Influence of Nutrition Intervention on Quality of Life and Survival Prognosis of Patients with Locally Advanced Pancreatic Cancer
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摘要:
目的 探讨基于营养风险筛查的营养干预对局部晚期胰腺癌化疗患者的生活质量及生存预后的影响。 方法 选取2021年8月至2023年12月临沧市人民医院肝胆胰微创外科收治的胰腺癌患者118例，随机分成营养干预组及对照组，每组59例，所有患者均接受姑息性化疗，对照组予常规饮食指导，干预组基于营养风险评分给予的营养干预。比较两组患者的营养状况、生活质量评分及生存预后。 结果 第1次化疗至第6次化疗，干预组和对照组NRS2002评分（Nutritional risk screening 2002）水平逐渐升高，且干预组第4次化疗、第5次化疗、第6次化疗NRS2002评分低于于对照组（P < 0.05）。干预组第1次化疗至第3次化疗，营养不良发生率分别为11.9%、30.9%、32.2%，均低于对照组20.3%、32.2%、40.7%，差异无统计学意义（P > 0.05）；干预组第4次化疗至第6次化疗，营养不良发生率分别为32.2%、45.8%、52.5%，显著低于对照组59.3%、69.5%、88.5%（P < 0.05）；治疗后干预组的生活质量评分各个维度显著高于对照组（P < 0.05）。经营养干预治疗后显著改善患者的中位OS时间及中位PFS时间（P < 0.05）。 结论 营养的干预可以降低局部晚期胰腺癌化疗期间的营养风险，进而提高局部晚期胰腺癌患者的生活质量及改善其生存预后。 Abstract:Objective To investigate the impact of nutritional risk-based intervention on the quality of life and survival prognosis of patients with the locally advanced pancreatic cancer and undergoing the chemotherapy. Methods A total of 118 patients with the pancreatic cancer and admitted to the Department of Hepatobiliary and Minimally Invasive Surgery, Lincang People's Hospital from April 2021 to April 2024 were selected and randomly divided into the nutritional intervention group and the control group, with 59 patients in each group. All patients received the palliative chemotherapy, and the control group received the routine dietary guidance, while the intervention group received the nutritional intervention based on the nutritional risk score. The nutritional status, quality of life score, and survival prognosis of the two groups were compared. Results The NRS2002 score of the intervention group and the control group gradually increased from the first to the sixth chemotherapy, and the NRS2002 score of the intervention group was lower than that of the control group at the 4th, 5th, and 6th chemotherapy （P < 0.05）. The incidence of malnutrition in the intervention group was lower than that of the control group at the 1st, 2nd, and 3rd chemotherapy （11.9%, 30.9%, and 32.2%, respectively）, but there was no significant difference （P > 0.05）; The incidence of malnutrition in the intervention group was significantly lower than that of the control group at the 4th, 5th, and 6th chemotherapy （32.2%, 45.8%, and 52.5%, respectively）, while the incidence of malnutrition in the control group was 59.3%, 69.5%, and 88.5%, respectively （P < 0.05）; The quality of life score of the intervention group in all dimensions was significantly higher than that of the control group after the treatment （P < 0.05）. After the nutritional intervention, the median OS time and median PFS time of the patients were significantly improved （P < 0.05）. Conclusion Nutritional intervention can reduce the nutritional risk during the chemotherapy for locally advanced pancreatic cancer patients and improve their quality of life. -
Key words:
- Pancreatic cancer /
- Nutritional intervention /
- Locally advanced /
- Quality of life
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图 3 两组患者无进展生存曲线
Figure 3. The progression-free survival curves of the two groups of patients
表 1 患者基线信息[n（%）]
Table 1. Patients' baseline information [n（%）]
项目 干预组（n = 59） 对照组（n = 59） t 或χ2 P 年龄（岁） 58.12±9.896 59.05±9.655 0.518 0.606 性别 男 40（67.8） 31（52.5） 2.864 0.091 女 19（32.2） 28（47.5） 肿瘤位置 胰头 52（88.1） 50（84.7） 0.289 0.591 胰体尾 7（11.9） 9（15.3） 病理学类型 胰腺导管腺癌 58（98.3） 57（96.6） 0.342 0.559 胰腺非导管腺癌 1（1.7） 2（3.4） 临床分期 III期 45（76.3） 47（79.7） 0.197 0.657 IV期 14（23.7） 12（20.3） 
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表 2 两组患者NRS2002评分比较[（$\bar x \pm s $），分]
Table 2. Comparison of NRS2002 scores between the two groups of patients [（$\bar x \pm s $），points]
项目 NRS2002评分 F时点值 P F组间值 P F交互值 P 干预组（n = 59） 对照组（n = 59） t P 化疗前 1.85±0.638 1.76±0.597 0.791 0.430 23.041 0.001* 14.531 0.001* 11.041 0.001* 第1次化疗 1.97±0.524 2.00±0.643 −0.108 0.782 第2次化疗 1.98±0.841 2.05±0.860 −0.447 0.656 第3次化疗 2.19±0.798 2.41±0.812 −1.484 0.140 第4次化疗 2.24±0.652 2.76±0.935 −3.504 0.001 第5次化疗 2.32±1.025 2.92±0.794 −3.555 0.001 第6次化疗 2.64±1.079 3.31±0.701 −4.000 0.001 *P < 0.05
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表 3 两组患者营养不良率比较[n（%）]
Table 3. Comparison of malnutrition rates between the two groups of patients [n（%）]
项目 化疗前 第1次化疗 第2次化疗 第3次化疗 第4次化疗 第5次化疗 第6次化疗 干预组（n = 59） 8（13.6） 7（11.9） 18（30.9） 18（30.9） 19（32.2） 27（45.8） 31（52.5） 对照组（n = 59） 5（8.5） 12（20.3） 19（32.2） 19（32.2） 35（59.3） 41（69.5） 54（88.5） χ2值 0.778 1.568 0.039 0.039 8.741 6.802 18.795 P值 0.378 0.210 0.843 0.843 0.003* 0.009* 0.001* *P < 0.05。
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表 4 两组患者化学治疗前后生活质量比较[（$\bar x \pm s $），分]
Table 4. Comparison of quality of life in the two groups of patients before and after chemotherapy [（$\bar x \pm s $），points]
躯体功能 角色功能 认知功能 情绪功能 社会功能 化疗前 化疗后 化疗前 化疗后 化疗前 化疗后 化疗前 化疗后 化疗前 化疗后 干预组
（n = 59）62.61± 4.279 78.63± 5.356 58.97± 5.027 75.53± 5.670 60.51± 4.158 77.20± 5.595 59.47± 4.328 78.37± 5.149 60.49± 4.606 77.12± 4.545 对照组
（n = 59）63.49± 4.710 67.63± 5.105 59.08± 4.469 71.12± 5.272 61.59± 5.123 70.17± 5.503 60.76± 5.1.07 69.92± 5.076 62.00± 4.668 69.22± 4.351 t值 −0.990 10.548 −0.121 4.171 −1.345 6.020 −1.453 9.124 −1.670 9.260 P值 0.326 <0.001* 0.904 <0.001* 0.184 <0.001* 0.152 <0.001* 0.1000 <0.001* *P < 0.05。
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