Department of Radiation Oncology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
Nutrition. 2024 Jan;117:112227. doi: 10.1016/j.nut.2023.112227. Epub 2023 Sep 19.
Radiation for locally advanced esophageal squamous cell carcinoma often is accompanied by radiation esophagitis, which interferes with oral intake. We aimed to develop a nomogram model to identify initially inoperable patients with relative and absolute weight loss who need prophylactic nutritional supplementation.
A total of 365 initially inoperable patients with locally advanced esophageal squamous cell carcinoma receiving radiotherapy between January 2018 and December 2022 were included in the study, which was divided into discovery and validation cohorts. Receiver operating characteristic and Kaplan-Meier curve analyses were performed to compare the areas under the curve and survival benefits.
A total of 42.2% (154 of 365) of the patients had been diagnosed with cancer cachexia. The malnourished group had a higher interruption rate of radiotherapy and number of complication diseases (P < 0.05). Meanwhile, patients with malnutrition had lower lymphocytes and prognostic nutritional index (P < 0.05). The combined index showed a higher area under the curve value (0.67; P < 0.001) than number of complication diseases (area under the curve = 0.52) and prognostic nutritional index (area under the curve = 0.49) for relative weight loss (≥ 5%). Similarly, the combined index had a higher area under the curve value (0.79; P < 0.001) than number of complication diseases (area under the curve = 0.56), treatment regimens (area under the curve = 0.56), subcutaneous fat thickness (area under the curve = 0.60), pretreatment body weight (area under the curve = 0.61), neutrophils (area under the curve = 0.56), and prognostic nutritional index (area under the curve = 0.50) for absolute weight loss (≥ 5 kg). Absolute and relative weight loss remained independent prognostic factors, with short overall survival rates compared with the normal group (P < 0.05). Patients with high nomogram scores supported by nutritional intervention had less weight loss, better nutrition scores, and increased plasma CD8+ T cells, and interferon gamma.
We developed a nomogram model that was intended to estimate relative and absolute weight loss in initially inoperable patients with locally advanced esophageal squamous cell carcinoma during radiotherapy, which might help facilitate an objective decision on prophylactic nutritional supplementation.
局部晚期食管鳞癌的放疗常伴有放射性食管炎，这会干扰口服摄入。我们旨在开发一个列线图模型，以识别出最初不能手术的、有相对和绝对体重减轻的患者，这些患者需要预防性营养补充。
本研究纳入了 2018 年 1 月至 2022 年 12 月期间接受放疗的 365 例局部晚期食管鳞癌的初始不可手术患者，将其分为发现队列和验证队列。采用受试者工作特征和 Kaplan-Meier 曲线分析比较曲线下面积和生存获益。
共有 42.2%（154/365）的患者被诊断为癌症恶病质。营养不良组的放疗中断率和并发症疾病数量较高（P < 0.05）。同时，营养不良患者的淋巴细胞和预后营养指数较低（P < 0.05）。联合指数的曲线下面积值（0.67；P < 0.001）高于并发症疾病数量（曲线下面积=0.52）和预后营养指数（曲线下面积=0.49）的相对体重减轻（≥5%）。同样，联合指数的曲线下面积值（0.79；P < 0.001）高于并发症疾病数量（曲线下面积=0.56）、治疗方案（曲线下面积=0.56）、皮下脂肪厚度（曲线下面积=0.60）、治疗前体重（曲线下面积=0.61）、中性粒细胞（曲线下面积=0.56）和预后营养指数（曲线下面积=0.50）的绝对体重减轻（≥5kg）。绝对和相对体重减轻仍然是独立的预后因素，与正常组相比，总生存率较低（P < 0.05）。接受营养干预支持的高列线图评分患者体重减轻较少，营养评分较好，血浆 CD8+T 细胞和干扰素γ增加。
我们开发了一个列线图模型，旨在估计局部晚期食管鳞癌放疗中初始不可手术患者的相对和绝对体重减轻，这可能有助于对预防性营养补充做出客观决策。
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