Chiang Hsueh-Chien, Lin Meng-Ying, Lin Forn-Chia, Chiang Nai-Jung, Wang Yi-Ching, Lai Wu-Wei, Chang Wei-Lun, Sheu Bor-Shyang
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Nutr Cancer. 2022;74(10):3546-3555. doi: 10.1080/01635581.2022.2079687. Epub 2022 Jun 2.
In this study, we aimed to analyze whether serum prealbumin and transferrin have a higher sensitivity than albumin for detecting malnutrition and predicting survival in esophageal cancer patients. A total of 212 patients were prospectively enrolled. Serum albumin, prealbumin, and transferrin were analyzed by enzyme-linked immunosorbent assays. The association of nutritional markers with survival was analyzed. We found that malnutrition was presented in 44.5% of the patients, while 56.6% were unaware of their body weight change. The area under the curve for diagnosing malnutrition was largest for prealbumin, followed by transferrin and albumin, with optimal breakpoints of 21 mg/dL, 206 mg/dL, and 4.3 g/dL, respectively, for diagnosing malnutrition. The diagnostic sensitivity for malnutrition was 34.1-63.4% with a single marker and this increased to 80.5% with all 3 markers. In patients with normal albuminemia (≥ 4.3 g/dL), a low level of prealbumin and/or transferrin predicted malnutrition and poor prognosis. Multivariate Cox regression analysis confirmed that a low level of the nutritional marker was an independent poor prognostic factor. In conclusion, serum prealbumin and transferrin outperformed albumin in identifying esophageal cancer patients with malnutrition and poor prognosis. Checking all three markers will help with the early diagnosis of malnutrition and enable timely intervention.
在本研究中，我们旨在分析血清前白蛋白和转铁蛋白在检测食管癌患者营养不良及预测生存方面是否比白蛋白具有更高的敏感性。总共前瞻性纳入了212例患者。采用酶联免疫吸附测定法分析血清白蛋白、前白蛋白和转铁蛋白。分析了营养标志物与生存的相关性。我们发现44.5%的患者存在营养不良，而56.6%的患者未意识到自己的体重变化。诊断营养不良的曲线下面积以前白蛋白最大，其次是转铁蛋白和白蛋白，诊断营养不良的最佳切点分别为21mg/dL、206mg/dL和4.3g/dL。单个标志物对营养不良的诊断敏感性为34.1%-63.4%，而使用所有3个标志物时，该敏感性提高到80.5%。在白蛋白水平正常（≥4.3g/dL）的患者中，低水平的前白蛋白和/或转铁蛋白预示着营养不良和预后不良。多因素Cox回归分析证实，营养标志物水平低是独立的不良预后因素。总之，血清前白蛋白和转铁蛋白在识别营养不良和预后不良的食管癌患者方面优于白蛋白。检查所有这三个标志物将有助于营养不良的早期诊断并能及时进行干预。
