤医院进行诱导化疗序贯放化疗的局部晚期口咽鳞癌患者共52例,统计分析每例患者不同治疗阶段的小野寺预后营养指数(PNI),并运用受试者工作特征(ROC)曲线确定PNI的最佳临界值,将患者分为营养良好组(27例)和营养不良组(25例)。应用Kaplan-Meier法生存分析,Cox模型分析不同营养状况与预后关系,并比较两组患者的临床特征及不良反应。结果放疗后PNI值降低最为明显,最佳临界值为42.4。营养良好组(PNI≥42.4)的5年总生存率和无进展生存率分别为62.6%和60.9%,均优于营养不良组(PNI<42.4)的30.1%和29.7%(χ^(2)=11.12、5.74,P<0.05)。多因素分析显示放疗后PNI为总生存的独立预后因素(HR=2.752,95%CI:1.095~6.917,P=0.031)。年龄>60岁及诱导化疗后疗效评估无缓解的口咽鳞癌患者,在放化疗后出现营养不良的比例更高(χ^(2)=4.89、5.05,P<0.05)。结论治疗后PNI预测指标能够评估局部晚期口咽癌诱导化疗序贯放化疗后的预后。对于年龄>60岁,或者诱导化疗无效的口咽鳞癌患者,放化疗期间给予更多营养关注。

Objective To explore the effects of Onodera's prognostic nutritional index(PNI)on the prognosis of locally advanced oropharyngeal squamous cell carcinoma(LA-OPSCC)after induction chemotherapy followed by sequential chemoradiotherapy.Methods A retrospective analysis was conducted on the clinical data of 52 LA-OPSCC patients receiving induction chemotherapy followed by sequential chemoradiotherapy in The Affiliated Cancer Hospital of Guizhou Medical University during 2014-2018.The PNI values of all the patients at different treatment phases were statistically analyzed,and the ROC curve was employed to determine the optimal critical value of PNI.The patients in this study were divided into a well-nourished group(n=27)and a poorly-nourished group(n=25).The Kaplan-Meier method was used for survival analysis.The Cox proportional hazards model was utilized to analyze the relationships between different nutritional status and prognosis.Clinical features and adverse reactions were compared between the two groups.Results The PNI values decreased significantly after radiotherapy,with an optimal critical value of 42.4.The 5-year overall survival(OS)and progression-free survival(PFS)of the well-nourished group(PNI≥42.4)were 62.6%and 60.9%,respectively,which were significantly higher than those(30.1%and 29.7%)of the poorly-nourished group(PNI<42.4,χ^(2)=11.12,5.74,P<0.05).The multivariate analysis showed that PNI was an independent prognostic factor for the OS after radiotherapy(HR=2.752,95%CI:1.095-6.917,P=0.031).The LA-OPSCC patients aged over 60 years or those who did not respond to induction chemotherapy accounted for a higher proportion of malnutrition after chemoradiotherapy(χ^(2)=4.89,5.05,P<0.05).Conclusions PNI after radiotherapy can be used as a prognostic factor in the evaluation of LA-OPSCC patients receiving induction chemotherapy followed by sequential chemoradiotherapy.The LA-OPSCC patients aged over 60 years or those who do not respond to induction chemotherapy should receive more nutritional support during the chemoradiotherapy.