Effect of Early Nutrition Intervention on Advanced Nasopharyngeal Carcinoma Patients Receiving Chemoradiotherapy
Effect of Early Nutrition Intervention on Advanced Nasopharyngeal Carcinoma Patients Receiving Chemoradiotherapy
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早期营养干预对晚期鼻咽癌放化疗患者的影响
DOI：
10.7150/jca.33475
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Jiang, Xin
中科院分区：
文献类型：
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作者：
Meng, Lingbin;Wei, Jinlong;Jiang, Xin
背景：鼻咽癌患者在诊断时经常出现营养不良的问题。化疗（CRT）甚至会使情况恶化。因此，应进行营养干预，以防止CRT相关的体重减轻和CRT中断。然而，早期营养干预是否对鼻咽癌CRT患者有益仍存在争议。本研究通过评估晚期鼻咽癌CRT患者的营养状况和CRT治疗耐受性，探讨早期营养干预对CRT治疗的影响。方法：将78例Ⅲ ~ Ⅳ期鼻咽癌患者分为早期营养干预组（n=46）和晚期营养干预组（n=32）。早期组患者在CRT开始时接受营养支持，而晚期组患者接受这种支持直到出现副作用，如50%需要口服饮食摄入或>10%体重减轻。收集数据并进行统计学分析。结果如下：两组患者的基线临床特征无显著性差异，表明未发生选择偏倚。两组患者在CRT结束时和3个月后体重减轻。然而，在稍后的时间点，早期组开始恢复体重，而晚期组继续减肥。在这两个时间点，早期组的体重减轻百分比低于晚期组。对于BMI、白蛋白和前白蛋白水平也获得了类似的结果（所有p<0.05）。此外，早期组显示晚期粘膜炎的发生率较低，RT中断超过3天的患者百分比较低，因毒性而延迟RT的天数较少，计划外住院的患者百分比较低（所有p<0.05）。体重减轻的百分比和RT延迟的天数之间也存在线性相关。结论：早期营养干预通过维持NPC患者的营养状况和增强CRT治疗耐受性，为NPC患者提供了有益的结局。提示早期营养干预可降低住院费用，提高患者生活质量。
Background: Patients with nasopharyngeal carcinoma (NPC) frequently developed the problem of malnutrition at the time of diagnosis. Chemoradiotherapy (CRT) can even worsen the situation. Therefore, nutritional intervention should be applied to prevent CRT-associated weight loss and interruption of CRT. However, it is still controversial if early nutritional intervention is beneficial to NPC patients with CRT. This study is to investigate the influence of early nutritional intervention on advanced NPC patients with CRT by evaluating the nutritional status and CRT treatment tolerance. Methods: A cohort of 78 stage III-IV nasopharyngeal carcinoma patients was divided into early (n=46) and late (n=32) nutrition intervention groups. The early group of patients received nutritional support at the beginning of CRT, whereas the late group received such a support until development of the side effects, like 50% required oral dietary intake or >10% weight loss. The data were collected and statistically analyzed. Results: There was no significant difference in baseline clinical characteristics between these two groups, suggesting that no selection bias occurred. Both groups of patients had weight loss at the end of CRT and 3 months thereafter. However, at the later time point, the early group started to regain their weight, while the late group continued to lose weight. At both time points, the early group had a lower percentage of weight loss than the late group. Similar results were also obtained for BMI, albumin, and pre-albumin levels (All p<0.05). Besides, the early group showed a lower rate of advanced mucositis, a lower percentage of patients with more than 3 days RT breaks, fewer days of RT delayed for toxicity, and a lower percentage of patients with unplanned hospitalizations (All p<0.05). A linear correlation was also found between the percentage of weight loss and the number of days of RT delayed. Conclusion: Early nutritional intervention provides beneficial outcomes to NPC patients by maintaining their nutritional status and enhancing CRT treatment tolerance. Our results also indicated early nutrition intervention may reduce the hospital cost and improve patients' life quality.