Furness Kate, Silvers Mary Anne, Savva June, Huggins Catherine E, Truby Helen, Haines Terry
Nutrition and Dietetics, Monash Health, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
Nutrition and Dietetics, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
Support Care Cancer. 2017 Nov;25(11):3587-3593. doi: 10.1007/s00520-017-3789-2. Epub 2017 Jun 14.
This study aimed to evaluate the long-term survival of all patients who participated in a pilot randomised trial of an early nutritional intervention for adults with upper gastrointestinal cancer. It also sought to identify factors that predicted patient mortality.
All participants (n = 21) who were randomised into the original study were followed for a maximum of 5 years and 2 months (final follow-up April 2016). The primary outcome measure was time from date of recruitment until date of death, ascertained by the Victorian Cancer Registry and/or Monash Health Scanned Medical Records. Secondary analyses were conducted to identify factors that adversely affected survival.
At the end of the follow-up period, three patients were alive in the nutrition intervention group whilst only two patients were living from the standard care group. Visual evaluation of the Kaplan-Meier survival curves demonstrated a possible survival benefit from being exposed to the intervention between 6 months and 1.4 years post-recruitment, though this benefit dissipated soon after. The intervention was not associated with increased survival in univariate analyses, but was after adjustment for other factors found to adversely impact on survival (adjusted hazard ratio 0.12 (95% CI 0.02-0.72) p = 0.02). These factors were being a smoker (14.2 (1.43 to 140.67), p = 0.02); low baseline physical functioning (1.11 (1.01 to 1.21), p = 0.03); high baseline fatigue (1.09 (1.02-1.16), p = 0.007); and high baseline dyspnoea (1.08 (1.02-1.13), p = 0.003).
Early and intensive nutrition intervention may increase the survival of people with upper gastrointestinal cancer.
本研究旨在评估所有参与针对成年上消化道癌患者的早期营养干预试点随机试验的患者的长期生存率。研究还试图确定预测患者死亡率的因素。
所有被随机纳入原研究的参与者（n = 21）被随访了最长5年零2个月（最终随访时间为2016年4月）。主要结局指标是从招募日期到死亡日期的时间，通过维多利亚癌症登记处和/或莫纳什健康扫描医疗记录确定。进行了二次分析以确定对生存有不利影响的因素。
在随访期结束时，营养干预组有3名患者存活，而标准护理组只有2名患者存活。对Kaplan-Meier生存曲线的直观评估表明，在招募后6个月至1.4年期间接受干预可能有生存获益，不过这种获益很快就消失了。在单变量分析中，干预与生存率提高无关，但在对其他发现会对生存产生不利影响的因素进行调整后，干预与生存率提高有关（调整后的风险比为0.12（95%可信区间为0.02 - 0.72），p = 0.02）。这些因素包括吸烟（14.2（1.43至140.67），p = 0.02）；基线身体功能低下（1.11（1.01至1.21），p = 0.03）；基线疲劳程度高（1.09（1.02 - 1.16），p = 0.007）；以及基线呼吸困难程度高（1.08（1.02 - 1.13），p = 0.003）。
早期强化营养干预可能会提高上消化道癌患者的生存率。
