Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China (Wang Q now unit:Department of Oncology,General Hospital of Hebei Province,Shijiazhuang 050000,China)
Abstract：Objective To examine the effects of different pre-treatment nutritional status and inflammatory markers on acute adverse reactions in esophageal cancer patients during concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy. Methods The acute adverse reactions of 338 eligible esophageal cancer patients who received concurrent IMRT and chemotherapy in our hospital from 2006 to 2014 were reviewed. The effects of different pre-treatment nutritional status, such as body mass index level (BMI), albumin level (ALB), total lymphocyte count (TLC), the presence or absence of anemia, and inflammatory indicators including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), on acute adverse reactions in the patients were examined. Data were analyzed using the chi-square test with continuity correction and logistic regression analysis. Results The incidence rate of malnutrition in the patients based on their nutritional status was 5.62%-54.14%. The incidence rate of grade≥2 acute radiation esophagitis (RE) was significantly higher in the low ALB group than in the normal ALB group (P=0.000). The incidence rate of adverse reactions in the hematologic system increased as TLC decreased (P=0.006), but the incidence rate of acute radiation pneumonitis (RP) was reduced as TLC decreased (P=0.001). In addition, the incidence rate of grade ≥2 acute RE was significantly higher in the anemia group than in the non-anemia group. Inflammatory marker analysis demonstrated that the incidence rate of acute RE was significantly higher in the high NLR group and high PLR group than in the low NLR group and low PLR group (P=0.000 and P=0.024, respectively). Logistic regression analysis of nutritional status and inflammatory markers showed that TLC was an independent risk factor for acute adverse reactions in the hematologic system (P=0.001), and ALB and PLR were independent risk factors for acute RE (P=0.017 and P=0.011,respectively). Conclusions Nutritional status and inflammatory markers are associated with concurrent chemoradiotherapy-induced acute adverse reactions in esophageal carcinoma patients, and hence may be valuable indicators of acute adverse reactions during treatment. In addition, nutritional treatment and support care should be actively provided to the patients to prevent the development of acute adverse reactions during treatment.
Wang Qian,Wang Jun,Wang Yi et al. Effect of nutritional status and inflammatory markers on acute adverse reactions during concurrent chemoradiotherapy for esophageal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(9): 1012-1018.
[1] Brantley SL,Russell MK,Mogensen KM,et al. American society for parenteral and enteral nutrition and academy of nutrition and dietetics:revised 2014 standards of practice and standards of professional performance for registered dietitian nutritionists (competent,proficient,and expert) in nutriti[J].Nutr Clin Pract,2014,29(6):792-828.DOI:10.1177/0884533614554264. [2] Yuan D,Zhu K,Li K,et al. The preoperative neutrophil–lymphocyte ratio predicts recurrence and survival among patients undergoing R0 resections of adenocarcinomas of the esophagogastric junction[J].J Surg Oncol,2014,110(3):333-340.DOI:10.1002/jso.23651. [3] Duan X,Zhang H,Fei F X,et al. Prognostic role of neutrophil-lymphocyte ratio in operable esophageal squamous cell carcinoma[J].World J Gastroenterol,2015,21(18):5591-5597.DOI:10.3748/wjg.v21.i18.5591. [4] 蔡军,尹杰,宋建宁,等.胃癌患者外周血中性粒细胞与淋巴细胞比值的临床意义研究[J].临床和实验医学杂志,2014(12):996-998.DOI:10.3969/j.issn.1671-4695.2014.12.016. Cai J,Yin J,Song JN,et al. Study on the clinical significance of peripheral blood of gastric cancer and neutral granulocyte and lymphocyte ratio[J].J Clin Exp Med,2014(12):996-998.DOI:10.3969/j.issn.1671-4695.2014.12.016. [5] Yoo EJ,Park JC,Kim EH,et al. Sa1919 prognostic value of neutrophil to lymphocyte ratio in patients treated with concurrent chemoradiation therapy for locally advanced esophageal cancer[J].Dig Liver Dis,2014,46(9):846-853.DOI:10.1016/j.dld.2014.05.009. [6] He W,Yin C,Guo G,et al. Initial neutrophil lymphocyte ratio is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer[J].Cancer Sci,2013,30(1):1-6.DOI:10.1007/s12032-012-0439-x. [7] 中国非手术治疗食管癌临床分期专家小组.非手术治疗食管癌的临床分期标准(草案)[J].中华放射肿瘤学杂志,2010,19(3):179-180.Chinese non surgical treatment of clinical staging of esophageal cancer expert group. Clinical non operative treatment of esophageal cancer staging criteria (Draft)[J].Chin J Radiat Oncol,2010,19(3):179-180. [8] 中国肥胖问题工作组.中国成人超重与肥胖症预防与控制指南(节录)[J].营养学报,2004,26(1):1-4.The working group China obesity. China adult overweight and obesity prevention and control guidelines (excerpt)[J].J Nutrit,2004,26(1):1-4. [9] 于康.临床营养医师速查手册[M].北京:科学技术文献出版社,2003:59.Yu K.Handbook of clinical nutrition physician Handbook[M].Beijing:Science and technology literature press,2003:59. [10] 陆在英,钟南山.内科学(7版)[M].北京:人民卫生出版社,2011:567. Lu ZY,Zhong NS.Internal medicine (7 ed)[M].Beijing:People health press,2011:567. [11] Cox JD,Stetz J,Pajak TF.Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC)[J].Int J Radiat Oncol Biol Phys,1995,31(5):1341-1346. [12] CSCO肿瘤肿瘤营养支持专家委员会.恶性肿瘤患者的营养支持专家共识[J].临床肿瘤学杂志,2012,17(1):59-73.DOI:10.3969/j.issn.1009-0460.2012.01.013.Tumor nutrition expert committee of CSCO.Malignant tumor patients with nutritional support expert consensus[J].J Clin Oncol,2012,17(1):59-73.DOI:10.3969/j.issn.1009-0460.2012.01.013. [13] 朱步东,翁洁.恶性肿瘤病人营养状况的评价[J].中国肿瘤临床与康复,2002,9(1):106-108. Zhu BD,Weng J.To evaluate the nutritional status of patients with malignant tumor[J].Chin Clin Oncol Rehabilit,2002,9(1):106-108. [14] Peng S,Fei ZC,Xin A,et al. Comparison of the prognostic values of various nutritional parameters in patients with esophageal squamous cell carcinoma from Southern China[J].J Thorac Dis,2013,5(4):484-491.DOI:10.3978/j.issn.2072-1439.2013.08.38. [15] 罗茜,曹伟新,吴蓓雯.不同营养评价方法对消化系恶性肿瘤病人营养状况评价的意义[J].外科理论与实践,2010,15(4):393-397.DOI:10.16139/j.1007-9610.2010.04.026. Luo Q,Cao WX,Wu PW.Evaluation of different methods of nutritional assessment of the nutritional status of patients with malignant tumors of digestive system significance[J].Theo Prac Surg,2010,15(4):393-397.DOI:10.16139/j.1007-9610.2010.04.026. [16] 吴国豪.恶性肿瘤病人代谢改变及防治对策[J].中国实用外科杂志,2008,2(8):1-2.DOI:1005-2208(2008)08-0608-03.Wu GH.Metabolic changes and prevention strategies of patients with malignant tumor[J].Chin J Pract Surg,2008,2(8):1-2.DOI:1005-2208(2008)08-0608-03. [17] 陈晓秋,李柱,胡阳春,等.消化道恶性肿瘤患者营养风险、营养状况与炎症因子的相关性及其对临床结局的影响[J].广东医学,2015(10):1505-1508. Chen XQ,Li Z,Hu CY,et al. Nutritional risk, nutritional status and inflammatory factors in patients with digestive tract cancer and their effects on clinical outcomes[J].Guangdong Med J,2015(10):1505-1508. [18] Saito N,et al. Low body mass index as a risk factor of moderate to severe oral mucositis in oral cancer patients with radiotherapy. Support Care Cancer.2012,20(12):3373-7.DOI:1007/s00520-012-1620-7. [19] Arrieta O,Ortega R M M,Villanuevarodríguez G,et al. Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy:a prospective study[J]. Eur J Cancer,2010,10(23):583-589.DOI:10.1186/1471-2407-10-50. [20] Henke M,Bechtold C,Momm F,et al. Blood hemoglobin levelmay affect radiosensitivity-preliminary results on acutely reacting normal tissues[J].Int J Radiat Oncol Biol Phys,2000,48(2):339-345. [21] 刘桂超,刘冬生,胡学锋,等.放疗前贫血对鼻咽癌患者调强放疗疗效及不良反应的影响[J].肿瘤,2014,34(6):531-535.DOI:10.3781/j.issn.1000-7431.2014.06.008. Liu GC,Liu DS,Hu XF,et al. Influence of intensity-modulated radiotherapy efficacy and adverse reactions of anemia in patients with nasopharyngeal carcinoma before radiotherapy[J].Tumour,2014,34(6):531-535.DOI:10.3781/j.issn.1000-7431.2014.06.008. [22] 袁平,洪荣涛,郑奎城,等.头颈部肿瘤患者营养指标与放疗急性毒性反应相关分析[J].卫生研究,2011,40(6):735-737. Yuan P,Hong RT,Zheng KC,et al. Correlation analysis in patients with head and neck cancer nutrition index and acute toxicity of radiotherapy[J].Heal Res,2011,40(6):735-737. [23] Rashid F,Waraich N,Bhatti I,et al. A pre-operative elevated neutrophil:lymphocyte ratio does not predict survival from oesophageal cancer resection[J].World J Surg Oncol,2010,8(1):1. [24] 陈恒琦,赫捷.术前外周血中性粒细胞与淋巴细胞比值在食管鳞状细胞癌预后评估中的价值[J].中华肿瘤杂志,2014,36(4):294-297.DOI:10.3760/cma.j.issn.0253-3766.2014.04.011. Chen HQ,He J.The value of preoperative peripheral blood neutrophil to lymphocyte ratio in evaluating prognosis of esophageal squamous cell carcinoma[J].Chin J Oncol,2014,36(4):294-297.DOI:10.3760/cma.j.issn.0253-3766.2014.04.011. [25] Hildebrandt AT,Ritsuko K,Zhongxing L,et al. Genetic variants in inflammation-related genes are associated with radiation-induced toxicity following treatment for non-small cell lung cancer[J/OL].PloS One,2010,5(8):e12402. [26] Shaverdian N,Veruttipong D,Wang J,et al. Pretreatment immune parameters predict for overall survival and toxicity in early-stage non–small-cell lung cancer patients treated with stereotactic body radiation therapy[J].Clin Lung Cancer,2015,17(1):39-46.
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