营养风险相关指标对接受根治性放射治疗的老年食管鳞状细胞癌患者预后的预测价值  

Predictive value of nutritional risk related indicators in the prognosis of elderly esophageal squamous cell carcinoma patients undergoing radical radiotherapy

作　　者：武亚娟[1] 王婕 李琦[1] 任雅琼[1] 陈飞[1] 李晓敏[1] Wu Yajuan;Wang Jie;Li Qi;Ren Yaqiong;Chen Fei;Li Xiaomin(Department of Radiotherapy Chest 3,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院放射治疗科胸部放疗三病区,太原030013

出　　处：《肿瘤研究与临床》2025年第1期19-26,共8页Cancer Research and Clinic

摘　　要：目的探讨营养风险相关指标对接受根治性放射治疗的老年食管鳞状细胞癌(ESCC)患者预后的预测价值。方法回顾性病例系列研究。回顾性分析2015年1月至2019年12月在山西省肿瘤医院接受根治性放射治疗且年龄≥70岁的ESCC患者资料。依据放射治疗计划系统,计算食管原发肿瘤靶区(GTVt)最大横径和GTVt体积;计算并记录患者放疗前后的营养风险相关指标:体质量指数(BMI)、老年营养风险指数(GNRI)和中性粒细胞与淋巴细胞比值(NLR);采用Kaplan-Meier法进行生存分析,并行log-rank检验;采用Cox比例风险模型分析患者预后的影响因素;比较不同临床病理特征患者总生存(OS)、无进展生存(PFS)、近期疗效及不良反应。结果随访截至2023年12月30日。161例老年ESCC患者1、3、5年OS率为79.5%、33.9%、16.1%,中位OS时间25.8个月(95%CI:20.11~31.49个月);1、3、5年PFS率为65.8%、28.9%、14.8%,中位PFS时间20.0个月(95%CI:16.31~23.69个月)。不同年龄、病变造影长度、GTVt最大横径、GTVt体积、近期疗效、放疗前BMI、放疗后BMI、放疗后GNRI、放疗前NLR和放疗后NLR患者的中位OS时间比较,差异均有统计学意义(均P<0.05);不同年龄、GTVt最大横径、GTVt体积、近期疗效、放疗前BMI、放疗后BMI、放疗后GNRI和放疗前NLR的中位PFS时间比较,差异均有统计学意义(均P<0.05)。多因素Cox回归分析结果显示,GTVt最大横径为患者OS的独立影响因素(P<0.05);GTVt体积、近期疗效、放疗后GNRI和放疗前NLR为患者OS、PFS的独立影响因素(均P<0.05)。161例老年ESCC患者中,达完全缓解(CR)45例,部分缓解(PR)111例,疾病稳定(SD)5例。不同GTVt最大横径、GTVt体积、放疗后BMI、放疗后GNRI和放疗前NLR达CR和PR+SD的患者比例比较,差异均有统计学意义(均P<0.05)。161例患者中,治疗期间及治疗后3个月内发生0、1、2、3级放射性食管炎(RE)分别为59、54、42、6例,其中≥2级RE 48例(29.8%);发ObjectiveTo investigate the predictive value of nutritional risk related indicators in the prognosis of elderly esophageal squamous cell carcinoma(ESCC)patients undergoing radical radiotherapy.MethodsA retrospective case series study was conducted.The clinical data of ESCC patients aged≥70 years who received radical radiotherapy in Shanxi Province Cancer Hospital from January 2015 to December 2019 were retrospectively analyzed.According to the radiotherapy planning system,the maximum transverse diameter of gross tumor volume of primary tumors(GTVt)and GTVt volume in the esophagus were calculated.The nutritional risk related indicators of ESCC patients before and after radiotherapy were calculated and recorded,including body mass index(BMI),geriatric nutritional risk index(GNRI),and neutrophil-to-lymphocyte ratio(NLR);Kaplan-Meier method was used for survival analysis,and log-rank test was performed;Cox proportional risk model was used to analyze the factors influencing the prognosis of patients.The overall survival(OS),progression-free survival(PFS),short-term efficacy,and adverse reactions of patients with different clinicopathological characteristics were compared.ResultsThe last follow-up time was 30 December,2023.The 1-year,3-year,and 5-year OS rates of 161 elderly patients with ESCC were 79.5%,33.9%,and 16.1%respectively,with a median OS time of 25.8 months(95%CI:20.11-31.49 months);the 1-year,3-year,and 5-year PFS rates were 65.8%,28.9%,and 14.8%,respectively,with a median PFS time of 20.0 months(95%CI:16.31-23.69 months).There were statistically significant differences in the median OS time of patients with different age,lesion contrast length,maximum transverse diameter of GTVt,GTVt volume,short-term efficacy,BMI before radiotherapy,BMI after radiotherapy,GNRI after radiotherapy,NLR before radiotherapy,and NLR after radiotherapy(all P<0.05);there were statistically significant differences in the median PFS time of ESCC patients with different age,maximum transverse diameter of GTVt,GTVt volume,short-ter

关 键 词：食管鳞状细胞癌 营养评价 人体质量指数 放射治疗计划 计算机辅助 预后 

分 类 号：R735.1[医药卫生—肿瘤]