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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (2): 261-268. doi: 10.19723/j.issn.1671-167X.2020.02.011

• 论著 • 上一篇    下一篇

肠内营养支持治疗减轻晚期食管癌患者化疗不良反应

孙志伟,贾军,杨颖,刘传玲,肖艳洁,余靖,张晓东   

  1. 北京大学肿瘤医院暨北京市肿瘤防治研究所消化系统肿瘤VIP-Ⅱ病区,恶性肿瘤发病机制及转化研究教育部重点实验室, 北京 100142
  • 收稿日期:2019-11-19 出版日期:2020-04-18 发布日期:2020-04-18
  • 通讯作者: 张晓东

Enteral nutrition support reduces toxicity of chemotherapy in patients with advanced or metastatic esophageal cancer

Zhi-wei SUN,Jun JIA,Ying YANG,Chuan-ling LIU,Yan-jie XIAO,Jing YU,Xiao-dong ZHANG   

  1. VIP-Ⅱ Gastrointestinal Cancer Division of the Department of Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China
  • Received:2019-11-19 Online:2020-04-18 Published:2020-04-18
  • Contact: Xiao-dong ZHANG

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摘要：

目的 评估肠内营养支持治疗对晚期食管癌患者一线化疗疗效及不良反应的影响.方法: 回顾性收集2014年7月至2016年12月于北京大学肿瘤医院接受一线化疗的118例不可手术切除的局部进展期或转移性食管癌患者资料,将患者分为两组,营养支持组(化疗同时予肠内营养支持)和对照组(单纯化疗).比较两组患者化疗前后各营养指标[KPS功能状态评分(Karnofsky performance status),体质量,体重指数(body mass index,BMI),血红蛋白,淋巴细胞数,总蛋白,白蛋白,甘油三酯,总胆固醇]的变化及化疗疗效,化疗不良反应的差异.结果: (1)对照组化疗后,患者体质量,BMI和血红蛋白水平均明显下降(P<0.001);营养支持组患者化疗后,患者体质量和BMI并无明显变化,仅血红蛋白有明显下降;两组患者化疗前后其他营养指标差异均无统计学意义.(2)与对照组相比,营养支持组化疗后3级以上血液学毒性发生率显著降低(15.4% vs. 42.1%,P=0.004),3级以上非血液学毒性发生率也有所降低但两组差异无统计学意义(0 vs. 9.2%,P=0.123).Logistic回归多因素分析显示,营养治疗是食管癌患者化疗后发生3级以上血液学毒性的独立影响因素(P=0.008,RR=6.048,95%CI:1.589~23.027).(3)两组患者化疗疗效差异无统计学意义.结论: 晚期食管癌患者在化疗同时予肠内营养支持治疗可改善患者营养状态,减轻化疗毒性和不良反应.

关键词: 食管肿瘤, 化疗, 肠内营养支持

Abstract:

Objective: To assess the impact of enteral nutrition support on response and toxicity of the first-line chemotherapy in those patients with advanced or metastatic esophageal cancer.Methods: We collected the clinical data of 118 patients with unresectable advanced or metastatic esophageal cancer who received the first-line chemotherapy in our center from July 2014 to December 2016. All these 118 eso-phageal cancer patients were then divided into two groups: the nutrition group (received enteral nutrition support in addition to chemotherapy) and the control group (received chemotherapy only). Differences were analyzed before and after chemotherapy in each of the nutritional indicators including Karnofsky performance status (KPS), weight, body mass index (BMI), hemoglobin (Hb), number of lymphocytes (Lymph), total protein (TP), albumin (Alb), triglycerides (TG), total cholesterol (TC) in both groups. And differences of the efficacy and toxicities of the first-line chemotherapy between the two groups were also analyzed.Results: (1) Weight, BMI and Hb were all significantly decreased after chemotherapy in the control group (P<0.001), while there was no significant change of weight and BMI in the nutrition group, just with Hb decrease only. However, there was no significant change of all the other nutrition indicators after chemotherapy in both groups. (2) Compared with the control group, the nutrition group had significantly lower incidence of grade 3 to 4 hematologic toxicities after chemotherapy (15.4% vs. 42.1%, P=0.004). In addition, the incidence of grade 3 to 4 nonhematologic toxicities after chemotherapy was also lower in the nutrition group but without statistical significance (0 vs. 9.2%, P=0.123). Logistic regression model was then used for multivariate analysis to identify the factors that affected the toxicity of chemotherapy in these patients, and the results showed that nutrition therapy was an independent influencing factor of grade 3 or higher hematological toxicity after chemotherapy in the patients with esophageal cancer (P=0.008, RR=6.048, 95%CI: 1.589-23.027). (3) The response rate of chemotherapy between the control group and the nutrition group had not significant difference.Conclusion: Enteral nutrition support in addition to chemotherapy could improve nutrition status and reduce toxicity of chemotherapy in advanced or metastatic esophageal cancer patients.

Key words: Esophageal neoplasms, Chemotherapy, Enteral nutrition support

中图分类号: 

  • R735.1

表1

患者一般资料"

Items Control group, n (%) Nutrition group, n (%) P value
Gender 0.084
Male 60 (76.9) 36 (90.0)
Female 18 (23.1) 4 (10.0)
Age/years 0.824
≤70 73 (93.6) 37 (92.5)
>70 5 (6.4) 3 (7.5)
KPS 0.438
≥90 73 (93.6) 35 (87.5)
80-70 5 (6.4) 5 (12.5)
Grade 0.888
Well 51 (65.4) 24 (60.0)
Poorly 24 (30.8) 12 (30.0)
Not known 3 (3.8) 4 (10.0)
Stage 0.147
Locally advanced 57 (73.1) 24 (60.0)
Recurrent/metastatic 21 (26.9) 16 (40.0)

表2

化疗前营养指标"

Items Control group, $\bar{x}±s$ Nutrition group, $\bar{x}±s$ P value
KPS 89.49±2.74 88.75±3.35 0.234
BMI/(kg/m2) 22.65±3.81 20.64±2.73 0.004
Hb/(g/L) 141.65±14.26 130.31±25.86 0.003
Lymph/(×109/L) 1.82±0.68 1.63±0.47 0.104
TP/(g/L) 70.24±4.47 69.57±6.77 0.577
Alb/(g/L) 43.11±3.13 41.47±7.64 0.200
TG/(mmol/L) 1.12±0.50 1.17±0.88 0.693
TC/(mmol/L) 4.93±1.10 4.74±1.04 0.394

表3

全部食管癌患者化疗前后营养指标变化（$\bar{x}±s$）"

表4

局部进展期食管癌患者化疗前后营养指标变化（$\bar{x}±s$）"

表5

复发/转移性食管癌患者化疗前后营养指标变化($\bar{x}$ ±s)"

Items KPS Weight/kg BMI/(kg/m2) Hb/(g/L)
Nutrition group
B 88.75±3.42 58.70±8.95 21.01±2.36 135.12±11.93
A 89.38±2.50 57.49±9.64 20.56±2.58 123.81±9.37
Δ(B-A) -0.63±2.50 1.21±2.77 0.45±1.05 11.31±14.46
P 0.333 0.112 0.119 0.007
Control group
B 89.05±3.01 64.11±10.37 22.82±2.52 139.84±15.67
A 88.10±4.02 62.60±10.54 22.29±2.74 124.11±14.89
Δ(B-A) 0.95±3.01 1.51±1.89 0.53±0.70 15.74±11.74
P 0.160 0.003 0.004 <0.001
Items Lymph/(×109/L) TP/(g/L) Alb/(g/L) TG/(mmol/L) TC/(mmol/L)
Nutrition group
B 1.69±0.50 71.30±5.63 42.65±3.38 1.04±0.35 4.79±1.11
A 1.55±0.51 72.46±3.88 42.49±4.12 1.23±0.71 4.73±1.67
Δ(B-A) 0.14±0.35 -1.16±5.53 0.16±5.37 -0.19±0.63 0.07±1.70
P 0.134 0.417 0.909 0.237 0.874
Control group
B 1.63±0.65 71.18±4.15 43.33±2.59 1.05±0.39 4.82±1.24
A 1.55±0.61 69.89±3.07 42.56±3.10 1.21±0.47 4.62±1.10
Δ(B-A) 0.08±0.56 1.29±4.20 0.78±2.66 -0.17±0.39 0.20±0.61
P 0.539 0.208 0.231 0.093 0.191

表6

食管癌患者化疗疗效与肠内营养相关性"

Stage Efficacy Control group Nutrition group P value
All Response rate 43.7% 41.7% 0.844
Disease control rate 95.8% 100.0% 0.528
Locally advanced Response rate 41.5% 27.3% 0.246
Disease control rate 96.2% 100.0% 1.000
Recurrent/metastatic Response rate 50.0% 64.3% 0.490
Disease control rate 94.4% 100.0% 1.000

表7

食管癌患者化疗不良反应与肠内营养的相关性"

Stage Efficacy Control group Nutrition group P value
All Response rate 43.7% 41.7% 0.844
Disease control rate 95.8% 100.0% 0.528
Locally advanced Response rate 41.5% 27.3% 0.246
Disease control rate 96.2% 100.0% 1.000
Recurrent/metastatic Response rate 50.0% 64.3% 0.490
Disease control rate 94.4% 100.0% 1.000

表8

食管癌患者化疗不良反应相关因子的Logistic回归多因素分析"

Variables Wald OR 95%CI P
Gender 0.227 0.705 0.167-2.976 0.634
Age 0.335 0.558 0.077-4.026 0.563
KPS 1.862 5.174 0.488-54.851 0.172
Grade 0.238 0.755 0.244-2.335 0.626
Stage 0.066 1.163 0.368-3.678 0.797
BMI 0.910 1.074 0.927-1.245 0.340
Hb 2.435 0.966 0.924-1.009 0.119
Lymph 0.175 1.192 0.524-2.712 0.675
TP 0.735 1.064 0.923-1.227 0.391
Alb 1.551 1.150 0.923-1.434 0.213
TG 0.846 0.589 0.191-1.820 0.358
TC 0.046 1.063 0.607-1.863 0.831
Nutrition support 6.962 6.048 1.589-23.027 0.008
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