营养干预对食管癌同步放化疗期间骨骼肌的影响

目的 评估营养干预对食管癌同步放化疗(CCRT)患者的营养支持作用,调查CCRT后骨骼肌损失的发生率和危险因素。方法 回顾性分析2017年4月至2019年11月在山东大学齐鲁医院放疗科行CCRT的食管癌患者的临床资料,分析CCRT前后CT图像,统计患者骨骼肌损失的发生情况、营养指标变化和放化疗延迟情况,并对可能影响骨骼肌指数(SMI)下降的危险因素进行分析。结果 营养干预组内,口服营养补充(ONS)组、肠外营养(PN)组和ONS+PN组平均每人每日能量摄入分别为(273.5±252.8)、(310.6±311.2)和(745.3±637.8)kcal(1 kcal=4.1868 kJ),差异有统计学意义(F=5.870,P=0.005)。CCRT后,营养干预组有40例(40.3%)出现肌肉减少症,明显低于对照组的42例(45.2%)(χ²=4.247,P=0.038);营养干预组SMI丢失值为(1.4±8.3)cm²/m²,明显低于对照组的(5.4±9.1)cm²/m²(t=2.187,P=0.031);营养干预组分别有18、10例出现放、化疗延迟,均明显低于对照组的25(χ²=4.501,P=0.039)、19例(χ²=8.929,P=0.005);营养干预组放、化疗延迟时间分别为(2.3±4.4)、(0.9±1.3)d、均明显短于对照组的(4.2±5.3)(t=0.691,P=0.047)、(2.2±3.2)d(t=0.847,P=0.041)。CCRT前肌肉减少症的患病率为75.2%,明显低于CCRT后的88.2%(χ²=5.183,P=0.023)。多元线性回归分析显示,基线时T分期(P=0.007)、N分期(P<0.001)和营养干预(P=0.014)对食管癌放化疗后患者SMI下降有显著影响。结论 营养干预能够降低食管癌CCRT过程中放化疗延迟的发生率,减少SMI丢失,SMI下降主要和基线时T分期、N分期和营养干预相关。

Effect of Nutrition Intervention on Skeletal Muscle during Concurrent Chemoradiotherapy for Esophageal Cancer

Objective To evaluate the role of nutritional intervention during concurrent chemoradiotherapy (CCRT) for esophageal cancer and investigate the incidence and risk factors of skeletal muscle loss after CCRT.Methods The clinical data of patients with esophageal cancer who underwent CCRT in our center from April 2017 to November 2019 were retrospectively collected.The CT images before and after CCRT were analyzed.The incidence of skeletal muscle loss,changes in nutritional indicators,and chemoradiotherapy delay were recorded,and the risk factors associated with declined skeletal muscle index (SMI) were analyzed.Results In the nutritional intervention group,the average daily energy intake per person in the oral nutritional supplement (ONS) subgroup,parenteral nutrition (PN) subgroup,and ONS+PN subgroup were (273.5±252.8), (310.6±311.2),and (745.3±637.8) kcal (1 kcal=4.1868 kJ),respectively,and the difference was statistically significant (F=5.870,P=0.005).After CCRT,the incidence of sarcopenia was 40.3% (n=40) in the nutrition intervention group,which was significantly lower than that (45.2%,n=42) in the control group (χ²=4.247,P=0.038);the decline of SMI in the nutrition intervention group was (1.4±8.3) cm²/m²,which was significantly lower than that in the control group (5.4±9.1) cm²/m²] (t=2.187,P=0.031).In the nutrition intervention group,the radiotherapy delay and chemotherapy delay occurred in 18 patients and 10 patients,which were significantly lower than those in the control group 25 patients (χ²=4.501,P=0.039) and 19 patients (χ²=8.929,P=0.005) ].The duration of radiotherapy delay and chemotherapy delay in the nutrition intervention group was (2.3±4.4) and (0.9±1.3) days,which were significantly shorter than those in the control group (4.2±5.3) (t=0.691,P=0.047) and (2.2±3.2) days (t=0.847,P=0.041) ].The incidence of sarcopenia was 75.2% before CCRT,which was significantly lower than that (88.2%) after CCRT (χ²=5.183,P=0.023).Multivariate linear regression analysis showed that T stage (P=0.007),N stage (P<0.001),and nutritional intervention (P=0.014) at baseline had significant effects on the decrease of SMI in patients with esophageal cancer after radiotherapy and chemotherapy.Conclusions Nutrition intervention can reduce the incidence of delayed chemoradiotherapy during esophageal cancer CCRT and reduce skeletal muscle loss.The decline of SMI is mainly related to the T stage,N stage,and nutrition intervention at baseline.