State Key Laboratory of Oncology in South China, Guangzhou 510060, P. R. China; ; Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, P. R. China;
J Thorac Dis. 2013 Aug;5(4):484-91. doi: 10.3978/j.issn.2072-1439.2013.08.38.
Nutritional evaluation is important for patients with esophageal cancer, but the impact of undernutrition on outcome of those patients is not well elucidated. Our aim is to assess the impact of baseline nutritional status on overall survival (OS) in Chinese patients with esophageal squamous cell carcinoma (ESCC) and to detect a most appropriate indicator for nutritional evaluation.
502 patients from Southern China diagnosed as ESCC in Sun Yat-Sen University Cancer Center were included. A series of nutritional indicators were introduced to evaluate the baseline nutritional status. Kaplan-Meier method was used to estimate the 5-year OS and the log-rank test was used to determine the survival differences. Cox proportional hazards model was used in the univariate and multivariate analyses of OS.
With a median follow up time of 30 months, the median OS for the entire patient group was 37.3 months with the 5-year OS rate of 43.0%. Only performance status, AJCC 6th stage and body mass index (BMI) were the independent prognostic factors in multivariate analysis of OS. The median OS for patients with BMI less than 18.5, patients with BMI within 18.5-24.9 and patients with BMI more than 24.9 were 19.2, 43.2 and 51.6 months, respectively, with the 5-year OS rates of 25.2%, 46.1% and 48.1% (P<0.001). Patients with BMI <18.5 tended to present with a more advanced stage disease and a poorer tumor grade.
Baseline nutritional status is predictive of OS in Chinese patients with ESCC. BMI is a steady indicator for nutritional evaluation and a sensitive prognostic parameter for ESCC patients. Treatment optimization in ESCC patients with low BMI should integrate the modalities and individual nutritional support.
营养评估对食管癌患者很重要，但营养不良对这些患者预后的影响尚不清楚。我们的目的是评估中国食管鳞状细胞癌（ESCC）患者基线营养状况对总生存（OS）的影响，并发现最适合营养评估的指标。
本研究纳入了中山大学肿瘤防治中心诊断为 ESCC 的 502 例患者。引入了一系列营养指标来评估基线营养状况。采用 Kaplan-Meier 法估计 5 年 OS，并采用对数秩检验比较生存差异。采用单因素和多因素 Cox 比例风险模型分析 OS。
中位随访时间为 30 个月，全组患者的中位 OS 为 37.3 个月，5 年 OS 率为 43.0%。只有体能状态、AJCC 第 6 期和体重指数（BMI）是 OS 多因素分析的独立预后因素。BMI<18.5、BMI 为 18.5-24.9 和 BMI>24.9 的患者的中位 OS 分别为 19.2、43.2 和 51.6 个月，5 年 OS 率分别为 25.2%、46.1%和 48.1%（P<0.001）。BMI<18.5 的患者往往处于更晚期的疾病状态，肿瘤分级也较差。
基线营养状况是中国 ESCC 患者 OS 的预测指标。BMI 是一种稳定的营养评估指标，也是 ESCC 患者的敏感预后参数。低 BMI 的 ESCC 患者的治疗优化应结合多种方式和个体化营养支持。
