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| 食管癌放疗/放化疗后营养状态恶化的影响因素分析 |
| 操礼群1,甘盼盼1,朱和玲1,2,陈晗1,2,孙娜林1,陈立豪1,2,余嘉文1,2,3* |
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(1. 安徽医科大学附属安庆第一人民医院(安徽省安庆市第一人民医院)肿瘤科, 安庆 246052;
2. 安徽医科大学附属安庆第一人民医院(安徽省安庆市第一人民医院)临床营养科, 安庆 246052;
3. 安徽医科大学附属安庆第一人民医院(安徽省安庆市第一人民医院)质量控制办公室, 安庆 246052
*通信作者) |
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| 摘要: |
| 目的 分析食管癌患者接受放疗/放化疗后营养状态恶化的影响因素，为抗肿瘤治疗期间的营养管理提供参考。方法 选取2017年12月至2023年12月在安徽医科大学附属安庆第一人民医院接受放疗或放化疗的食管癌患者106例，收集患者性别、年龄、手术史、放疗干预时机、是否同步放化疗、放疗剂量、临床分期、初始营养状态、行为状况评分等资料，监测抗肿瘤治疗前后患者主观整体营养评估量表评分变化。根据入组开始和放疗结束时营养状态将患者分为营养状态恶化组与非恶化（稳定或改善）组，比较两组患者临床特征的差异，通过logistic回归分析筛选营养状态恶化的影响因素，通过Spearman相关分析探讨营养状态恶化与不良反应（放射性食管炎、肺部感染、中性粒细胞减少、血小板减少、转氨酶升高）的相关性。结果 食管癌放疗/放化疗后营养状态恶化组与非恶化组患者性别、放疗剂量、初始营养状态、行为状况评分差异均无统计学意义（均P＞0.05），营养状态恶化组既往食管癌手术史、同步放化疗、低于90%目标能量需求量时启动放疗、临床分期为Ⅳ期的患者比例均高于非恶化组（均P＜0.05）。logistic回归分析显示，临床分期为Ⅳ期（OR＝4.684，95% CI 1.252～17.519，P＝0.022）、既往食管癌手术史（OR＝7.338，95% CI 1.878～28.666，P＝0.004）是食管癌患者放疗/放化疗后营养状态恶化的独立不良风险因素；放疗干预时机也是食管癌患者放疗/放化疗后营养状态恶化的独立影响因素，以耐受70%～90%目标能量需求量为参照水平，在耐受90%～100%目标能量需求量时启动放疗具有最优的营养状态保护作用（OR＝0.166，95% CI 0.050～0.551，P＝0.003）。Spearman相关分析显示营养状态恶化与放疗后转氨酶升高呈正相关（rs＝0.283，P＝0.003），与其他不良反应无相关性（均P＞0.05）。结论 标准营养干预模式下，既往手术和复发转移食管癌患者接受放疗/放化疗仍存在营养状态恶化风险，耐受90%～100%目标能量需求量可能是放疗干预较为合适的时机，治疗期间营养状态恶化时需警惕转氨酶升高。 |
| 关键词: 食管肿瘤 放射治疗 放射化学治疗 营养状态 恶化 |
| DOI：10.16781/j.CN31-2187/R.20240122 |
| 投稿时间：2024-02-22修订日期：2024-12-09 |
| 基金项目:安徽医科大学校基金资助项目（2023xkj216），皖南医学院教学医院科研专项（JXYY202285）. |
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| Analysis of factors influencing the deterioration of nutritional status after radiotherapy/radiochemotherapy for esophageal cancer |
| CAO Liqun1,GAN Panpan1,ZHU Heling1,2,CHEN Han1,2,SUN Nalin1,CHEN Lihao1,2,YU Jiawen1,2,3* |
(1. Department of Oncology, Anqing First People's Hospital of Anhui Medical University & Anqing First People's Hospital of Anhui Province, Anqing 246052, Anhui, China;
2. Department of Clinical Nutrition, Anqing First People's Hospital of Anhui Medical University & Anqing First People's Hospital of Anhui Province, Anqing 246052, Anhui, China;
3. Department of Quality Controlling Office, Anqing First People's Hospital of Anhui Medical University & Anqing First People's Hospital of Anhui Province, Anqing 246052, Anhui, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the factors influencing the deterioration of nutritional status after radiotherapy/radiochemotherapy for esophageal cancer, so as to provide reference for nutritional management during antitumor therapy. Methods A total of 106 patients with esophageal cancer who received radiotherapy or radiochemotherapy at Anqing First People’s Hospital of Anhui Medical University from Dec. 2017 to Dec. 2023 were enrolled. Patients’ gender, age, surgical history, timing of radiotherapy intervention, synchronous chemoradiotherapy, radiotherapy dose, clinical stage, initial nutritional status, and performance status score were collected. The patient generated subjective global assessment scale (PG-SGA) scores were monitored before and after antitumor treatment. According to the nutritional status at the beginning of enrollment and at the end of radiotherapy, the patients were assigned to deterioration group or non-deterioration (stable or improved) group. The clinical characteristics of the 2 groups were compared. The factors influencing the deterioration of nutritional status were screened by logistic regression analysis. The correlation between nutritional status deterioration and adverse reactions (radiation esophagitis, pulmonary infection, neutropenia, thrombocytopenia, and elevated aminotransferase) was analyzed by Spearman correlation analysis. Results There were no significant differences in gender, radiotherapy dose, initial nutritional status, or performance status score between the 2 groups for the deterioration of nutritional status after radiotherapy (all P＞0.05). The proportions of patients with previous surgical history of esophageal cancer, synchronous chemoradiotherapy, initiation of radiotherapy at less than 90% of target calorie requirement, and clinical stage Ⅳ were significantly higher in the deterioration group than those in the non-deterioration group (all P＜0.05). Logistic regression analysis showed that clinical stage Ⅳ (odds ratio ［OR］＝4.684, 95% confidence interval ［CI］ 1.252-17.519, P＝0.022) and previous surgical history of esophageal cancer (OR＝7.338, 95% CI 1.878-28.666, P＝0.004) were the independent adverse risk factors for the deterioration of nutritional status after radiotherapy/radiochemotherapy. The timing of radiotherapy intervention was also an independent risk factor for the deterioration of nutritional status, and taking the tolerance of 70%-90% target energy as the reference level, starting radiotherapy when the tolerance of 90%-100% target energy had the optimal protection of nutritional status (OR＝0.166, 95% CI 0.050-0.551, P＝0.003). Spearman correlation analysis showed that the deterioration of nutritional status was positively correlated with elevated transaminases after radiotherapy (rs＝0.283, P＝0.003), while it was not correlated with the other adverse reactions (all P＞0.05). Conclusion Under the standard nutritional intervention model, patients with previous surgery and recurrent metastatic esophageal cancer who receive radiotherapy/chemoradiotherapy are still at risk of nutritional status deterioration. Tolerance to 90%-100% target energy requirement may be a more appropriate timing for radiotherapy intervention. When the nutritional status deteriorates during treatment, it is necessary to be alert to the elevated transaminases. |
| Key words: esophagus neoplasms radiotherapy radiochemotherapy nutritional status deterioration |
