Hua Xin, Liao Jun-Fang, Liu Shan, Zhang Jun, Huang Han-Ying, Wen Wen, Long Zhi-Qing, Zhang Wen-Wen, Guo Ling, Lin Huan-Xin
State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Nutr. 2020 Jan 15;6:195. doi: 10.3389/fnut.2019.00195. eCollection 2019.
Nasopharyngeal carcinoma (NPC) patients receiving concurrent chemoradiotherapy (CCRT) frequently develop low skeletal muscle mass (SMM), but, little is known about the impacts of low SMM on health-related quality of life (QOL). We retrospectively assessed 56 patients with locoregionally advanced NPC enrolled in a prospective trial. Low SMM was determined on routine computed tomography simulation (CT-sim) scans taken before radiotherapy, at the third cervical (C3) vertebral level with validated sex-specific cutoffs. QOL was assessed using the World Health Organization Quality of Life Questionnaire-100 at baseline and after 3 weeks. Pain was scored every 24 h using a numerical rating scale (NRS). Characteristics related to low SMM were identified by logistic regression. The chi-square test was used to examine the association of low SMM with QOL and pain. Of the 56 participants (mean age 44.20 ± 10.93 years), over half (60.71%) developed low SMM. Patients with low SMM were more likely to be older ( = 0.035), male ( = 0.066), have a lower body-mass index (BMI; = 0.091), and have a higher pain score ( = 0.001). Older age (hazard ratio [HR] = 1.788, = 0.016), being male (HR = 3.145, = 0.010), lower BMI (HR = 0.761, = 0.033), and lower prognostic nutritional index (HR = 0.186, = 0.034) were associated with higher risk of low SMM. Low SMM was associated with poorer baseline QOL scores ( = 0.072), especially in the physical domain ( = 0.002) and its three facets: pain ( = 0.003), energy ( = 0.021), and sleep ( = 0.007). Low SMM was also associated with significantly worse QOL scores ( = 0.006) at 3 weeks, especially in the physical ( = 0.002), psychological ( = 0.046), independence ( = 0.003), social domains ( = 0.023), and in general health condition ( = 0.043). For pain score, low SMM group had worse overall changes from baseline to week 3 ( = 0.011). The incidence of low SMM, as evaluated using routine CT-sim scans, is high in patients receiving CCRT for locoregionally advanced NPC. Low SMM results in poorer QOL and higher pain scores, which underscores the requirement for nutritional and functional interventions to address low SMM early in the treatment course.
接受同步放化疗（CCRT）的鼻咽癌（NPC）患者经常出现骨骼肌质量（SMM）降低的情况，但关于低SMM对健康相关生活质量（QOL）的影响却知之甚少。我们回顾性评估了56例局部晚期NPC患者，这些患者均参与了一项前瞻性试验。在放疗前进行的常规计算机断层扫描模拟（CT-sim）扫描中，在第三颈椎（C3）椎体水平，使用经过验证的性别特异性临界值来确定低SMM。在基线和3周后，使用世界卫生组织生活质量问卷-100对生活质量进行评估。每隔24小时使用数字评分量表（NRS）对疼痛进行评分。通过逻辑回归确定与低SMM相关的特征。使用卡方检验来检验低SMM与生活质量和疼痛之间的关联。在56名参与者中（平均年龄44.20±10.93岁），超过一半（60.71%）出现了低SMM。低SMM患者更可能年龄较大（P = 0.035）、为男性（P = 0.066）、体重指数（BMI）较低（P = 0.091）且疼痛评分较高（P = 0.001）。年龄较大（风险比[HR] = 1.788，P = 0.016）、男性（HR = 3.145，P = 0.010）、较低的BMI（HR = 0.761，P = 0.033）以及较低的预后营养指数（HR = 0.186，P = 0.034）与低SMM的较高风险相关。低SMM与较差的基线生活质量评分相关（P = 0.072），尤其是在身体领域（P = 0.002）及其三个方面：疼痛（P = 0.003）、精力（P = 0.021）和睡眠（P = 0.007）。低SMM还与3周时显著更差的生活质量评分相关（P = 0.006），尤其是在身体（P = 0.002）、心理（P = 0.046）、独立（P = 0.003）、社会领域（P = 0.023）以及总体健康状况（P = 0.043）方面。对于疼痛评分，低SMM组从基线到第3周的总体变化更差（P = 0.011）。使用常规CT-sim扫描评估，接受CCRT治疗的局部晚期NPC患者中低SMM的发生率很高。低SMM导致较差的生活质量和较高的疼痛评分，这凸显了在治疗过程早期进行营养和功能干预以解决低SMM问题的必要性。
