Lin Yu-Ching, Wang Cheng-Hsu, Ling Hang Huong, Pan Yi-Ping, Chang Pei-Hung, Chou Wen-Chi, Chen Fang-Ping, Yeh Kun-Yun
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Keelung & Chang Gung University, Taoyuan 333007, Taiwan.
Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.
Biomedicines. 2022 Feb 6;10(2):388. doi: 10.3390/biomedicines10020388.
Only few prospective cohort trials have evaluated the risk factors for the 2-year mortality rate between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC): oral cavity cancer with adjuvant concurrent chemoradiotherapy (CCRT) (OCC) and non-oral cavity cancer with primary CCRT (NOCC), under the recommended calorie intake and investigated the interplay among calorie supply, nutrition-inflammation biomarkers (NIBs), and total body composition change (TBC), as assessed using dual-energy X-ray absorptiometry (DXA). Patients with LAHNSCC who consumed at least 25 kcal/kg/day during CCRT were prospectively recruited. Clinicopathological variables, blood NIBs, CCRT-related factors, and TBC data before and after treatment were collected. Factor analysis was performed to reduce the number of anthropometric and DXA-derived measurements. Cox proportional hazards models were used for analysis. We enrolled 123 patients with LAHNSCC (69 with OCC and 54 with NOCC). The mean daily calorie intake correlated with the treatment interval changes in total body muscle and fat. Patients consuming ≥30 kcal/kg/day had lower pretreatment levels but exhibited fewer treatment interval changes in anthropometric and DXA measurements than patients consuming <30 kcal/kg/day. In the multivariate analysis of the 2-year mortality rate, the prognostic influence of the recommended calorie intake could not be confirmed, but different risk factors (performance status, pretreatment platelet-to-lymphocyte ratio, and treatment interval body muscle changes in patients with OCC; age, pretreatment neutrophil-to-lymphocyte ratio, and body fat storage in patients with NOCC) showed independent effects. Therefore, the inflammation status and body composition, but not the recommended calorie supply, contribute to the 2-year mortality rate for patients with LAHNSCC receiving CCRT.
仅有少数前瞻性队列试验评估了局部晚期头颈部鳞状细胞癌（LAHNSCC）两个患者亚组之间2年死亡率的风险因素：接受辅助同步放化疗（CCRT）的口腔癌（OCC）和接受原发CCRT的非口腔癌（NOCC），这些试验是在推荐热量摄入情况下进行的，并研究了热量供应、营养炎症生物标志物（NIBs）和使用双能X线吸收法（DXA）评估的全身成分变化（TBC）之间的相互作用。前瞻性招募了在CCRT期间每日至少摄入25千卡/千克的LAHNSCC患者。收集临床病理变量、血液NIBs、CCRT相关因素以及治疗前后的TBC数据。进行因子分析以减少人体测量和DXA衍生测量的数量。使用Cox比例风险模型进行分析。我们纳入了123例LAHNSCC患者（69例OCC患者和54例NOCC患者）。每日平均热量摄入与全身肌肉和脂肪的治疗间隔变化相关。摄入≥30千卡/千克/天的患者预处理水平较低，但与摄入<30千卡/千克/天的患者相比，其人体测量和DXA测量的治疗间隔变化较少。在对2年死亡率的多变量分析中，无法确认推荐热量摄入的预后影响，但不同的风险因素（OCC患者的体能状态、预处理血小板与淋巴细胞比值以及治疗间隔期身体肌肉变化；NOCC患者的年龄、预处理中性粒细胞与淋巴细胞比值以及身体脂肪储存）显示出独立作用。因此，炎症状态和身体成分而非推荐的热量供应，对接受CCRT的LAHNSCC患者的2年死亡率有影响。
