无脂肪质量指数对非转移性鼻咽癌患者营养状态和预后评估的临床价值

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摘要目的本研究旨在探讨使用生物电阻抗分析(BIA)测量的无脂肪质量指数(FFMI)在非转移性鼻咽癌患者营养状况评估与预后评估中的作用。方法本研究回顾性收集了 2019 年 1 月至 2022 年 6 月于海安市人民医院接受系统治疗的 162 例非转移性鼻咽癌患者的临床数据,通过 BIA 测量并计算 FFMI。根据亚洲肌肉质量评估工作组对 FFMI 截断点的建议(男性 FFMI<17 kg / m 2 ,女性 FFMI<15 kg / m 2 ),将所有患者分为低 FFMI 组(n = 55 例)与正常 FFMI 组( n = 107 例),比较两组患者的基线特征与无进展生存(PFS)期。生存分析采用 Kaplan-Meier 曲线和 Cox 风险回归模型,评估 FFMI 与鼻咽癌患者预后的关系。结果全组患者平均 FFMI 值为(17. 8±2. 0) kg / m 2 ,其中 34. 0%(55 / 162)被分划为低 FFMI 组。与正常 FFMI 组患者相比,低 FFMI 组 BMI 更低( t = 5. 168, P < 0. 001)。与无营养不良风险者相比,有营养不良风险者[ 营养风险筛查 2002 (NRS2002)评分≥3 分]的低 FFMI 发生率更高(χ 2 = 5. 817, P= 0. 015)。在营养评价参数方面,低 FFMI 组患者血清白蛋白值 (t = 2. 032, P= 0. 044)、淋巴细胞计数( t = 2. 674, P = 0. 008)、上臂中围( t = 3. 850, P< 0. 001) 和手握力( t = 2. 229, P = 0. 027)均显著低于正常 FFMI 组。 Kaplan-Meier 曲线显示,低 FFMI 与鼻咽癌患者不良预后显著相关,3 年 PFS 率分别为 45. 6%与 68. 4%(χ 2 = 7. 957, P= 0. 005)。单、多因素 Cox 回归分析显示 TNM 分期(HR = 3. 393, 95%CI = 1. 911 ~ 6. 023, P< 0. 001)和 FFMI(HR= 2. 182, 95%CI = 1. 242~ 3. 831, P = 0. 007)是鼻咽癌患者 PFS 的独立危险因素。结论人体成分测量的 FFMI 对鼻咽癌患者具有重要临床意义,或是评估营养状态与预后结局的有效参数。

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	1张蓓蕾
	1陆滢滢
	2施晓伟

关键词 ：鼻咽癌, 人体成分测量, 生物电阻抗分析, 无脂肪质量指数, 营养, 预后, 无进展生存, 体质指数

Abstract：Objective This study aimed to explore the role of fat-free mass index FFMI measured by bioelectrical impedance analysis BIA for nutritional and prognostic assessment of non - metastatic nasopharyngeal carcinoma patients. Method This retrospective study collected clinicopathological data of 162 nasopharyngeal carcinoma patients who received systematic treatment in Hai'an People's Hospital From January 2019 to June 2022 and FFMI was measured and calculated by BIA. All patients were divided into low FFMI n = 55 and normal FFMI group n = 107 according to its threshold recommended by Asian Working Group of Sarcopenia male FFMI <17 kg / m 2 female FFMI <15 kg / m 2 . The baseline characteristics and progression-free survival PFS of the two groups were compared. Kaplan-Meier curves and the Cox proportional regression model were used to evaluate the relationship between FFMI and the prognosis of nasopharyngeal carcinoma patients. Result The mean FFMI of the entire cohort was 17. 8 ± 2. 0 kg / m 2 . Of them 34. 0% 55 / 162 were diagnosed as low FFMI. The patients with low FFMI had a lower BMI t = 5. 168 P<0. 001 and higher risk of malnutrition NRS 2002≥ 3 points χ 2 = 5. 817 P = 0. 015 than those with normal FFMI. With regard to nutrition-related parameters the level of serum albumin t = 2. 032 P= 0. 044 lymphocyte count t = 2. 674 P= 0. 008 mid-arm circumference t = 3. 850 P<0. 001 and handgrip strength t = 2. 229 P= 0. 027 in patients with low FFMI were significantly lower than in those with normal FFMI. The Kaplan - Meier curve showed that low FFMI was correlated with poor prognosis of nasopharyngeal carcinoma patients. The 3-year PFS rates of patients with low and normal FFMI were 45. 6% and 68. 4% respectively χ 2 = 7. 957 P= 0. 005 . The univariate and multivariate Cox regression analysis revealed that TNM stage HR= 3. 393 95%CI = 1. 911-6. 023 P<0. 001 and FFMI HR = 2. 182 95% CI = 1. 242 - 3. 831 P = 0. 007 were independent predictor of PFS for nasopharyngeal carcinoma patients. Conclusion The FFMI measured by body composition analysis had important clinical significance for nasopharyngeal carcinoma patients and it might be a useful parameter for nutritional and prognostic assessment.

Key words： Nasopharyngeal carcinoma Body composition measurement Bioelectrical impedance analysis Fat-free mass index Nutritional Prognostic Progress-free survival Body mass index

基金资助:2023 年高层次卫生人才“六个一工程”拔尖人才科研项目(LGY202309)

通讯作者: 张蓓蕾,电子邮箱:l86545f78@163.com

引用本文:

1张蓓蕾,1陆滢滢,2施晓伟. 无脂肪质量指数对非转移性鼻咽癌患者营养状态和预后评估的临床价值[J]. 肿瘤代谢与营养电子杂志, 2025, 12(2): 238-244.
1Zhang Beilei,1Lu Yingying,2Shi Xiaowei. The clinical value of fat - free mass index for the assessment of nutritional status and prognosis in non - metastatic nasopharyngeal carcinoma patients. Electron J Metab Nutr Cancer, 2025, 12(2): 238-244.