三种营养不良诊断标准在头颈部恶性肿瘤放疗病人中的应用研究

目的:采用不同营养不良评定标准,描述并比较头颈部恶性肿瘤病人在放疗期间营养不良的变化情况。方法:在北京大学肿瘤医院放疗科选取拟接受放疗的头颈部恶性肿瘤病人,分别在放疗前、放疗中期和放疗结束时随访。采用营养不良评定标准全球领导人共识(GLIM)标准、欧洲肠外肠内营养学会2015年营养不良专家共识(ESPEN 2015)和病人参与主观全面评定(PG-SGA)进行营养评定,其中,营养筛查采用营养风险筛查2002,肌肉量评价采用生物电阻抗分析法测得的四肢骨骼肌指数和去脂体质指数。结果:共纳入502名头颈部恶性肿瘤病人。随着放疗进行,营养风险的比例显著增加;三种标准诊断的营养不良比例均显著增加;且三种标准得到的结果一致性均较差(0.303≤Kappa≤0.681)。结论:头颈部恶性肿瘤病人在放疗期间的营养风险和营养不良比例均显著增加,不同营养不良诊断标准得出的结果差异明显。建议结合临床结局指标进行评价研究,使其更具临床意义。     

头颈癌核心基因筛选及其预后分析

目的 利用生物信息学方法,筛选与头颈癌发生发展相关的差异表达基因,并进行相关的预后分析,寻找头颈癌新的诊断标志物以及治疗靶点。方法 在GEO数据库中下载头颈癌相关数据集GSE83519,利用GEO2R分析其差异表达基因,并对其进行功能注释及通路富集分析。通过STRING网站与Cytohubba软件筛选核心基因。利用UALCAN在线网站筛选预后相关基因,并使用cBioPortal在线工具对预后相关基因在头颈癌中的基因突变进行分析。 结果 GEO2R分析结果显示,GSE83519筛选出371个差异表达基因,其中含240个上调基因和131个下调基因。功能富集分析结果表明,差异表达基因主要与对氧含量的反应,凋亡信号通路的负调控等有关。 通路富集分析表明差异表达基因主要涉及癌症通路,细胞凋亡通路等。Cytohubba软件筛选出25个核心基因,这些基因参与了结直肠癌,乳腺癌,食管癌等多个癌症的发生发展,其中CASP8、CXCL12、MMP9等基因已被证实与头颈癌发生风险相关。通过UALCAN网站发现四个核心基因IL6、CD28、HDAC1、ESR1与头颈癌的预后相关。cBioPortal分析结果显示,四个预后相关基因在头颈癌的发生发展中均存在基因突变。结论 本研究筛选出了四个与头颈癌预后相关的基因,这些基因在头颈癌中存在基因突变的现象,有望成为临床诊断及治疗的新靶点。     

Zinc deficiency in head and neck cancer patients.

Although a great deal of attention has been given to protein and calorie malnutrition in patients with head and neck cancer, zinc status has not been assessed properly in such patients in the past.

In this study we characterized zinc status by cellular zinc criteria and assessed several measures of protein and calorie malnutrition in patients with head and neck cancer. We determined prognostic nutritional index (PNI) based on serum albumin, serum transferrin, triceps skin fold measures, and delayed hypersensitivity, as proposed by Buzby et al. In this study, the baseline zinc status and PNI of 60 head and neck cancer patients were correlated with the tumor size and overall stage of the disease.

Our results showed that the tumor size and overall stage correlated significantly to zinc status whereas no correlation was seen with PNI, alcohol intake, or smoking in our study subjects.

We conclude that zinc status is a better indicator of tumor burden and stage of the disease in head and neck cancer patients than the patients' overall nutritional status.     

Postsurgery enteral nutrition in head and neck cancer patients

OBJECTIVE: Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using an arginine-enriched diet, could improve nutritional variables as well as clinical outcomes. DESIGN: Randomized clinical trial. SETTING: Tertiary care. SUBJECTS: A population of 47 patients with oral and laryngeal cancer were enrolled. INTERVENTIONS: At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplemented with arginine and fiber (group I); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II). RESULTS: No significant intergroup differences in the trend of the three plasma proteins and lymphocytes were detected. Gastrointestinal tolerance (diarrhea) of both formulas was good (17.4% group I and 8.3% group II; NS). During the 3 months after hospital discharge five patients died; no differences were detected between groups (13% group I and 8.3% group II; NS). The incidences postoperative infection complications were similar (nine patients) in both groups (21.7% group I and 16.7% group II; NS). Fistula were less frequent in enriched nutrition group (0% group I and 20.8% group II; P<0.05); wound infection was more frequent in group II, but without statistical difference (4.3% group I and 12.5% group II; NS). The length of postoperative stay was 22.8+/-11.8 days in the enriched group and 31.2+/-19.1 days in the control group (P=0.07). CONCLUSIONS: In conclusion, enriched formula improves local wound complications in postoperative head and neck cancer patients. Our results suggest that these patients could benefit from an immunonutrient-enhanced enteral formula.     

Postoperative enteral immunonutrition in head and neck cancer patients

AIMS: to determine if postoperative feeding of head and neck cancer patients, using an enteral diet supplemented with arginine, improves immunological and nutritional status, and clinical outcome, i.e., reduces postoperative infectious/wound complications and length of stay, when compared with an isocaloric, isonitrogenous control diet. METHODS: at operation 44 patients were randomized into two groups to receive: a) an enriched diet (n=23);b) an isocaloric, isonitrogenous control diet (n=21). Thirteen patients with a history of significant weight loss (> or = 10% over the last 6 months) were considered malnourished. Preoperatively and on postoperative days 1, 4 and 8 the following parameters were evaluated: albumin, prealbumin, transferrin, total number of lymphocytes, lymphocyte subsets (CD3, CD4, CD8 and CD4/CD8 ratio) and immunoglobulins. Postoperative complications and length of stay were recorded. RESULTS: 'visceral' serum proteins and immunological parameters decreased on postoperative day 1 in both groups. However, only the enriched group demonstrated a significant increase (P<0.05) in the total number of lymphocytes, CD4, CD4/CD8 on postoperative day 4, and total number of lymphocytes, CD3, CD4, CD4/CD8 on postoperative day 8. In the malnourished subgroup the administration of the enriched formula significantly reduced both postoperative infectious/wound complications and length of stay compared with the control group (P<0.05). CONCLUSIONS: enteral immunonutrition of head and neck cancer patients improves postoperative immunological response. Significant clinical advantages were observed in malnourished patients.     

Enteral nutrition support of head and neck cancer patients.

Patients with head and neck cancer are at high risk for malnutrition due to dysphagia from the tumor and treatment. Despite difficulty with oral intake, these patients usually have a normal stomach and lower gastrointestinal tract. Enteral nutrition support via percutaneous endoscopic gastrostomy (PEG) administered in the home by the patient helps to prevent weight loss, dehydration, nutrient deficiencies, treatment interruptions, and hospitalizations. It also improves quality of life. Successful management of these patients requires orderly care and follow-up by a multidisciplinary nutrition team.     

The value of PET-CT imaging in malignant tumours of the head and neck

Imaging with fluor-18-deoxyglucose(FDG)-positron-emission tomography (PET) and CT combined in a single machine is a recent development. Using this technique both molecular and anatomical information are acquired. This results in an increased sensitivity and specificity in comparison to PET and CT as a single modality. One of the main advantages is that interpretation of PET images can be related to the anatomical information which helps to delineate the size and extent of a tumour as well as its relationship with surrounding tissues. It is also useful in planning surgical treatment and irradiation. At restaging PET-CT delineates the site and extent of a recurrence in the complex anatomy of the head and neck region and helps to define the location of a biopsy. This is particularly valuable in the anatomically complex head and neck region. Whole-body imaging can detect distant metastases and second primary tumours. PET-CT has the potential to become a part of the staging procedure of the primary tumour and also the follow-up in patients who have been treated for head and neck cancer.     

头颈部腺样囊性癌58例临床病理及预后分析

目的 研究头颈部腺样囊性癌的临床病理及预后因素.方法 回顾性收集1999年1月至2007年12月治疗的头颈部腺样囊性癌患者58例,通过对其临床病理资料的收集和预后随访,分析影响腺样囊性癌预后的因素.结果 单因素分析发现,组织病理类型、嗜神经侵袭、血管侵袭、肿瘤复发、肿瘤远处转移以及TNM分期与腺样囊性癌的预后有关(P＜0.05).多因素分析显示TNM分期、组织病理类型筛孔型以及嗜神经侵袭是腺样囊性癌的独立预后因子(P＜0.05).结论 组织病理类型、TNM分期、嗜神经侵袭、血管侵袭、肿瘤复发以及肿瘤远处转移是腺样囊性癌重要的预后因子.

Abstract：

Objective To approach the prognostic factors of head and neck adenoid cystic carcinoma.Methods Fifty-eight head and neck adenoid cystic carcinomas were treated from January 1999 to December 2007.The demographic and clinicopathological data were obtained from a retrospective chart review.The follow-up and survival analysis were carried out to analyze the significant prognostic factors.Results Using the univariate analysis,the variables,such as histologic type,perineural invasion,vascular invasion,recurrence,metastasis and TNM stage were found significantly associated with a worse prognosis (P ＜ 0.05 ).Multivariate analysis showed that histologic type,perineural invasion and TNM stage had an independent prognostic effect on survival (P ＜ 0.05 ).Conclusion The variables including histologic type,TNM stage,perineural and vascular invasion,recurrence and metastasis are important prognostic factors for head and neck adenoid cystic carcinoma.     

Neocortex development during severe malnutrition in the rat.

Histological methods (Golgi-Cox and Nissl) were used to study the maturation of the large pyramidal cells of layer V of the occipital cortex in malnourished rats (according to the method of Araya et al.). The main alterations were observed in pyramidal cells of cortical alyer V; These showed a decrease of the number and span of dendritic basilar processes. An increase in cell density was also observed in this layer. We assume that malnutrition during this period of development provokes a derangement which disturbs the process of neuron differentiation, with effects that probably are permanent.     

Gastrostomy tube placement in head and neck cancer patients undergoing radiotherapy

Background: In head and neck cancer (HNC) patients, the side effects of radiotherapy (RT) often lead to patients being unable to consume adequate nutrition and fluid (Chencharick and Mossman, 1983). Gastrostomy tube placement prior to RT can reduce incidence of severe weight loss and hospitalization during treatment (Beaver et al., 2001). However, gastrostomy tube usage is dependant upon HNC site and area of RT. The aims of the study were to identify the characteristics of those HNC patients who will require gastrostomy tube feeding during RT and utilize these data to target future patients for prophylactic tube placement prior to commencing RT and to write guidelines for the placement of feeding tubes. Method: Data were collected retrospectively regarding diagnosis, surgery and area of RT on all HNC patients who had had a prophylactic gastrostomy placed prior to RT between April 2000 and April 2002. Outcome measurements in terms of utilization of gastrostomy, body weight and nutrition related emergency admissions were recorded. Results: Thirty‐five patients had a prophylactic gastrostomy placed [26 male, nine female; mean age 62 (range 26–84) years]. Of these, 26 utilized their tube for feeding or fluids during RT. The sites of radiotherapy were: bilateral RT to the oro‐ or nasopharynx and neck (20 patients), bilateral RT to the neck (five) and RT to the left oropharynx and neck (one). The mean weight loss during RT in patients who utilized their prophylactic gastrostomy was 3.3 (range 0–11.5%) compared to 8 (5.5–12.0%) in patients who did not have a prophylactic gastrostomy. Only one of the patients with a prophylactic gastrostomy had a hospital admission (length of stay 11 days) compared to four patients who did not [mean length of stay 21 days (range 14–29)]. Six of the nine patients who did not utilize their gastrostomy for feeding and were able to maintain their nutrition orally, received bilateral RT to the neck only. Discussion: Most of the patients who received bilateral RT to the oro‐ or nasopharynx required gastrostomy feeding during RT, which is consistent with findings of Beaver et al. (2001) who reported the highest incidence of weight loss in patients receiving RT to the nasopharynx or base of the tongue. Conclusion: In view of the association between the site of RT and gastrostomy utilization, hospital admissions, length of stay and weight loss, HNC patients with planned bilateral RT to the oro‐ or nasopharynx or with existing dysphagia should be targeted for gastrostomy tube placement prior to starting treatment. References: Beaver, M.E., Matheny, K.E., Roberts, D.B. & Myers, J.N.(2001) Predictors of weight loss during radiation therapy. Otolaryngol. Head Neck Surg. 125 , 645–648. Chencharick, J.D. & Mossman, K.L. (1983) Nutritionalconsequences of the radiotherapy of head and neck cancer. Cancer 51 , 811–815.     

血清HMGB1、IGF-1、ficolin-3在重症颅脑损伤患者中的表达及预后价值

目的探究高迁移率族蛋白1(HMGB1)、胰岛素样生长因子-1(IGF-1)、纤维胶凝蛋白3(ficolin-3)在重症颅脑损伤患者中的表达及预测预后价值。方法选取本院2017年6月至2019年6月重症颅脑损伤患者62例作为观察组,另选取同期轻中度颅脑损伤患者65例作为对照组。统计对比两组血清HMGB1、IGF-1、ficolin-3水平,并随访28 d,比较不同Rankin量表(MRS)及格拉斯哥预后(GOS)评分患者各血清水平,Spearman等级相关分析各血清与MRS、GOS评分相关性,受试者工作特征(ROC)曲线分析预后预测价值,Kaplan-Meier(KM)曲线分析生存状况。结果观察组血清HMGB1水平高于对照组,IGF-1、ficolin-3水平低于对照组(P<0.05);入院第3、5 d神经功能恢复良好者血清HMGB1水平低于神经功能恢复不良者,IGF-1、ficolin-3水平高于神经功能恢复不良者(P<0.05);入院第3、5 d预后良好者血清HMGB1水平低于预后不良者,IGF-1、ficolin-3水平高于预后不良者(P<0.05);血清HMGB1与MRS评分呈正相关,与GOS评分呈负相关,血清IGF-1、ficolin-3与MRS评分呈负相关,与GOS评分呈正相关(P<0.05);ROC曲线分析显示,血清HMGB1、IGF-1、ficolin-3水平入院后第5 d AUC大于入院第3 d;经KM曲线分析显示,血清HMGB1、IGF-1、ficolin-3高危组、低危组生存曲线存在差异,有统计学意义(P<0.05)。结论血清HMGB1、IGF-1、ficolin-3水平在重症颅脑损伤中呈异常表达状态,与神经功能损伤密切相关,动态监测上述血清水平,可为临床评估脑损伤程度、预测预后提供科学指导。     

Associations between dietary patterns and head and neck cancer: the Carolina head and neck cancer epidemiology study

Few studies have examined the associations between dietary patterns and head and neck squamous cell carcinoma (SCC) or whether they differ by race. This was evaluated using data from a population-based case-control study (2002-2006) including 1,176 cases of head and neck SCC and 1,317 age-, race-, and gender-matched controls from central and eastern North Carolina whose diets had been assessed by food frequency questionnaire. Factor analysis identified 2 patterns of intake: 1) high consumption of fruits, vegetables, and lean protein and 2) high consumption of fried foods, high-fat and processed meats, and sweets. Associations were estimated using logistic regression, adjusting for matching factors and confounders. Heterogeneity by tumor site (oral/pharyngeal vs. laryngeal) and effect-measure modification were also evaluated. Reduced odds of head and neck SCC were found for the fruit, vegetable, and lean protein pattern (for highest quartile vs. lowest, odds ratio = 0.53, 95% confidence interval: 0.39, 0.71). The fried foods, high-fat and processed meats, and sweets pattern was positively associated only with laryngeal cancer (odds ratio = 2.12, 95% confidence interval: 1.21, 3.72). These findings underline the importance of a dietary pattern rich in fruits and vegetables and low in high-fat and processed meats and sweets for prevention of head and neck cancer.     

Neighborhood deprivation and clinical outcomes among head and neck cancer patients

The unique effects of neighborhood-level economic deprivation on survival, recurrence, and second primary malignancy development were examined using adjusted Cox proportional hazards regression models among 1151 incident squamous cell carcinomas of the head and neck patients. Cancer site was examined as a potential moderator. Main analyses yielded null results; however, interaction analyses indicated poorer overall survival [HR=1.59 (1.00-2.53)] and greater second primary malignancy development [HR=2.99 (1.46-6.11)] among oropharyngeal cancer patients from highly deprived neighborhoods relative to less deprived neighborhoods. Results suggest a dual focus on individual and neighborhood risk factors could help improve clinical outcomes among oropharyngeal cancer patients.