Ho Sheng-Yow, Guo How-Ran, Chen Helen H W, Peng Cheau-Jane
Department of Radiation Oncology, Sin-Lau Christian Hospital, Tainan, Taiwan.
J Formos Med Assoc. 2003 Aug;102(8):544-50.
Malnutrition can affect the prognosis of terminally ill patients, but over-treatment of malnutrition can worsen patients' quality of life. Decisions on nutrition and the supply of fluids to terminally ill patients are complex, and the identification of useful clinical indicators is needed. This study evaluated the relationships between various nutritional indices and survival of terminally ill cancer patients.
We recruited terminally ill patients from a teaching hospital between February 2000 and January 2001. All of the 145 candidates were cancer patients, 109 (75%) of whom agreed to participate. Nutritional assessments including physical examination, anthropometric measurements, and biochemical profiles were performed on admission.
Univariate analyses showed that triceps skin-fold thickness (TSF) and midarm muscle circumference were significant predictors of survival. Poor survival was associated with prealbumin </= 100 mg/L (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; p = 0.03), asparate transaminase (AST) > 45 U/L (HR, 1.6; 95% CI, 1.1 to 2.3; p = 0.03), alkaline phosphatase > 120 U/L (HR, 1.6; 95% CI, 1.1 to 2.5; p = 0.02), creatinine > 1.4 mg/dL (HR, 1.9; 95% CI, 1.2 to 3.2; p = 0.01), and blood urea nitrogen (BUN) > 20 mg/dL (HR, 1.9; 95% CI, 1.3 to 2.8; p < 0.01) at admission. Multivariate analyses found that TSF < 25% of the nomogram (HR, 2.9; 95% CI, 1.6 to 5.3; p < 0.01), prealbumin </= 100 mg/L (HR, 2.2; 95% CI, 1.4 to 3.5; p < 0.01), AST > 45 U/L (HR, 2.0; 95% CI, 1.3 to 3.2; p = 0.01), and BUN > 20 mg/dL (HR, 2.8; 95% CI, 1.7 to 4.5; p < 0.01) were independent predictors of poor survival.
This study found that nutritional status was associated with the survival of terminally ill cancer patients. Both TSF and prealbumin appeared to be useful predictors that may help set strategies to improve palliative care. Because predictors of survival are not necessarily factors that actually influence survival, further studies should be conducted to evaluate the usefulness of these prognostic indicators in clinical practice.
营养不良会影响晚期患者的预后，但对营养不良的过度治疗会使患者生活质量恶化。晚期患者的营养和液体供应决策复杂，需要确定有用的临床指标。本研究评估了各种营养指标与晚期癌症患者生存之间的关系。
我们于2000年2月至2001年1月在一家教学医院招募晚期患者。145名候选患者均为癌症患者，其中109名（75%）同意参与。入院时进行了包括体格检查、人体测量和生化指标在内的营养评估。
单因素分析显示，肱三头肌皮褶厚度（TSF）和上臂中部肌肉周长是生存的显著预测因素。生存不良与入院时前白蛋白≤100 mg/L（风险比[HR]，1.5；95%置信区间[CI]，1.1至2.3；p = 0.03）、天冬氨酸转氨酶（AST）>45 U/L（HR，1.6；95%CI，1. I至2.3；p = 0.03）、碱性磷酸酶>120 U/L（HR，1.6；95%CI，1.1至2.5；p = 0.02）、肌酐>1.4 mg/dL（HR，1.9；95%CI，1.2至3.2；p = 0.01）以及血尿素氮（BUN）>20 mg/dL（HR，1.9；95%CI，1.3至2.8；p<0.01）相关。多因素分析发现，TSF<列线图的25%（HR，2.9；95%CI，1.6至5.3；p<0.01）、前白蛋白≤100 mg/L（HR，2.2；95%CI，1.4至3.5；p<0.01）、AST>45 U/L（HR，2.0；95%CI，1.3至3.2；p = 0.01）以及BUN>20 mg/dL（HR，2.8；95%CI，1.7至4.5；p<0.01）是生存不良的独立预测因素。
本研究发现营养状况与晚期癌症患者的生存相关。TSF和前白蛋白似乎都是有用的预测指标，可能有助于制定改善姑息治疗的策略。由于生存预测因素不一定是实际影响生存的因素，应进一步开展研究以评估这些预后指标在临床实践中的实用性。
