Wang Chao-Hung, Ling Hang Huong, Liu Min-Hui, Pan Yi-Ping, Chang Pei-Hung, Lin Yu-Ching, Chou Wen-Chi, Peng Chia-Lin, Yeh Kun-Yun
Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan.
Cancers (Basel). 2022 Jun 24;14(13):3112. doi: 10.3390/cancers14133112.
We investigated risk factors for treatment interruption (TI) in patients with locally advanced head and neck squamous-cell carcinoma (LAHNSCC) following concurrent chemoradiotherapy (CCRT), under the provision of recommended calorie and protein intake; we also evaluated the associations between clinicopathological variables, calorie and protein supply, nutrition-inflammation biomarkers (NIBs), total body composition change (TBC), and a four-serum-amino-acid metabolite panel (histidine, leucine, ornithine, and phenylalanine) among these patients. Patients with LAHNSCC who completed the entire planned CCRT course and received at least 25 kcal/kg/day and 1 g of protein/kg/day during CCRT were prospectively recruited. Clinicopathological variables, anthropometric data, blood NIBs, CCRT-related factors, TBC data, and metabolite panels before and after treatment were collected; 44 patients with LAHNSCC were enrolled. Nine patients (20.4%) experienced TIs. Patients with TIs experienced greater reductions in hemoglobin, serum levels of albumin, uric acid, histidine, and appendicular skeletal mass, and suffered from more grade 3/4 toxicities than those with no TI. Neither increased daily calorie supply (≥30 kcal/kg/day) nor feeding tube placement was correlated with TI. Multivariate analysis showed that treatment-interval changes in serum albumin and histidine levels, but not treatment toxicity, were independently associated with TI. Thus, changes in serum levels of albumin and histidine over the treatment course could cause TI in patients with LAHNSCC following CCRT.
我们在提供推荐热量和蛋白质摄入量的情况下，调查了局部晚期头颈部鳞状细胞癌（LAHNSCC）患者同步放化疗（CCRT）后治疗中断（TI）的风险因素；我们还评估了这些患者的临床病理变量、热量和蛋白质供应、营养炎症生物标志物（NIBs）、全身成分变化（TBC）以及四种血清氨基酸代谢物（组氨酸、亮氨酸、鸟氨酸和苯丙氨酸）之间的关联。前瞻性招募了完成整个计划CCRT疗程且在CCRT期间每天至少摄入25千卡/千克/天和1克蛋白质/千克/天的LAHNSCC患者。收集临床病理变量、人体测量数据、血液NIBs、CCRT相关因素、TBC数据以及治疗前后的代谢物面板；44例LAHNSCC患者入组。9例患者（20.4%）出现治疗中断。与未出现治疗中断的患者相比，出现治疗中断的患者血红蛋白、血清白蛋白、尿酸、组氨酸水平及附属骨骼质量下降幅度更大，且出现3/4级毒性反应的情况更多。每日热量供应增加（≥30千卡/千克/天）和放置饲管均与治疗中断无关。多因素分析显示，血清白蛋白和组氨酸水平的治疗间期变化而非治疗毒性与治疗中断独立相关。因此，在CCRT后的LAHNSCC患者中，治疗过程中血清白蛋白和组氨酸水平的变化可能导致治疗中断。
