治疗前营养状态对接受根治性放疗的老年局部晚期食管鳞状细胞癌患者预后的影响  

Effect of pre-treatment nutritional status on outcome in elderly patients with locally advanced esophageal squamous cell carcinoma undergoing radical radiotherapy

作　　者：蔡荟萃[1] 王燕[1] 叶劲军[1] 陈燕[1] Cai Huicui;Wang Yan;Ye Jinjun;Chen Yan(Department of Radiotherapy,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,Jiangsu,China)

机构地区：[1]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院放疗科,江苏南京210009

出　　处：《肿瘤代谢与营养电子杂志》2024年第4期525-531,共7页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：江苏省创新人才团队项目(TD-SWYY-007)。

摘　　要：目的探索治疗前营养状态对接受根治性放疗的老年局部晚期食管鳞状细胞癌患者预后的影响。方法收集2021年5月至2023年1月在江苏省肿瘤医院接受治疗的96例老年局部晚期食管鳞状细胞癌患者作为研究对象,均在治疗前进行了前清蛋白(PAB)、血红蛋白(Hb)、血清白蛋白(ALB)水平检测和营养风险筛查2002(NRS 2002)进行营养风险筛查,经二元Logistic回归分析影响患者预后因素。再根据患者预后分为两组,即预后不良组(死亡,n=32),预后良好组(生存,n=64),比较两组PAB、Hb、ALB水平和NRS 2002评分。经受试者操作特征(ROC)曲线分析PAB、Hb、ALB水平,NRS 2002评分预测价值。结果96例患者治疗前经血清检查,ALB水平(43.86±9.86)g/L,PAB水平(178.95±18.53)mg/L,Hb水平(129.84±15.43)g/L,NRS 2002评分值(3.49±1.86)分。经二元Logistic回归分析,治疗前ALB水平≤44 g/L、治疗前PAB水平≤179 mg/L、治疗前Hb水平≤126 g/L、治疗前NRS 2002评分>3分是影响老年局部晚期食管鳞状细胞癌患者预后因素(P<0.05)。利用Bootstrap法验证回归模型,提示本模型准确性较好(AUC为0.866,95%CI=0.795~0.938)。同时,预后良好组ALB(52.65±8.91)g/L、PAB(189.63±19.12)mg/L、Hb(141.58±17.21)g/L高于预后不良组,NRS 2002(1.55±0.75)分低于预后不良组(P<0.05),经ROC曲线分析,ALB、PAB、Hb、NRS 2002评分预测老年局部晚期食管鳞状细胞癌患者预后的ROC分别为0.836、0.898、0.877、0.914。结论治疗前PAB、Hb、ALB水平和NRS 2002评分能预测老年局部晚期食管鳞状细胞癌患者生存预后情况,通过治疗前检测患者营养状态,能够在改善近期疗效、生存预后中均起到重要作用,利于降低死亡率。Objective To explore the impact of pre-treatment nutritional status on the outcome of elderly patients with locally advanced esophageal squamous cell carcinoma undergoing radical radiotherapy.Method A total of 96 elderly patients with locally advanced esophageal squamous cell carcinoma who received treatment at Jiangsu Cancer Hospital from May 2021 to January 2023 were selected.Prior to treatment,levels of prealbumin(PAB),hemoglobin(Hb),serum albumin(ALB),and NRS 2002 score were tested,and binary logistic regression analysis was performed to determine the prognostic factors affecting the patients.According to the patient′s prognosis,they were further divided into two groups,namely the poor prognosis group(death,n=32)and the good prognosis group(survival,n=64).The levels of PAB,Hb,ALB,and NRS 2002 scores were compared between the two groups.Analyze the predictive value of PAB,Hb,ALB levels,and NRS 2002 score values through ROC curve analysis.Result 96 patients underwent serum tests before treatment,with ALB(43.86±9.86)g/L,PAB(178.95±18.53)mg/L,Hb(129.84±15.43)g/L,and NRS 2002(3.49±1.86)points.According to binary logistic regression analysis,pre-treatment ALB≤44g/L,pre-treatment PAB≤179 mg/L,pre-treatment Hb≤126 g/L,and pre-treatment NRS 2002 score>3 points are prognostic factors affecting elderly patients with locally advanced esophageal squamous cell carcinoma(P<0.05).The regression model was validated using Bootstrap method,with an AUC of 0.866 and 95%CI=0.795-0.938.Meanwhile,the ALB(52.65±8.91)g/L,PAB(189.63±19.12)mg/L,and Hb(141.58±17.21)g/L in the group with good prognosis were higher than those in the group with poor prognosis,and the NRS 2002 score(1.55±0.75)was lower than that in the group with poor prognosis(P<0.05).Through ROC analysis,the ALB,PAB,Hb,and NRS 2002 scores predicted the prognosis of elderly patients with locally advanced esophageal squamous cell carcinoma to be 0.836,0.898,0.877,and 0.914,respectively.Conclusion PAB,Hb,ALB levels and NRS 2002 score value can predict the surv

关 键 词：前清蛋白 血红蛋白 白蛋白 放疗 食管鳞状细胞癌 预后 营养状态 营养风险筛查2002 

分 类 号：R735.1[医药卫生—肿瘤]