国际肿瘤学杂志

国际肿瘤学杂志 ›› 2020, Vol. 47 ›› Issue (11): 663-668.doi: 10.3760/cma.j.cn371439-20200318-00097

• 论著 • 上一篇    下一篇

NRS-2002对胸段食管鳞状细胞癌术后淋巴结转移放化疗患者疗效及预后的预测价值

郭信伟1, 张晗2, 曹云1, 周菊英3, 刘阳晨1, 叶宏勋1(), 冀胜军4()   

  1. 1蚌埠医学院附属泰兴人民医院肿瘤放疗科,泰兴 225400
    2南京师范大学泰州学院数学系,泰州 225300
    3苏州大学附属第一医院肿瘤放疗科 215006
    4南京医科大学附属苏州医院肿瘤放疗科,苏州 215002
  • 收稿日期:2020-03-18 修回日期:2020-04-16 出版日期:2020-11-08 发布日期:2021-01-05
  • 通讯作者: 叶宏勋,冀胜军 E-mail:yhx4032@126.com;drshengjunji@163.com
  • 基金资助:
    蚌埠医学院科研课题计划(BYKY18163)

Predictive value of NRS-2002 on the efficacy and prognosis of chemoradiotherapy in patients with lymph node metastasis after esophagectomy of thoracic esophageal squamous cell carcinoma

Guo Xinwei1, Zhang Han2, Cao Yun1, Zhou Juying3, Liu Yangchen1, Ye Hongxun1(), Ji Shengjun4()   

  1. 1Department of Radiation Oncology, Affiliated Taixing People's Hospital of Bengbu Medical College, Taixing 225400, China
    2School of Mathematics, Taizhou College, Nanjing Normal University, Taizhou 225300, China
    3Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
    4Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215002, China
  • Received:2020-03-18 Revised:2020-04-16 Online:2020-11-08 Published:2021-01-05
  • Contact: Ye Hongxun,Ji Shengjun E-mail:yhx4032@126.com;drshengjunji@163.com
  • Supported by:
    Scientific Research for Planned Project of Bengbu Medical College(BYKY18163)

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摘要：

目的 探索营养风险筛查-2002(NRS-2002)对胸段食管鳞状细胞癌术后淋巴结转移放化疗患者疗效及预后的预测价值。方法 对2013年1月至2016年12月间在蚌埠医学院附属泰兴人民医院肿瘤放疗科接受放化疗的140例胸段食管鳞状细胞癌术后伴有淋巴结转移患者进行回顾性分析,根据治疗前血红蛋白的中位值将患者分为血红蛋白<127 g/L组(n=65)及血红蛋白≥127 g/L组(n=75);参照NRS-2002工具标准,进行营养风险评分,并根据最佳临界值将患者分为NRS-2002<3分组(n=65)和NRS-2002≥3分组(n=75)。采用logistic回归分析影响近期疗效的相关因素;采用Kaplan-Meier法计算生存率并行log-rank检验,采用Cox回归模型进行生存预后单因素及多因素分析。绘制受试者工作特征(ROC)曲线,计算曲线下面积评估NRS-2002预测疗效及生存预后的准确性。结果 全组患者总体治疗有效率为65.0%(91/140),其中,血红蛋白<127 g/L组及血红蛋白≥127 g/L组患者的治疗有效率分别52.3%(34/65)和76.0%(57/75),差异有统计学意义(χ2=8.592,P=0.003);NRS-2002<3分组和NRS-2002≥3分组患者的治疗有效率分别为81.5%(53/65)、50.7%(38/75),差异有统计学意义(χ2=14.588,P<0.001)。单因素logistic回归分析显示,治疗方式(HR=1.322,95%CI为1.121~3.632,P=0.012)、血红蛋白(HR=0.346,95%CI为0.169~0.711,P=0.004)和NRS-2002评分(HR=3.374,95%CI为1.185~9.611,P<0.001)与近期疗效密切相关;多因素logistic回归分析显示,治疗方式(HR=1.125,95%CI为1.098~2.927,P=0.042)与NRS-2002评分(HR=3.868,95%CI为1.723~8.685,P<0.001)是近期疗效的独立影响因素。所有入组患者中位总生存期(OS)为16.0个月(95%CI为14.3~17.7),1、2、3年生存率分别为69.3%、28.6%和21.4%。其中,血红蛋白<127 g/L组患者的1、2、3年生存率分别为62.1%、21.5%和10.8%,血红蛋白≥127 g/L组患者的1、2、3年生存率分别为74.7%、34.7%和30.7%,差异有统计学意义(χ2=7.370,P=0.007);NRS-2002评分<3分组患者的1、2、3年生存率分别为89.2%、50.8%和43.1%,NRS-2002评分≥3分组患者的1、2、3年生存率分别为52.0%、9.3%和2.7%,差异有统计学意义(χ2=48.778,P<0.001)。Cox单因素分析显示,治疗方式(HR=1.375,95%CI为1.108~1.968,P=0.019)、血红蛋白(HR=0.607,95%CI为0.417~0.885,P=0.009)和NRS-2002评分(HR=0.471,95%CI为0.349~0.636,P<0.001)均与胸段食管鳞状细胞癌术后淋巴结转移患者的OS密切相关,Cox多因素分析结果显示,仅NRS-2002评分(HR=0.494,95%CI为0.365~0.669,P<0.001)是影响OS的独立预后因素。ROC曲线显示,NRS-2002评分预测近期疗效和OS的曲线下面积分别为0.669(95%CI为0.576~0.762,P=0.001)和0.798(95%CI为0.719~0.878,P<0.001)。结论 治疗前NRS-2002评分<3分的胸段食管鳞状细胞癌术后淋巴结转移放化疗患者具有较好的近期疗效及远期生存。

关键词: 食管肿瘤, 淋巴转移, 预后, 放化疗, 营养风险筛查

Abstract:

Objective To explore the predictive value of nutritional risk screening-2002 (NRS-2002) on the efficacy and prognosis of chemoradiotherapy (CRT) in patients with lymph node metastasis (LNM) after esophagectomy of thoracic esophageal squamous cell carcinoma (ESCC). Methods From January 2013 to December 2016, 140 patients with LNM after esophagectomy of thoracic ESCC receiving curative radiotherapy (RT) only or concurrent CRT in the Department of Radiation Oncology, Affiliated Taixing People's Hospital of Bengbu Medical College were retrospectively analyzed. According to the median hemoglobin before treatment, the patients were divided into two groups: hemoglobin<127 g/L group (n=65) and hemoglobin≥127 g/L group (n=75). According to NRS-2002 tool standard, the nutritional risk was scored and grouped by the best cutoff value, patients were divided into NRS-2002<3 group (n=65) and NRS-2002≥3 group (n=75). The logistic regression was used to analyze the factors influencing the short-term efficacy. Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The univariate and multivariate analyses were carried out by Cox proportional hazards model. Finally, receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated to confirm the prediction accuracy of NRS-2002 in efficacy and survival prognosis. Results The treatment effective rate of the whole group was 65.0% (91/140). The effective rates of the patients in hemoglobin<127 g/L group and hemoglobin≥127 g/L group were 52.3% (34/65) and 76.0% (57/75) respectively, and there was a statistically significant difference (χ2=8.592, P=0.003). The effective rates of the patients in NRS-2002<3 group and NRS-2002≥3 group were 81.5% (53/65) and 50.7% (38/75) respectively, and there was a statistically significant difference (χ 2=14.588, P<0.001). The univariate logistic regression analysis showed that the short-term efficacy of CRT was highly associated with treatment method (HR=1.322, 95%CI: 1.121-3.632, P=0.012), hemoglobin (HR=0.346, 95%CI: 0.169-0.711, P=0.004) and NRS-2002 score (HR=3.374, 95%CI: 1.185-9.611, P<0.001). Multivariate logistic regression analysis found that treatment method (HR=1.125, 95%CI: 1.098-2.927, P=0.042) and NRS-2002 score (HR=3.868, 95%CI: 1.723-8.685, P<0.001) were independent factors for short-term effect of CRT. The median overall survival (OS) of all patients was 16.0 months (95%CI: 14.3-17.7), the 1-, 2- and 3-year survival rates were 69.3%, 28.6% and 21.4%, respectively. In the hemoglobin<127 g/L group, the 1-, 2-, and 3-year survival rates were 62.1%, 21.5% and 10.8%, and in the hemoglobin≥127 g/L group, the 1-, 2-, and 3-year survival rates were 74.7%, 34.7% and 30.7%, with a statistically significant difference (χ 2=7.370, P=0.007). In the NRS-2002<3 group, the 1-, 2-, and 3-year survival rates were 89.2%, 50.8% and 43.1%, and in the NRS-2002≥3 group, the 1-, 2-, and 3-year survival rates were 52.0%, 9.3% and 2.7%, with a statistically significant difference (χ 2=48.778, P<0.001). Cox univariate factor analysis found that treatment method (HR=1.375, 95%CI: 1.108-1.968, P=0.019), hemoglobin (HR=0.607, 95%CI: 0.417-0.885, P=0.009) and NRS-2002 score (HR=0.471, 95%CI: 0.349-0.636, P<0.001) were closely related to OS of patients with LNM after esophagectomy of thoracic ESCC. However, Cox multivariate analysis showed that only NRS-2002 score (HR=0.494, 95%CI: 0.365-0.669, P<0.001) was an independent prognostic factor for OS. ROC curve showed that NRS-2002 score predicted AUC of short-term efficacy and OS were 0.669 (95%CI: 0.576-0.762, P=0.001) and 0.798 (95%CI: 0.719-0.878, P<0.001), respectively. Conclusion Thoracic ESCC patients with LNM receiving CRT after esophagectomy with NRS-2002 score<3 before treatment have a better short-term efficacy and long-term survival.

Key words: Esophageal neoplasms, Lymphatic metastasis, Prognosis, Chemoradiotherapy, Nutritional risk screening