鼻咽癌调强放疗患者综合营养指数的构建及其与生命质量、预后的关系

Construction of a comprehensive nutritional index and relationship with quality of life and survival in patients with nasopharyngeal carcinoma undergoing intensity-modulated radiation therapy

目的构建调强放疗鼻咽癌患者治疗后的综合营养指数,并分析其与患者生命质量和3年生存期之间的关系,旨在为鼻咽癌患者管理提供参考。方法本研究为前瞻性队列研究,采用便利抽样法选取2017年1月至2021年12月首都医科大学附属北京同仁医院就诊的431例鼻咽癌患者为研究对象。分别收集患者调强放疗前后的BMI、体质量变化百分比、血红蛋白、淋巴细胞计数和白蛋白等临床资料,并使用主成分分析构建调强放疗后综合营养指数。利用癌症患者生命质量测定量表(EORTC QLQ-C30)中文3.0版和头颈部肿瘤患者生命质量测定量表(QLQ-H&N35)中文版评价患者生命质量,并分析综合营养指数与生命质量的Pearson相关性。使用ROC预测患者3年内死亡的最佳诊断切点,并根据所确定最佳诊断切点将全部患者分为低综合营养指数组和高综合营养指数组。利用Kaplan-Meier法和Log-rank检验比较2组患者3年生存率差异。结果使用ROC曲线诊断界值,将全部患者分为低综合营养指数组(280例)和高综合营养指数组(151例)。鼻咽癌患者调强放疗前BMI、体质量变化百分比、白蛋白、血红蛋白、淋巴细胞计数分别为(23.14±2.87)kg/m^(2)、(1.08±0.14)%、(44.02±4.52)g/L、(147.28±15.57)g/L、(1.76±0.56)×10^(9)/L,高于调强放疗后的(21.14±4.07)kg/m^(2)、(0.97±0.16)%、(38.99±5.12)g/L、(113.87±18.24)g/L、(0.50±0.18)×10^(9)/L,差异均有统计学意义(t值为8.34~44.47,均P<0.05)。使用主成分分析构建的综合营养指数与EORTC QLQ-C30、QLQ-H&N35多个维度存在相关性,差异均有统计学意义(r值为-0.169~0.245,均P<0.05)。Kaplan-Meier曲线表明,高综合营养指数组与低综合营养指数组的3年生存率分别为87.42%和79.29%,差异有统计学意义(χ^(2)=4.53,P<0.05)。结论本研究所构建的综合营养指数可反映鼻咽癌患者的综合营养状况。综合营养指数评分低的鼻咽癌患者,其生命质量更差、3年生存期更短。应积极干预和改善鼻咽癌患者营养不良,以改善患者生命质量,提高生存率。

Objective To construct a comprehensive nutritional index after treatment of nasopharyngeal carcinoma patients with intensity-modulated radiation therapy(IMRT),and to analyze its relationship with quality of life and 3-year survival period,and aimed to provide some reference for the management of nasopharyngeal carcinoma patients.Methods This was a prospective cohort study.The clinical data of 431 nasopharyngeal carcinoma patients who admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from January 2017 to December 2021 were collected using convenience sampling method.To evaluate the nutritional status of the patients,the BMI,change in body weight,hemoglobin,lymphocyte count,and albumin level and other clinical data of the patients were collected before and after intensity-modulated radiation therapy.The comprehensive nutrition index after IMRT was constructed by principal component analysis.The Chinese version of European Organization for Reasearch and Treatment of Cancer quality of life questionnare-Core 30(EORTC QLQ-C30)and Quality of life questionnaire head and neck cancer module(QLQ-H&N35)were used to evaluate the patients′quality of life.The best diagnostic cutoff point for predicting patient death within 3 years using ROC,and based on the determined optimal diagnostic cutoff point,all patients were divided into a low comprehensive nutritional index group and a high comprehensive nutritional index group.And analyzed the Pearson correlation between comprehensive nutritional index and quality of life.Differences in 3-year survival between the two groups were compared using the Kaplan-Meier method and Log-rank test.Results Using the diagnostic threshold of receiver operating characteristic,all patients were divided into low comprehensive nutrition index group(n=280)and high comprehensive nutrition index group(n=151).The BMI,percentage of weight change,albumin,hemoglobin,and lymphocyte count of nasopharyngeal carcinoma patients before intensity-modulated radiation therapy were(23.14±2.87)kg/m^(2),(1.08±0.14)%,(44.02±4.52)g/L,(147.28±15.57)g/L,(1.76±0.56)×10^(9)/L,and higher than after intensity-modulated radiation therapy(21.14±4.07)kg/m^(2),(0.97±0.16)%,(38.99±5.12)g/L,(113.87±18.24)g/L,(0.50±0.18)×10^(9)/L,respectively,the difference were statistically significant(t values were 8.34 to 44.47,all P<0.05).The comprehensive nutritional index constructed using principal component analysis was correlated with multiple dimensions of EORTC QLQ-C30)and QLQ-H&N35,with statistically significant differences(r values were-0.169-0.245,all P<0.05).Kaplan-Meier curves indicated that the 3-year survival rate of the high comprehensive nutritional index group was higher than that of the low comprehensive nutritional index group,with 87.42%and 79.29%respectively,and the difference was statistically significant(χ^(2)=4.53,P<0.05).Conclusions The constructed comprehensive nutritional index could reflect the comprehensive nutritional status of nasopharyngeal carcinoma patients.Nasopharyngeal carcinoma patients with a low comprehensive nutritional index score had a worse quality of life and shorter 3-year survival.Active intervention and improvement of malnutrition in nasopharyngeal carcinoma patients should be undertaken to improve patient quality of life and improve survival.