目的 根据全球营养不良领导倡议(GLIM)调查鼻咽癌(NPC)患者接受放、化疗前的营养状况,探讨 GLIM 诊断的营 养不良与患者预后的关系。 方法 对 2017 年 1 月至 2021 年 12 月间于扬州大学建湖临床医学院和南京大学医学院附属盐城第 一医院接受放、化疗的 175 例 NPC 患者进行回顾性研究,使用 GLIM 标准通过两步法确定该人群的营养不良发生率。 通过 Kaplan-Meier 生存曲线和 Log-rank 检验比较营养不良与非营养不良患者的无进展生存(PFS)与总生存(OS),单、多变量 Cox 回归分析 NPC 患者的独立预后因素。 结果 使用营养风险筛查 2002(NRS 2002)量表进行初步筛查,共有 17. 1%(30 / 175)的 患者被认为存在 NRS 2002 评分≥3 分。 根据 GLIM 标准将所有 NPC 患者分为营养不良组( n = 45) 与非营养不良组( n = 130),NPC 患者的营养不良发生率为 25. 7% (45 / 175),其中 8. 6%(15 / 175)存在非自主性体重丢失,9. 7%(17 / 175)有体质指 数(BMI)减低,20. 6%(36 / 175)的患者存在肌肉质量减少。 生存分析表明,营养不良与非营养不良患者 3 年 PFS 率分别为 74. 6%和 95. 3%(χ 2 = 15. 871, P<0. 001),3 年 OS 率分别为 73. 1%和 90. 5%( χ 2 = 7. 384, P = 0. 007),差异均有统计学意义。 GLIM 标准诊断的营养不良是 NPC 患者 PFS (HR = 2. 335, 95%CI = 1. 072 ~ 5. 084, P = 0. 031) 与 OS (HR = 4. 810, 95%CI = 1. 763~ 13. 127, P= 0. 002)的独立预测因素。 结论 GLIM 标准是 NPC 患者营养评估与预后预测的有效工具,或许有助于早期发现营养不良患者并指导临床干预。

Objective To evaluate the pre-treatment nutritional status of nasopharyngeal carcinoma NPC patients who received chemoradiotherapy and explore the relationship between malnutrition diagnosed by the Global Leadership Initiative on Malnutrition GLIM and survival outcome. Method This retrospective study was conducted in a series of 175 NPC patients treated with chemoradiotherapy at our hospitals from January 2017 to December 2021. Using a two-step method the prevalence of malnutrition in this population was investigated by GLIM criteria. Kaplan-Meier curves with Log-rank test were used to compare progress-free survival PFS and overall survival OS of malnourished and non-malnourished patients. The independent prognostic factors for NPC patients were determined by the univariate and multivariate Cox regression analysis. Result A total of 17. 1% 30 / 175 of patients had malnutrition risk according to the Nutrition Risk Screening 2002. According to GLIM criteria the prevalence of malnutrition was 25. 7% 45 / 175 in NPC patients of which 8. 6% 15 / 175 had unintentional weight loss 9. 7% 17 / 175 had low body mass index BMI and 20. 6% 36 / 175 had a decrease in muscle mass. The survival analysis indicated that the 3-year PFS rates of malnourished and non-malnourished patients were 74. 6% and 95. 3% respectively χ 2 = 15. 871 P<0. 001 . The 3-year OS rates of malnourished and non-malnourished patients were 73. 1% and 90. 5% respectively χ 2 = 7. 384 P= 0. 007 . There were significant survival differences between the two groups for PFS and OS. Malnutrition diagnosed by GLIM criteria was an independent predictor of PFS HR = 2. 335 95%CI = 1. 072-5. 084 P= 0. 031 and OS HR= 4. 810 95%CI = 1. 763-13. 127 P = 0. 002 for NPC patients. Conclusion GLIM criteria was an effective tool for nutritional assessment and survival prediction of NPC patients and it might be helpful for early detection of malnutrition and guidance of clinical intervention.