Stegel P, Kozjek N R, Brumen B A, Strojan P
Department of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana Slovenia.
Clinical Nutrition Unit, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Eur J Clin Nutr. 2016 May;70(5):602-6. doi: 10.1038/ejcn.2016.13. Epub 2016 Feb 24.
BACKGROUND/OBJECTIVES: Malnutrition and cachexia have a negative impact on the course of treatment in patients with head and neck squamous cell carcinoma (HNSCC). Good evidence exists for the practical use of the bioelectrical impedance analysis (BIA) parameter phase angle (PA) for the evaluation of nutritional and overall health status in cancer patients. In the present study, two hypotheses were tested: that PA can distinguish between malnutrition and cachexia; in non-cachectic patients, pre-treatment PA is predictive for cachexia development during (chemo)radiation.
SUBJECTS/METHODS: In 55 head and neck cancer patients, nutritional status was determined by the NRS-2002, anthropometric, laboratory tests and BIA before and after (chemo)radiotherapy. For the diagnosis of cachexia, the international consensus criteria were used. Patients were categorized as well-nourished, malnourished or cachectic. The resulting group distribution was compared with pre- and post-treatment PA values.
Before treatment, 69.1% of patients were well-nourished, 16.4% malnourished and 14.5% cachectic; post-treatment proportions were 16.4%, 45.4% and 38.2%, respectively. Well-nourished patients had a higher pre-treatment mean PA value compared with the others (P=0.045). The risk of malnutrition/cachexia increased by 1.71 (95% confidence interval (CI) 1.10-2.66) per mean PA decrease by one unit (P=0.018). In 47 initially non-cachectic patients, PA failed to show any predictive value for cachexia (area under the receiver operating characteristic curve: 0.578, 95% CI 0.385-0.772, P>0.05).
PA did not distinguish between malnourished and cachectic patients with HNSCC, and pre-treatment PA did not predict cachexia development during (chemo)radiation. Nevertheless, PA seems to be a good marker of nutritional status in HNSCC patients.
背景/目的：营养不良和恶病质对头颈部鳞状细胞癌（HNSCC）患者的治疗过程有负面影响。生物电阻抗分析（BIA）参数相角（PA）在评估癌症患者营养和整体健康状况方面的实际应用有充分证据。在本研究中，检验了两个假设：PA能够区分营养不良和恶病质；在非恶病质患者中，治疗前的PA可预测（放）化疗期间恶病质的发生。
对象/方法：对55例头颈部癌患者在（放）化疗前后通过NRS - 2002、人体测量、实验室检查和BIA测定营养状况。采用国际共识标准诊断恶病质。患者被分为营养良好、营养不良或恶病质。将所得组间分布与治疗前后的PA值进行比较。
治疗前，69.1%的患者营养良好，16.4%营养不良，14.5%恶病质；治疗后的比例分别为16.4%、45.4%和38.2%。营养良好的患者治疗前的平均PA值高于其他患者（P = 0.045）。平均PA每降低一个单位，营养不良/恶病质的风险增加1.71（95%置信区间（CI）1.10 - 2.66）（P = 0.018）。在47例最初无恶病质的患者中，PA未显示出对恶病质的任何预测价值（受试者工作特征曲线下面积：0.578，95% CI 0.385 - 0.772，P>0.05）。
PA不能区分HNSCC患者的营养不良和恶病质，治疗前的PA也不能预测（放）化疗期间恶病质的发生。然而，PA似乎是HNSCC患者营养状况的一个良好指标。
