营养状况和血清白蛋白水平与紫杉醇-顺铂化疗治疗晚期非小细胞肺癌患者毒性发展的关系：一项前瞻性研究。
Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study.
机构信息
Medical Oncology Department Instituto Nacional de Cancerología Av San Fernando No 22, Col Sección XVI, Mexico City, 14080 Mexico.
出版信息
BMC Cancer. 2010 Feb 21;10:50. doi: 10.1186/1471-2407-10-50.
BACKGROUND
A frequent manifestation of advanced NSCLC is malnutrition, even though there are many studies which relate it with a poor survival, its relation with toxicity has not yet been consistently reported. The aim of this study was to associate malnutrition and albumin serum levels with the occurrence of chemotherapy-induced toxicity in cisplatin plus paclitaxel chemotherapy-treated NSCLC.
METHODS
We prospectively evaluated 100 stage IV NSCLC patients treated with paclitaxel (175 mg/m2) and cisplatin (80 mg/m2). Malnutrition was assessed using SGA prior treatment. Neutrophil Lymphocyte Ratio (NLR) and the Platelet Lymphocyte Ratio (PLR) were used to determine the presence of systemic inflammatory response (SIR) and were related to the development of toxicity. Toxicity was graded according to NCI CTCAE version 3.0 after two chemotherapy cycles.
RESULTS
Median age was 58 +/- 10 years, 51% of patients were malnourished, 50% had albumin < or =3.0 mg/mL. NLR > or = 5 was associated with basal hypoalbuminemia (mean ranks, 55.7 vs. 39 p = 0.006), ECOG = 2 (47.2 vs. 55.4 p = 0.026) and PLR > or = 150 were significantly related with a basal body mass index < or =20 (56.6 vs. 43.5; p = 0.02) and hypoalbuminemia (58.9 vs. 41.3; p = 0.02). Main toxicities observed after 2 cycles of chemotherapy were alopecia (84%), nausea (49%), neuropathy (46%), anemia (33%), lymphopenia (31%), and leukopenia (30%). Patients malnourished and with hypoalbuminemia developed more chemotherapy-induced toxicity overall when compared with those without malnutrition (31 vs 22; p = 0.02) and normal albumin (mean ranks, 62 vs 43; p = 0.002), respectively. Hypoalbuminemia was associated with anemia (56 vs 47; p = 0.05), fatigue (58 vs 46; p = 0.01), and appetite loss (57.1 vs 46.7; p = 0.004) compared with normal albumin. PLR > or = 150 was related with the development of toxicity grade III/IV (59.27 vs. 47.03 p = 0.008) and anemia (37.9 vs 53.8 p = 0.004).
CONCLUSION
SIR parameters were associated with malnutrition, weight loss and hypoalbuminemia. Chemotherapy-induced toxicity in NSCLC patients treated with paclitaxel and cisplatin was associated with malnutrition and hypoalbuminemia. Early nutritional assessment and support might confer beneficial effects.
背景
晚期非小细胞肺癌（NSCLC）常表现为营养不良，尽管有许多研究表明其与生存率降低有关，但它与毒性的关系尚未得到一致报道。本研究旨在探讨营养不良和血清白蛋白水平与顺铂联合紫杉醇治疗 NSCLC 患者化疗诱导毒性的关系。
方法
我们前瞻性评估了 100 例接受紫杉醇（175mg/m2）和顺铂（80mg/m2）治疗的 IV 期 NSCLC 患者。治疗前采用 SGA 评估营养不良。中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）用于评估全身炎症反应（SIR），并与毒性的发生相关。根据 NCI CTCAE 第 3.0 版对两个化疗周期后的毒性进行分级。
结果
中位年龄为 58±10 岁，51%的患者存在营养不良，50%的患者白蛋白<或=3.0mg/mL。NLR>或=5 与基础低白蛋白血症（平均秩次，55.7 与 39，p=0.006）、ECOG=2（47.2 与 55.4，p=0.026）相关，PLR>或=150 与基础 BMI<或=20（56.6 与 43.5，p=0.02）和低白蛋白血症（58 与 41.3，p=0.02）显著相关。化疗 2 周期后观察到的主要毒性为脱发（84%）、恶心（49%）、周围神经病变（46%）、贫血（33%）、淋巴细胞减少（31%）和白细胞减少（30%）。与非营养不良患者（31%比 22%，p=0.02）和正常白蛋白患者（平均秩次，62 比 43，p=0.002）相比，营养不良和低白蛋白血症患者发生的化疗诱导毒性总体更多。与正常白蛋白相比，低白蛋白血症与贫血（56 比 47，p=0.05）、疲劳（58 比 46，p=0.01）和食欲下降（57.1 比 46.7，p=0.004）相关。PLR>或=150 与 III/IV 级毒性（59.27 比 47.03，p=0.008）和贫血（37.9 比 53.8，p=0.004）的发生相关。
结论
SIR 参数与营养不良、体重减轻和低白蛋白血症相关。接受紫杉醇和顺铂治疗的 NSCLC 患者的化疗诱导毒性与营养不良和低白蛋白血症有关。早期营养评估和支持可能有益。
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