营养、炎症状态和睡眠质量对癌症幸存者死亡率的综合影响。

Combined effects of nutrition, inflammatory status, and sleep quality on mortality in cancer survivors.

机构信息

Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.

Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, 393, Xinyi Road, Xinshi District, Urumqi, 830000, China.

出版信息

BMC Cancer. 2024 Nov 27;24(1):1456. doi: 10.1186/s12885-024-13181-x.

DOI:10.1186/s12885-024-13181-x

PMID:39592977

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11600600/

Abstract

BACKGROUND

Cancer survivors face many challenges in long-term health management, including malnutrition, systemic inflammation, and sleep issues, which significantly affect their survival and quality of life.

METHODS

A prospective cohort study was derived from the National Health and Nutrition Examination Survey from 2005-2018 harboring 1,908 cancer survivors (weighted population, 11,453,293), of whom 688 deaths (220 from cancer mortality, 468 from non-cancer mortality). The Advanced Lung Cancer Inflammation Index (ALI) was used as a measure of nutritional status and systemic inflammation in cancer patients. Weighted multivariable Cox proportional hazards regression models were utilized to explore the independent and combined effects of ALI and sleep quality on mortality outcomes.

RESULTS

The participants with a high ALI were more likely to be female, aged 40 to 64 years, non-Hispanic white, and have a higher BMI. We observed that elevated ALI levels were associated with decreased risks of all-cause mortality (Hazard ratio [HR] = 0.601, 95% Confidence interval [CI] = 0.521-0.695, P < 0.001), cancer-specific mortality (HR = 0.659, 95% CI = 0.497-0.870, P = 3.34 × 10) and non-cancer-specific mortality (HR = 0.579, 95% CI = 0.478-0.701, P < 0.001). Similarly, better sleep quality (e.g., without sleep troubles) was associated with lower risks of all-cause mortality (HR = 0.761, 95% CI = 0.620-0.933, P = 8.79 × 10) and non-cancer-specific mortality (HR = 0.713, 95% CI = 0.572-0.890, P = 2.80 × 10). Notably, the joint analysis showed that cancer survivors with higher ALI levels and better sleep quality (e.g., standard sleep duration) had the lowest risks of all-cause (HR = 0.468, 95% CI = 0.352-0.622, P < 0.001), cancer-specific mortality (HR = 0.631, 95% CI = 0.333-0.672, P = 7.59 × 10) and non-cancer-specific mortality (HR = 0.440, 95% CI = 0.315-0.615, P < 0.001).

CONCLUSIONS

This study suggests that better nutritional and inflammatory status, combined with good sleep quality, may contribute to improved survival among cancer survivors. These results underscore the potential clinical importance of integrating nutritional and sleep quality assessments into the long-term care of cancer survivors to enhance their overall prognosis.

摘要

背景

癌症幸存者在长期健康管理方面面临诸多挑战，包括营养不良、全身炎症和睡眠问题，这些问题显著影响他们的生存和生活质量。

方法

本前瞻性队列研究源自 2005 年至 2018 年的全国健康和营养检查调查，纳入 1908 名癌症幸存者（加权人口 11453293 人），其中 688 人死亡（220 人死于癌症死亡率，468 人死于非癌症死亡率）。高级肺癌炎症指数（ALI）被用作癌症患者营养状况和全身炎症的衡量标准。利用加权多变量 Cox 比例风险回归模型探讨 ALI 和睡眠质量对死亡率结局的独立和联合影响。

结果

高 ALI 组更可能为女性、年龄在 40 至 64 岁、非西班牙裔白人，且 BMI 更高。我们发现，升高的 ALI 水平与全因死亡率降低相关（风险比 [HR] = 0.601，95%置信区间 [CI] = 0.521-0.695，P<0.001）、癌症特异性死亡率（HR = 0.659，95% CI = 0.497-0.870，P=3.34×10）和非癌症特异性死亡率（HR = 0.579，95% CI = 0.478-0.701，P<0.001）。同样，更好的睡眠质量（例如无睡眠问题）与全因死亡率（HR = 0.761，95% CI = 0.620-0.933，P=8.79×10）和非癌症特异性死亡率（HR = 0.713，95% CI = 0.572-0.890，P=2.80×10）降低相关。值得注意的是，联合分析显示，ALl 水平较高且睡眠质量较好（例如标准睡眠时间）的癌症幸存者全因死亡率（HR = 0.468，95% CI = 0.352-0.622，P<0.001）、癌症特异性死亡率（HR = 0.631，95% CI = 0.333-0.672，P=7.59×10）和非癌症特异性死亡率（HR = 0.440，95% CI = 0.315-0.615，P<0.001）最低。