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Title: [Prognostic evaluation of nutritional indicators in patients with limited-stage small cell lung cancer].
Author: Zhang JQ, Wang YY, Xu KP, Qi J, Wang X, Xu LM, Liu NN, Zhao LJ, Wang P.
Journal: Zhonghua Zhong Liu Za Zhi; 2019 Dec 23; 41(12):937-942. PubMed ID: 31874552.
Abstract:
Objective: To explore the effect of nutritional status pre-and during chemoradiotherapy on the prognosis of patients with limited- stage small cell lung cancer (LS-SCLC). Methods: We retrospectively collected medical records of 172 LS-SCLC patients undergoing concurrent chemoradiotherapy in our hospital from 2000 to 2014, with 126 males and 46 females. The data of complete blood count and hepatic and renal function were collected before initial treatment, before radiotherapy, 4 weeks during radiotherapy, and 1 month after complete of treatment. The prognostic nutritional index(PNI)was calculated. Kaplan-Meier method was used to calculate the survival rate. Log-rank test was performed used to compare the survival differences between groups. Multivariate prognostic analysis was performed using Cox regression model. Results: The median overall survival (OS) was 21 months, with median progression-free survival (PFS) of 11 months. At the beginning of treatment, patients with pre-treatment PNI ≥ 53 had significantly superior OS (median 37 vs 15 months, P=0.001) and PFS (median 16 vs 10 months, P=0.017). Patients with pre-treatment hemoglobin ≥140 g/L and <140 g/L had an median OS of 32 months and 17 months (P=0.019), and median PFS of 16 months and 9 months (P=0.040), respectively. During chemoradiation, patients with elevated hemoglobin had similar median OS compared with those had decreased hemoglobin (27 vs 18 months, P=0.063, but superior median PFS (15 vs 9 months, P=0.017). Multivariate analysis revealed that prophylactic cranial irradiation, pre-treatment hemoglobin ≥140 g/L, and pretreatment PNI ≥53 were independent predictors of OS and PFS in patients with LS-SCLC. Conclusion: Pre-treatment nutritional status and the changes of nutritional status during chemoradiotherapy is significantly associated with the prognosis of patients with limited-stage small cell lung cancer. The patients with better pre-treatment nutritional status have a better prognosis. 目的： 研究局限期小细胞肺癌(LS－SCLC)患者治疗前和同步放化疗期间营养状态变化对预后的影响。 方法： 回顾性分析2008—2014年在天津肿瘤医院接受同步放化疗的172例LS－SCLC患者的临床资料，其中男性126例，女性46例；中位年龄58岁。收集患者初始治疗前、放疗前、同步放化疗期间4周及治疗后1个月的血常规及肝肾功能指标，并计算预后营养指数(PNI)。采用Kaplan－Meier法计算生存率，log rank检验比较组间生存差异，以Cox回归模型进行多因素预后分析。 结果： 全组172例LS－SCLC患者的中位生存时间为21个月，中位无进展生存时间为11个月。治疗前PNI≥53和<53患者的中位生存时间分别为37和15个月，差异有统计学意义(P＝0.001)，中位无进展生存时间分别为16和10个月，差异有统计学意义(P＝0.017)。治疗前血红蛋白≥140和<140 g/L患者的中位生存时间分别为32和17个月，差异有统计学意义(P＝0.019)；中位无进展生存时间分别为16和9个月，差异有统计学意义(P＝0.040)。同步放化疗期间血红蛋白升高与降低患者的中位生存时间分别为27和18个月，差异无统计学意义(P＝0.063)；中位无进展生存时间分别为15和9个月，差异有统计学意义(P＝0.017)。Cox多因素分析结果显示，接受预防性脑照射、治疗前血红蛋白≥140 g/L和治疗前PNI≥53为影响LS－SCLC患者总生存和无进展生存的独立因素(均P<0.05)。 结论： LS－SCLC患者治疗前和同步放化疗期间营养状态的变化与预后明显相关，治疗前营养状态较好的患者预后较好。.

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