Rickard K A, Detamore C M, Coates T D, Grosfeld J L, Weetman R M, White N M, Provisor A J, Boxer L A, Loghmani E S, Oei T O, Yu P L, Baehner R L
Cancer. 1983 Aug 15;52(4):587-98. doi: 10.1002/1097-0142(19830815)52:4<587::aid-cncr2820520402>3.0.co;2-t.
The effect of the state of nutrition of 18 children with Stage IV neuroblastoma at diagnosis and during initial therapy, was evaluated with respect to treatment delays, drug dosage alterations, tumor response, days to first event (relapse or death), and survival. All patients received similar therapy (CCSG protocol CCG 371). Based on nutrition staging at diagnosis, nine were classified as malnourished; four were randomized to receive total parenteral nutrition (TPN) and four peripheral parenteral nutrition plus enteral nutrition for 28 days (through 2 chemotherapy courses), and one died before randomization. Nine were nourished at diagnosis; seven received a comprehensive enteral nutrition program and two received TPN. By life-table analysis, the duration of remission was significantly greater in the nourished than the malnourished (P less than 0.01) and a trend towards improved survival was evident at one year (P = 0.08). The median length of survival for children nourished at diagnosis was approximately 12 months, whereas those malnourished had a median survival of only 5 months. Nine children remained nourished or were becoming renourished during the first 21 days of therapy, and one of these had treatment delays and decreased drug dosages. Seven were becoming malnourished or remained malnourished during this period and six had treatment delays (P less than 0.01). These data support the idea that nutrition staging at diagnosis and during initial treatment should be an integral part of protocol design and initial evaluation of children with Stage IV neuroblastoma.
对18例诊断时及初始治疗期间处于IV期神经母细胞瘤患儿的营养状况，就治疗延迟、药物剂量改变、肿瘤反应、首次事件发生天数（复发或死亡）及生存情况进行了评估。所有患者均接受了相似的治疗（儿童癌症研究组方案CCG 371）。根据诊断时的营养分期，9例被归类为营养不良；4例被随机分配接受全胃肠外营养（TPN），4例接受外周胃肠外营养加肠内营养28天（贯穿2个化疗疗程），1例在随机分组前死亡。9例诊断时营养状况良好；7例接受了综合肠内营养方案，2例接受了TPN。通过寿命表分析，营养状况良好患儿的缓解期明显长于营养不良患儿（P<0.01），且在1年时生存改善趋势明显（P = 0.08）。诊断时营养状况良好患儿的中位生存时长约为12个月，而营养不良患儿的中位生存期仅为5个月。9例患儿在治疗的前21天内保持营养良好或营养状况正在改善，其中1例出现治疗延迟且药物剂量降低。7例在此期间营养状况正在变差或仍处于营养不良状态，6例出现治疗延迟（P<0.01）。这些数据支持这样的观点，即诊断时及初始治疗期间的营养分期应成为IV期神经母细胞瘤患儿方案设计及初始评估的一个组成部分。
