Zhang J Q, Wang Y Y, Xu K P, Qi J, Wang X, Xu L M, Liu N N, Zhao L J, Wang P
Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
Zhonghua Zhong Liu Za Zhi. 2019 Dec 23;41(12):937-942. doi: 10.3760/cma.j.issn.0253-3766.2019.12.010.
To explore the effect of nutritional status pre-and during chemoradiotherapy on the prognosis of patients with limited- stage small cell lung cancer (LS-SCLC). We retrospectively collected medical records of 172 LS-SCLC patients undergoing concurrent chemoradiotherapy in our hospital from 2000 to 2014, with 126 males and 46 females. The data of complete blood count and hepatic and renal function were collected before initial treatment, before radiotherapy, 4 weeks during radiotherapy, and 1 month after complete of treatment. The prognostic nutritional index(PNI)was calculated. Kaplan-Meier method was used to calculate the survival rate. Log-rank test was performed used to compare the survival differences between groups. Multivariate prognostic analysis was performed using Cox regression model. The median overall survival (OS) was 21 months, with median progression-free survival (PFS) of 11 months. At the beginning of treatment, patients with pre-treatment PNI ≥ 53 had significantly superior OS (median 37 vs 15 months, =0.001) and PFS (median 16 vs 10 months, =0.017). Patients with pre-treatment hemoglobin ≥140 g/L and <140 g/L had an median OS of 32 months and 17 months (=0.019), and median PFS of 16 months and 9 months (=0.040), respectively. During chemoradiation, patients with elevated hemoglobin had similar median OS compared with those had decreased hemoglobin (27 vs 18 months, =0.063, but superior median PFS (15 vs 9 months, =0.017). Multivariate analysis revealed that prophylactic cranial irradiation, pre-treatment hemoglobin ≥140 g/L, and pretreatment PNI ≥53 were independent predictors of OS and PFS in patients with LS-SCLC. Pre-treatment nutritional status and the changes of nutritional status during chemoradiotherapy is significantly associated with the prognosis of patients with limited-stage small cell lung cancer. The patients with better pre-treatment nutritional status have a better prognosis.
探讨放化疗前及放化疗期间营养状况对局限期小细胞肺癌（LS-SCLC）患者预后的影响。我们回顾性收集了2000年至2014年在我院接受同步放化疗的172例LS-SCLC患者的病历资料，其中男性126例，女性46例。收集初始治疗前、放疗前、放疗期间4周以及治疗结束后1个月的血常规及肝肾功能数据。计算预后营养指数（PNI）。采用Kaplan-Meier法计算生存率。进行Log-rank检验以比较组间生存差异。使用Cox回归模型进行多因素预后分析。中位总生存期（OS）为21个月，中位无进展生存期（PFS）为11个月。治疗开始时，治疗前PNI≥53的患者OS（中位37个月对15个月，P = 0.001）和PFS（中位16个月对10个月，P = 0.017）显著更优。治疗前血红蛋白≥140 g/L和＜140 g/L的患者中位OS分别为32个月和17个月（P = 0.019），中位PFS分别为16个月和9个月（P = 0.040）。在放化疗期间，血红蛋白升高的患者与血红蛋白降低的患者中位OS相似（27个月对18个月，P = 0.063），但中位PFS更优（15个月对9个月，P = 0.017）。多因素分析显示，预防性颅脑照射、治疗前血红蛋白≥140 g/L以及治疗前PNI≥53是LS-SCLC患者OS和PFS的独立预测因素。放化疗前营养状况及放化疗期间营养状况的变化与局限期小细胞肺癌患者的预后显著相关。治疗前营养状况较好的患者预后更佳。
