鼻咽癌患者调强放射治疗后综合营养指数模型的构建及与生活质量的相关性
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摘要
目的构建鼻咽癌患者调强放射治疗后综合营养指数(comprehensive nutrition index,CNI)模型及探讨其与生活质量的相关性,以便改善患者营养状况,提高患者生活质量。方法采用便利取样方法,选择2013年11月至2017年12月在本院鼻咽科首次确诊为鼻咽癌并且接受调强放射治疗的61例患者作为研究对象,在入院48h、放射治疗结束前3d收集患者体重指数、通常体重百分比、血淋巴细胞总数、血红蛋白、白蛋白,构建鼻咽癌患者调强放射治疗后CNI。了解患者放射性口腔黏膜炎发生率、头颈部癌症生存质量及CNI与头颈部癌症生存质量各领域、一般人口学资料、疾病相关资料的相关性。结果鼻咽癌患者调强放射治疗后放射性口腔黏膜炎发生率100.00%;鼻咽癌患者调强放射治疗前后各项营养指标比较,差异具有统计学意义(均P<0.01),治疗后各项营养指标值均低于治疗前,其中75.40%患者体重减轻大于10.00%;鼻咽癌患者调强放射治疗后生存质量,除感觉问题、牙齿问题、使用鼻饲管及体重增加外,其他条目得分比较,差异具有统计学意义(均P<0.05),治疗后得分明显高于治疗前;构建的鼻咽癌患者调强放射治疗后CNI合适,CNI与患者靶向治疗、肿瘤分期、同期调强放射治疗化疗、牙齿有问题呈负相关(均P<0.05)。结论本研究构建鼻咽癌患者调强放射治疗后CNI合适;鼻咽癌患者调强放射治疗后放射性口腔黏膜炎严重,营养状况与生存质量明显下降,CNI与其同期调强放射治疗化疗、靶向药物、肿瘤分期、牙齿问题呈相关关系。应根据鼻咽癌患者调强放射治疗后发生营养不良状况尽早进行营养干预,改善患者营养状况,提高患者的生活质量。
Objective To construct a comprehensive nutritional index(CNI) after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma and to explore its correlation with quality of life in order to improve the nutritional status of patients and their quality of life. Methods A convenient sampling method was used to select 65 patients who were diagnosed with nasopharyngeal carcinoma for the first time from November 2013 to December 2017 and received intensity-modulated radiation therapy. The data including body mass index, normal body weight percentage, total number of blood lymphocytes, hemoglobin and albumin were collected when the patients were admitted to hospital in 48 hours and in 3 days before radiation therapy, and then CNI was constructed. The incidence of radiation oral mucositis and the quality of life of head and neck cancer were studied. The correlation of CNI with all the dimensions of quality of life of head and neck cancer: e.g. general demographic data, and disease-related data were investigated as well. Results The incidence of radioactive oral mucositis was 100.00% in patients with nasopharyngeal carcinoma after intensitymodulated radiation therapy. The differences in nutritional indexes between patients with nasopharyngeal carcinoma before and after intensity-modulated radiation therapy were statistically significant(P <0.01). The nutritional index values were lower than before treatment, of which 75.40% patients had weight loss by more than 10.00%. The quality of life of patients with nasopharyngeal carcinoma after intensity-modulated radiation therapy, except for feeling, teeth, nutrient use and nasal feeding tube had statistically significant difference(P <0.01), and the score after treatment was higher than that before treatment(P <0.05). It was appropriate to use CNI in patients with nasopharyngeal carcinoma after intensity-modulated radiation therapy. CNI was positively correlated with patient-targeted therapy and negatively correlated with tumor staging, concurrent intensification modulated radiotherapy and chemotherapy, and dental problems(P <0.05). Conclusions CNI is appropriate for patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy. The patients with nasopharyngeal carcinoma have severe radioactive oral mucositis after intensity-modulated radiation therapy, and the nutritional status and quality of life may be decreased significantly. CNI is related to their concurrent intensity-modulated radiotherapy, chemotherapy, targeted drugs, tumor staging and dental problems. According to the malnutrition after the intensity-modulated radiation therapy in patients with nasopharyngeal cancer, nutrition intervention should be carried out as soon as possible to improve the nutritional status of patients as well as their quality of life.
Objective To construct a comprehensive nutritional index(CNI) after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma and to explore its correlation with quality of life in order to improve the nutritional status of patients and their quality of life. Methods A convenient sampling method was used to select 65 patients who were diagnosed with nasopharyngeal carcinoma for the first time from November 2013 to December 2017 and received intensity-modulated radiation therapy. The data including body mass index, normal body weight percentage, total number of blood lymphocytes, hemoglobin and albumin were collected when the patients were admitted to hospital in 48 hours and in 3 days before radiation therapy, and then CNI was constructed. The incidence of radiation oral mucositis and the quality of life of head and neck cancer were studied. The correlation of CNI with all the dimensions of quality of life of head and neck cancer: e.g. general demographic data, and disease-related data were investigated as well. Results The incidence of radioactive oral mucositis was 100.00% in patients with nasopharyngeal carcinoma after intensitymodulated radiation therapy. The differences in nutritional indexes between patients with nasopharyngeal carcinoma before and after intensity-modulated radiation therapy were statistically significant(P <0.01). The nutritional index values were lower than before treatment, of which 75.40% patients had weight loss by more than 10.00%. The quality of life of patients with nasopharyngeal carcinoma after intensity-modulated radiation therapy, except for feeling, teeth, nutrient use and nasal feeding tube had statistically significant difference(P <0.01), and the score after treatment was higher than that before treatment(P <0.05). It was appropriate to use CNI in patients with nasopharyngeal carcinoma after intensity-modulated radiation therapy. CNI was positively correlated with patient-targeted therapy and negatively correlated with tumor staging, concurrent intensification modulated radiotherapy and chemotherapy, and dental problems(P <0.05). Conclusions CNI is appropriate for patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy. The patients with nasopharyngeal carcinoma have severe radioactive oral mucositis after intensity-modulated radiation therapy, and the nutritional status and quality of life may be decreased significantly. CNI is related to their concurrent intensity-modulated radiotherapy, chemotherapy, targeted drugs, tumor staging and dental problems. According to the malnutrition after the intensity-modulated radiation therapy in patients with nasopharyngeal cancer, nutrition intervention should be carried out as soon as possible to improve the nutritional status of patients as well as their quality of life.
引文
[1]梁锌,杨剑,高婷,等.中国鼻咽癌流行概况[J].中国肿瘤,2016,25(11):835-840.
[2]朱永杰,傅江涛,李界,等.晚期鼻咽癌患者同步放化疗后营养状况与医院感染的相关性分析[J].中华医院感染学杂志,2017,27(12):2786-2789.
[3]LI G, JIANG X, QIU B, et al. Vicious circle of acute radiation toxicities and weight loss predicts poor prognosis fornasopharyngeal carcinoma patients receiving intensity modulated radiotherapy[J]. Journal of Cancer,2017,8(5):832-838.
[4]郑荣辉,梁颖莹,田允鸿,等.鼻咽癌同期放化疗体质量下降规律及预测因素[J].实用医学杂志,2017,33(16):2682-2685.
[5]何妨,罗伟,张群,等.单纯调强放射治疗或结合化疗对局部区域晚期鼻咽癌的疗效观察[J].中华医学杂志,2013,93(29):2292-2295.
[6]蒋志雄,韦少雪.恶性骨肿瘤患者营养评价与营养风险筛查相关性研究分析[J].医学信息,2013,26(20):158-159.
[7]徐慧颖,李亚洁,赵洁,等.口腔黏膜炎评估量表及其应用研究[J].护理研究,2008,22(32):2917-2918.
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[9]张雪芳,郑巧兰,郝元涛,等. EORTC QLQ C30/H&N35在鼻咽癌患者生存质量中的应用评价[J].新医学,2013,44(7):467-471.
[10]HUS J C, BRUSCHWEILER R. Principal component method for assessing structural heterogeneity across multiple alignment media[J]. Journal of Biomolecular Nmr,2002,24(2):123.
[11]李凯新,辛培玲,陈媛媛,等.局部中晚期鼻咽癌IMRT同步化疗后急性放射性口腔黏膜炎的预测因素分析[J].中华放射肿瘤学杂志,2017,26(3):255-260.
[12]张海荣,洪金省,苏丽,等.鼻咽癌患者放疗期间营养指数模型构建及营养状况下降影响因素分析[J].中国卫生统计,2015,32(6):959-962.
[13] MA L,WU T,PAN J,et al. The correlation between the comprehensive nutrition index and quality of life of patients with nasopharyngeal carcinoma treated by intensitymodulated radiotherapy[J]. Nutrition and Cancer-an International Jounal, 2014,66(1):152-158.
[14] DU X J,TANG L L,MAO Y P,et al. Value of the prognostic nutritional index and weight loss in predicting metastasis and long-term mortality in nasopharyngeal carcinoma[J]. Journal of Translational Medicine,2015,13(1):1-9.
[15] MIAO J,XIAO W,LIN W,et al. The value of the prognostic nutritional index(PNI)in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma(NPC)patients receiving intensity-modulated radiotherapy(IMRT)with or without chemotherapy[J]. Journal of Cancer Research&Clinical Oncology, 2017,143(7):1263-1273.
[16] SHEN B J,SHUENG P W. Hemoglobin level during chemoradiation therapy predicts treatment outcome in nasopharyngeal cancer[J]. Radiation Therapy and Oncology,2014,21(2):77-87.
[17]中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会肿瘤康复与姑息治疗专业委员会,中国医师协会营养医师专业委员会,中国营养学会临床营养分会.鼻咽癌营养治疗专家共识[J].肿瘤代谢与营养电子杂志,2018,5(1):30-32.
[18]李开春,王静文,施展,等.阿瑞匹坦联合昂丹司琼和地塞米松预防化疗诱发恶心和呕吐的疗效及安全性[J].国际肿瘤学杂志,2016,43(8):561-564.
[19] QIU C,YANG N,TIAN G,et al. Weight loss during radiotherapy for nasopharyngeal carcinoma:a prospective study from northern China[J]. Nutrition&Cancer,2011,63(6):873-879.
[2]朱永杰,傅江涛,李界,等.晚期鼻咽癌患者同步放化疗后营养状况与医院感染的相关性分析[J].中华医院感染学杂志,2017,27(12):2786-2789.
[3]LI G, JIANG X, QIU B, et al. Vicious circle of acute radiation toxicities and weight loss predicts poor prognosis fornasopharyngeal carcinoma patients receiving intensity modulated radiotherapy[J]. Journal of Cancer,2017,8(5):832-838.
[4]郑荣辉,梁颖莹,田允鸿,等.鼻咽癌同期放化疗体质量下降规律及预测因素[J].实用医学杂志,2017,33(16):2682-2685.
[5]何妨,罗伟,张群,等.单纯调强放射治疗或结合化疗对局部区域晚期鼻咽癌的疗效观察[J].中华医学杂志,2013,93(29):2292-2295.
[6]蒋志雄,韦少雪.恶性骨肿瘤患者营养评价与营养风险筛查相关性研究分析[J].医学信息,2013,26(20):158-159.
[7]徐慧颖,李亚洁,赵洁,等.口腔黏膜炎评估量表及其应用研究[J].护理研究,2008,22(32):2917-2918.
[8] CHIE W C,HONG R L,LAI C C,et al. Quality of life in patients of nasopharyngeal carcinoma:validation of the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35[J]. Quality of Life Research, 2003,12(1):93-98.
[9]张雪芳,郑巧兰,郝元涛,等. EORTC QLQ C30/H&N35在鼻咽癌患者生存质量中的应用评价[J].新医学,2013,44(7):467-471.
[10]HUS J C, BRUSCHWEILER R. Principal component method for assessing structural heterogeneity across multiple alignment media[J]. Journal of Biomolecular Nmr,2002,24(2):123.
[11]李凯新,辛培玲,陈媛媛,等.局部中晚期鼻咽癌IMRT同步化疗后急性放射性口腔黏膜炎的预测因素分析[J].中华放射肿瘤学杂志,2017,26(3):255-260.
[12]张海荣,洪金省,苏丽,等.鼻咽癌患者放疗期间营养指数模型构建及营养状况下降影响因素分析[J].中国卫生统计,2015,32(6):959-962.
[13] MA L,WU T,PAN J,et al. The correlation between the comprehensive nutrition index and quality of life of patients with nasopharyngeal carcinoma treated by intensitymodulated radiotherapy[J]. Nutrition and Cancer-an International Jounal, 2014,66(1):152-158.
[14] DU X J,TANG L L,MAO Y P,et al. Value of the prognostic nutritional index and weight loss in predicting metastasis and long-term mortality in nasopharyngeal carcinoma[J]. Journal of Translational Medicine,2015,13(1):1-9.
[15] MIAO J,XIAO W,LIN W,et al. The value of the prognostic nutritional index(PNI)in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma(NPC)patients receiving intensity-modulated radiotherapy(IMRT)with or without chemotherapy[J]. Journal of Cancer Research&Clinical Oncology, 2017,143(7):1263-1273.
[16] SHEN B J,SHUENG P W. Hemoglobin level during chemoradiation therapy predicts treatment outcome in nasopharyngeal cancer[J]. Radiation Therapy and Oncology,2014,21(2):77-87.
[17]中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会肿瘤康复与姑息治疗专业委员会,中国医师协会营养医师专业委员会,中国营养学会临床营养分会.鼻咽癌营养治疗专家共识[J].肿瘤代谢与营养电子杂志,2018,5(1):30-32.
[18]李开春,王静文,施展,等.阿瑞匹坦联合昂丹司琼和地塞米松预防化疗诱发恶心和呕吐的疗效及安全性[J].国际肿瘤学杂志,2016,43(8):561-564.
[19] QIU C,YANG N,TIAN G,et al. Weight loss during radiotherapy for nasopharyngeal carcinoma:a prospective study from northern China[J]. Nutrition&Cancer,2011,63(6):873-879.
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