经皮胃造瘘对同期放化疗食管癌患者的营养、免疫炎症指标及疗效的影响  

Effects of Percutaneous Gastrostomy on Nutritional,Immunoinflammatory and Therapeutic Effects in Esophageal Cancer Patients Undergoing Concurrent Chemoradiotherapy

作　　者：李坤树 龚颖 马筑 李青松 耿一超 罗大先 杨文刚 陈霞霞 欧阳伟炜 胡银祥 苏胜发 卢冰 Li Kunshu;Gong Ying;Ma Zhu;Li Qingsong;Geng Yichao;Luo Daxian;Yang Wengang;Chen Xiaxia;Ouyang Weiwei;Hu Yinxiang;Su Shengfa;Lu Bing(Department of Oncology,Affliated Hospital of Guizhou Medical University,Guiyang 55000,Guizhou,China;Department of Oncology,School of Clinical Medicine,Guizhou Medical University,Guiyang 55000,Guizhou,China;Department of Thoracic Oncology,Afiliated Cancer Hospital of Guizhou Medical University,Guiyang 55000,Guizhou,China)

机构地区：[1]贵州医科大学附属医院肿瘤科,贵阳550000 [2]贵州医科大学临床医学院肿瘤学教研室,贵阳550000 [3]贵州医科大学附属肿瘤医院胸部肿瘤科,贵阳550000

出　　处：《肿瘤预防与治疗》2024年第10期843-852,共10页Journal of Cancer Control And Treatment

摘　　要：目的:探讨DSA引导下经皮胃造瘘术(percutaneous radiological gastrostomy,PRG)对接受同期放化疗的食管癌患者的营养状态、免疫炎症指标及疗效的影响。方法:回顾性分析2013年6月至2022年1月在贵州医科大学附属肿瘤医院接受同期放化疗的190例食管癌患者的临床资料,根据肠内营养的方式,分为PRG组(98例)或口服营养补充(oral nutrition supplements,ONS)组(92例)。采用倾向性评分匹配法,均衡组间混杂因素后比较PRG组和ONS组的营养、免疫炎症指标及疗效。结果:将PRG组的患者与ONS组的患者按照1:1的比例进行匹配后,每组各有79例患者。PRG组和ONS组放化疗后的白蛋白、前白蛋白、体重及体重指数分别下降(1.81±5.33)g/L和(3.75±6.24)g/L(t=2.101,P=0.037)、(23.40±64.93)mg/L和(46.36±74.04)mg/L(t=2.072,P=0.040)、(0.47±3.03)kg和(3.63±3.17)kg(t=6.420,P<0.001)、(0.17±1.09)kg/m^(2)和(1.37±1.21)kg/m^(2)(t=6.517,P<0.001),差异均有统计学意义;放化疗前PRG组与ONS组的中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)(t=1.949,P=0.053)、系统免疫炎症指数(systemic immunoinflammatory index,SII)(t=1.715,P=0.088)及预后营养指数(prognostic nutrition index,PNI)(t=-0.901,P=0.369)相似;放化疗后PRG组的NLR(t=2.659,P=0.009)、SII(t=-2.276,P=0.024)比ONS组低,PRG组的PNI比ONS组高,差异有统计学意义(t=2.292,P=0.023)。PRG组和ONS组完成4个周期化疗患者分别为63.29%和44.30%,差异有统计学意义(χ^(2)=10.560,P=0.014);PRG组比ONS组的3~4级血液学毒性(χ^(2)=6.369,P=0.041)和2级及以上放射性食管炎发生率下降,差异有统计学意义(χ^(2)=8.618,P=0.003)。PRG组和ONS组的1、2、3年总生存率分别为63.3%、41.8%、39.0%和43.0%、28.6%、22.9%,差异有统计学意义(χ^(2)=6.457,P=0.011);PRG组和ONS组的1、2、3年无进展生存率分别为59.5%、41.6%、38.7%和43.0%、26.0%、23.1%,差异有统计学意义(χ^(2)=6.673,P=0.010)。全组98例PRG患者中,感染、脱落、�Objective:To investigate the effects of digital subtraction angiography-guided percutaneous radiological gastrostomy(PRG)on nutritional status,immunoinflammatory indexes and curative effect of patients receiving concurrent chemoradiotherapy for esophageal cancer.Methods:The clinical data of 190 patients with esophageal cancer who received concurrent chemoradiotherapy in the Affiliated Cancer Hospital of Guizhou Medical University from June 2013 to January 2022 were retrospectively analyzed.According to the mode of enteral nutrition,the patients were assigned to the the PRG group(98 cases)or the oral nutritional supplements(ONS)group(92 cases).Propensity score matching(PSM)was used to balance the confounding factors between the PRG group and the ONS group before comparing the nutritional status,immunoinflammatory indexes and curative effect between the two groups.Results:After PSM was performed in the PRG group and ONS group in a ratio of 1:1,there were 79 patients in each group.Albumin,prealbumin,body weight and body mass index(BMI)in PRG group and ONS group after chemoradiotherapy decreased by(1.81±5.33)g/L and(3.75±6.24)g/L(t=2.101,P=0.037),(23.40±64.93)mg/L and(46.36±74.04)mg/L(t=2.072,P=0.040),(0.47±3.03)kg and(3.63±3.17)kg(t=6.420,P<0.001),(0.17±1.09)kg/m^(2)and(1.37±1.21)kg/m^(2)(t=6.517,P<0.001).Neutrophil/lymphocyte ratio(NLR)(t=1.949,P=0.053),systemic immunoinflammatory index(SII)(t=1.715,P=0.088)and prognostic nutrition index(PNI)(t=-0.901,P=0.369)were similar in the PRG group and the ONS group before chemoradiotherapy.After chemoradiotherapy,NLR(t=-2.659,P=0.009)and SII(t=-2.276,P=0.024)in the PRG group were lower than those in the ONS group,and PNI in the PRG group was higher than that in the ONS group(t=2.292,P=0.023).Patients in the PRG group and the ONS group who completed 4 cycles of chemotherapy were 63.29%and 44.30%,respectively(χ^(2)=10.560,P=0.014).Grade 3~4 hematological toxicity(χ^(2)=6.369,P=0.041)and the incidence of at least grade 2 radiation esophagitis were lower in PRG group

关 键 词：食管癌 同期放化疗 经皮胃造瘘术 

分 类 号：R730.58[医药卫生—肿瘤] R735.1[医药卫生—临床医学]