目的 探索基于全球领导人营养不良倡议(GLIM)标准的营养不良与鼻咽癌患者预后关联及预测模型构建。 方法 回顾性分析四川大学华西医院 2022 年 1 月至 2023 年 1 月期间收治的 185 例鼻咽癌患者资料,根据患者基于 GLIM 标准的营 养不良结果分为两组,即营养不良组(n = 72)、无营养不良组(n = 113),比较一般资料,经多因素二元 Logistic 回归分析影响营 养不良的因素。 随访 12 个月,经 Cox 比例风险模型、Kaplan-Meier 曲线分析鼻咽癌患者预后与营养状态关联,并经受试者操 作特征(ROC) 曲线分析基于 GLIM 标准的营养不良评估效能。 结果 经多因素二元 Logistic 回归分析,年龄≥60 岁(OR = 2. 393)、TNM 分期Ⅲ~Ⅳ期(OR= 2. 053)、消化道症状≥3 个(OR = 2. 288)、接受放化疗(OR = 2. 097)是影响鼻咽癌患者营养 不良的独立危险因素( P< 0. 05)。 经 12 个月随访,营养不良组无进展生存 66 例,无营养不良组无进展生存 112 例,经 Kaplan-Meier 曲线分析,两组患者死亡/ 复发率、生存时间比较差异有统计学意义(P< 0. 05);经 Cox 比例风险回归模型分 析,营养不良是影响鼻咽癌患者预后的独立因素(P<0. 05);经 ROC 曲线分析,基于 GLIM 标准的营养不良评估在预测鼻咽癌 预后中效能较高,AUC= 0. 743,S. E. = 0. 083,P = 0. 029,95%CI = 0. 580 ~ 0. 907,敏感度 = 85. 7%,特异度 = 62. 9%,约登指数 = 0. 486。 结论 鼻咽癌患者营养状态会受到年龄、肿瘤 TNM、消化道症状、放化疗影响,针对高危因素,需开展精准预防康复以降 低营养不良率。 同时,需重点监测基于 GLIM 标准的营养不良状态,及时发现营养不良并指导临床干预,改善预后。

Objective To explore the prognostic association of malnutrition and NPC patients based on GLIM criteria and the prediction model construction. Method A total of 185 NPC patients were collected from January 2022 to January 2023 and were divided into two groups based on GLIM criteria namely malnutrition group n = 72 and no malnutrition group n = 113 . Compared with general data malnutrition factors were affected by binary Logistic regression analysis. After another 12-month follow-up association with nutritional status by Cox proportional risk Kaplan-Meier survival analysis and ROC curve analysis of malnutrition based on GLIM criteria. Result After binary Logistic regression analysis age ≥ 60 years OR = 2. 393 TNM stage Ⅲ ~ Ⅳ OR = 2. 053 ≥3 gastrointestinal symptoms OR = 2. 288 and chemoradiotherapy OR = 2. 097 were independent risk factors for malnutrition in NPC patients P <0. 05 . After a 12-month follow-up visit 66 progression-free survival in the malnutrition group 112 control subjects with progression-free survival according to the Kaplan-Meier survival analysis statistical difference in death / recurrence rate and survival time between the two groups P <0. 05 After the Cox proportional risk analysis Malnutrition was an independent factor affecting the prognosis of NPC patients P <0. 05 After the ROC curve analysis Assessment of malnutrition based on GLIM criteria in predicting NPC prognosis AUC = 0. 743 S. E. = 0. 083 P = 0. 029 95% CI = 0. 580 - 0. 907 sensitivity of 85. 7% specificity of 62. 9% the Youden index is set at 0. 486 indicating a high predictive efficacy of malnutrition assessment based on the GLIM criteria. Conclusion The nutritional status of nasopharyngeal cancer patients will be affected by age tumor TNM digestive tract symptoms and radiotherapy and chemotherapy. For high-risk factors precise prevention and rehabilitation should be required to reduce the malnutrition rate. At the same time it is necessary to focus on monitoring the malnutrition status based on GLIM standards timely detect malnutrition and guide clinical intervention to improve the prognosis.