Department of Clinical Nutrition / Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
Support Care Cancer. 2023 Oct 17;31(12):638. doi: 10.1007/s00520-023-08104-8.
Nasopharyngeal carcinoma (NPC) patients usually presented malnutrition under chemoradiotherapy (CRT)/radiotherapy (RT). Few studies stratified by age to investigate the association of nutritional status with overall survival (OS) in NPC patients. This study aimed to explore the nutritional parameters related prognosis of NPC patients in different age. The total 1365 NPC patients were classified into young (1845), middle-aged (4660), and old groups (> 60). PG-SGA scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and blood indicators (albumin, prealbumin, transferrin, C-reactive protein, hemoglobin, and total lymphocyte) were assessed. Cox regression analysis was performed to evaluate the association between risk factors of nutritional status and the overall survival in different age group of NPC patients. Kaplan-Meier (KM) survival analysis was used to estimate the effect of nutritional indexes on prognosis. The abnormal rate of albumin, prealbumin, hemoglobin, hand grip strength, and calf circumference increased with age. The malnutrition occurred in all age group and low calf circumference (HR, 4.427, 1.167-16.791) was an independent death risk in young adults. Distant metastasis (HR, 4.754, 2.737-8.260), low albumin (HR, 3.530, 1.708-7.296), hand grip strength (HR, 1.901, 1.160-3.115), and the nutritional intervention requirement (NRS-2002 ≥ 3) (HR, 2.802, 1.211-6.483) was significantly correlated with poor OS in NPC patients with middled age adults. Distant metastasis (HR, 2.546, 1.497-4.330), low albumin (HR, 1.824, 0.949-3.507), low hemoglobin (HR, 1.757, 1.015-3.044), low hand grip strength (HR, 1.771, 1.112-2.818), and low calf circumference (HR, 1.951, 1.074-3.545) were associated with increased risk of death in the elderly. KM analysis indicated that over 60 years, distant metastasis, low albumin, low hand grip strength, low calf circumference, and malnutritional risk (NRS-2002 ≥ 3) were correlated to prognosis of NPC patients. Low calf circumference could be a prognosis not only in elderly but also in young adults of NPC patients, whereas low albumin and distant metastasis were the prognostic factors in middle-aged and elderly patients. Patients aged over 60 years exhibited poorer OS compared with young and middle-aged adults.
鼻咽癌（NPC）患者在放化疗/放疗（RT）下通常会出现营养不良。很少有研究按年龄分层来探讨 NPC 患者营养状况与总生存（OS）的关系。本研究旨在探讨不同年龄 NPC 患者的营养参数与预后的关系。将 1365 名 NPC 患者分为青年组（1845 岁）、中年组（4660 岁）和老年组（>60 岁）。评估 PG-SGA 评分、NRS-2002 评分、卡氏功能状态评分、人体测量学和血液指标（白蛋白、前白蛋白、转铁蛋白、C 反应蛋白、血红蛋白和总淋巴细胞）。采用 Cox 回归分析评估不同年龄 NPC 患者营养状况风险因素与总生存的相关性。采用 Kaplan-Meier（KM）生存分析估计营养指标对预后的影响。白蛋白、前白蛋白、血红蛋白、握力和小腿围的异常率随年龄增长而增加。所有年龄组均存在营养不良，且年轻成年人中低小腿围（HR，4.427，1.167-16.791）是独立的死亡风险因素。远处转移（HR，4.754，2.737-8.260）、低白蛋白（HR，3.530，1.708-7.296）、握力（HR，1.901，1.160-3.115）和营养干预需求（NRS-2002≥3）（HR，2.802，1.211-6.483）与中老年 NPC 患者的不良 OS 显著相关。远处转移（HR，2.546，1.497-4.330）、低白蛋白（HR，1.824，0.949-3.507）、低血红蛋白（HR，1.757，1.015-3.044）、低握力（HR，1.771，1.112-2.818）和低小腿围（HR，1.951，1.074-3.545）与老年患者死亡风险增加相关。KM 分析表明，60 岁以上、远处转移、低白蛋白、低握力、低小腿围和营养不良风险（NRS-2002≥3）与 NPC 患者的预后相关。低小腿围不仅与老年 NPC 患者有关，而且与年轻成年人有关，而低白蛋白和远处转移是中年和老年患者的预后因素。60 岁以上患者的 OS 明显差于年轻和中年患者。
