Read Jane A, Choy S T Boris, Beale Philip J, Clarke Stephen J
Sydney Cancer Centre, Concord and Royal Prince Alfred Hospitals, Sydney, NSW, Australia.
Nutr Cancer. 2006;55(1):78-85. doi: 10.1207/s15327914nc5501_10.
The purpose of this study was to evaluate novel inflammatory and nutritional prognostic factors in patients with advanced colorectal cancer (ACRC). All ACRC patients attending the clinic for palliative treatment were eligible for study. Demographics, including performance status (PS), C-reactive protein (CRP), albumin (Alb), Glasgow prognostic score (GPS), weight, weight history, body mass index (BMI), and nutritional status using the patient-generated subjective global assessment (PGSGA), were collected and correlated with survival. At a median follow-up of 29.8 mo, with a minimum follow-up of 15.7 mo, the median survival was 9.9 mo (0.8-21.8 mo). Fifteen (29%) patients were newly diagnosed (stage IV colorectal cancer), and 36 (71%) had received prior chemotherapy. Although the median BMI was 27 kg/m2 (range = 17-41 kg/m2), 28 of 50 (56%) were nutritionally at risk. In fact, 19 patients (38%) were critically in need of nutrition intervention (PGSGA score of > or =9). Thirty-three of 48 patients (69%) had an elevated CRP (>10 mg/l with a median of 21.1 mg/L), and 7 patients (15%) had both a CRP of >10 mg/l and hypoalbuminemia (< 35 g/l). A significant positive correlation was found between PGSGA score and CRP (P = 0.003; r = 0.430). Using univariate analysis, significantly worse survival was found for patients with poorer PS (P = 0.001), high GPS (P = 0.04), low Alb (P = 0.017), elevated serum alkaline phosphatase (SAP; P = 0.018), PGSGA score of > 9 (P = 0.001), and PGSGA group B/C (P = 0.02). Using the Cox proportional hazard model for multivariate survival analysis, type of treatment (hazard ratio, HR = 1.48; 95% confidence interval, CI = 1.11-1.79; P = 0.005), PS (HR = 2.37; 95% CI = 1.11-5.09; P = 0.026), GPS (HR = 2.27; 95% CI = 1.09-4.73; P = 0.028), and SAP (HR = 0.44; 95% CI = 0.18-1.07; P =0.069) remained significant predictors of survival. These preliminary data suggest that the type of treatment, PS, GPS, and SAP are important predictors of survival in ACRC.
本研究的目的是评估晚期结直肠癌（ACRC）患者新的炎症和营养预后因素。所有到诊所接受姑息治疗的ACRC患者均符合研究条件。收集了人口统计学数据，包括体能状态（PS）、C反应蛋白（CRP）、白蛋白（Alb）、格拉斯哥预后评分（GPS）、体重、体重史、体重指数（BMI）以及使用患者主观整体评定法（PGSGA）评估的营养状况，并将其与生存率进行关联分析。中位随访时间为29.8个月，最短随访时间为15.7个月，中位生存期为9.9个月（0.8 - 21.8个月）。15例（29%）患者为新诊断（IV期结直肠癌），36例（71%）曾接受过化疗。尽管中位BMI为27kg/m²（范围 = 17 - 41kg/m²），但50例中有28例（56%）存在营养风险。实际上，19例患者（38%）急需营养干预（PGSGA评分≥9）。48例患者中有33例（69%）CRP升高（>10mg/L，中位值为21.1mg/L），7例患者（15%）CRP>10mg/L且伴有低白蛋白血症（<35g/L）。发现PGSGA评分与CRP之间存在显著正相关（P = 0.003；r = 0.430）。采用单因素分析，PS较差（P = 0.001）、GPS较高（P = 0.04）、Alb较低（P = 0.017）、血清碱性磷酸酶（SAP）升高（P = 0.018）、PGSGA评分>9（P = 0.001）以及PGSGA分组为B/C（P = 0.02）的患者生存率显著较差。使用Cox比例风险模型进行多因素生存分析，治疗类型（风险比，HR = 1.48；95%置信区间，CI = 1.11 - 1.79；P = 0.005）、PS（HR = 2.37；95%CI = 1.11 - 5.09；P = 0.026）、GPS（HR = 2.27；95%CI = 1.09 - 4.73；P = 0.028）和SAP（HR = 0.44；95%CI = 0.18 - 1.07；P = 0.069）仍然是生存的重要预测因素。这些初步数据表明，治疗类型、PS、GPS和SAP是ACRC患者生存的重要预测因素。
