Objective To explore the trajectory of nutritional index changes in patients with head and neck cancer and to analyze their influencing factors. Method A total of 163 patients treated with radiotherapy for head and neck cancer in Jiangsu Provincial People's Hospital from January 2023 to September 2024 were selected as the study objects. A basic information questionnaire, prognostic nutrition index, and quality of life questionnaire were used for investigation. The latent class growth model and influencing factors were used to analyze the data. Results Three latent classes of nutritional index curve trajectories of head and neck cancer patients were identified, with mean probabilities of 0.953, 0.952, and 0.964, respectively. The three classes were the malnutrition - exacerbated group (58.8%), the stable nutritional status group (26.5%), and the malnutrition - improvement group (14.7%), respectively. There were significant differences in different trajectory classes in terms of age (χ2 = 12.630, P = 0.002), marital status (χ2 = 7.113, P = 0.029), BMI index (χ2 = 23.050, P < 0.001), and tumor stage (χ2 = 15.310, P = 0.004). Logistic regression analysis showed thatage > 60 years(OR=1.124),tumor stage(stage ⅡOR=2.542,stage ⅢOR=3.497) were the risk factors of the nutrition index trajectory (all P < 0.05), marriage status(with a spouse OR=0.702)and BMI(>18.5 kg/m2 OR=0.881,>24 kg/m2 OR=0.560) were the protective factors of the nutrition index trajectory (all P < 0.05). The difference analysis results of quality of life showed that the quality of life of patients in the malnutrition - exacerbated group was significantly lower than that of the stable nutrition group (P < 0.01) and that of the improved nutrition group (P < 0.01), and the quality of life of the improved nutrition group was lower than that of the stable nutrition group (P < 0.01). Conclusion In this study, by investigating the characteristics of changes in nutritional indices during radiotherapy in patients with head and neck cancer, three types of prognostic nutritional index trajectory types were identified. The different trajectories were affected by a combination of factors such as patients' own age, marital status, BMI, and tumor stage. Clinical staff should pay close attention to patients with head and neck cancer in the malnutrition - exacerbated group, formulate a personalized nutritional intervention plan, and provide active and targeted nutritional support to improve the quality of patients' prognosis and survival.
Key words
Head and neck cancer /
Radiotherapy /
Nutritional index /
Trajectory /
longitudinal study /
Influencing factors /
Risk factors /
Nutritional status
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References
[1] SHUNMUGA S C, DHILLON H M, BUTOW P N, et al. A systematic review of body image measures for people diagnosed with head and neck cancer (HNC)[J]. Support Care Cancer, 2019,27(10):3657-3666.
[2] D'ONOFRIO I, NARDONE V, REGINELLI A, et al. Chemoradiotherapy for head and neck cancer[J]. Cancers (Basel), 2023,15(10):2820.
[3] CARLSON E R, KADEMANI D. Head and neck cancer awareness month[J]. J Am Dent Assoc, 2020,151(4):223-224.
[4] MELISSANT H C, JANSEN F, EERENSTEIN S E, et al. Body image distress in head and neck cancer patients: what are we looking at?[J]. Support Care Cancer, 2021,29(4):2161-2169.
[5] 董怡君, 宋柳, 景星滔, 等. 《2023NCCN头颈癌临床实践指南(第1版)》更新解读[J]. 西部医学, 2023,35(10):1412-1417.
[6] MA C, YU R, LI J, et al. Preoperative prognostic nutritional index and systemic immune-inflammation index predict survival outcomes in osteosarcoma: A comparison between young and elderly patients[J]. J Surg Oncol, 2022,125(4):754-765.
[7] 谭铮可可, 杨丽, 李丹妮, 等. 胃癌围术期病人预后营养指数纵向变化规律及应用的研究进展[J]. 护理研究, 2024,38(15):2718-2722.
[8] 刘扬, 车瑾, 秦婷婷, 等. 预后营养指数及血清suPAR、TK1在晚期肝癌预后中的预测价值[J/CD]. 肿瘤代谢与营养电子杂志, 2024,11(1):110-115.
[9] 叶圣明, 郭树彬, 商娜. 预后营养指数在急危重症患者全因死亡中的预测价值[J]. 医学研究杂志, 2024,53(6):99-103.
[10] HUANG J C, PAN B, JIANG T, et al. Effect of the preoperative prognostic nutritional index on the long-term prognosis in patients with borderline resectable pancreatic cancer after pancreaticoduodenectomy[J]. Front Oncol, 2023,13:1098459.
[11] CHEN J, ZHENG C, ZHONG J, et al. Preoperative prognostic nutritional index is useful factor for predicting postoperative delirium after primary total joint arthroplasty[J]. BMC Musculoskelet Disord, 2021,22(1):778.
[12] HE Y, LIU H, MA Y, et al. Preoperative prognostic nutritional index predicts short-term complications after radical resection of distal cholangiocarcinoma[J]. Front Surg, 2022,9:1091534.
[13] 李金忠, 郑家伟. NCCN头颈癌诊治指南(2007版)[J]. 中国口腔颌面外科杂志, 2008,6(1):75-80.
[14] 李贤, 刘桂芬, 何大卫, 等. 重复测量设计样本含量估计[J]. 中国卫生统计, 2001,18(4):13-15.
[15] BUZBY G P, MULLEN J L, MATTHEWS D C, et al. Prognostic nutritional index in gastrointestinal surgery[J]. Am J Surg, 1980,139(1):160-167.
[16] 徐世斌, 徐美青, 孙效辉, 等. 预后营养指数与食管鳞癌患者术后并发症和远期预后的相关性研究[J]. 中国肿瘤临床, 2018,45(15):789-794.
[17] VAEZI A, SOOJOODI F, BANIHASHEMI A T, et al. The association between social support and postpartum depression in women: A cross sectional study[J]. Women Birth, 2019,32(2):e238-e242.
[18] 王孟成, 毕向阳, 叶浩生. 增长混合模型:分析不同类别个体发展趋势[J]. 社会学研究, 2014,29(4):220-241.
[19] JAIN N, JAIN S, SHARMA R, et al. Intensity-modulated radiotherapy in locally advanced head-and-neck cancers in elderly patients[J]. J Cancer Res Ther, 2022,18(Supplement):S157-S159.
[20] HAEHL E, RUHLE A, DAVID H, et al. Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?[J]. Radiat Oncol, 2020,15(1):31.
[21] VIANI G A, FAUSTINO A C, DANELICHEN A, et al. Radiotherapy for locally advanced head and neck cancer in elderly patients: results and prognostic factors a single cohort[J]. Rep Pract Oncol Radiother, 2021,26(1):12-19.
[22] YASUDA K, UCHINAMI Y, KANO S, et al. Radiotherapy with or without chemotherapy for locally advanced head and neck cancer in elderly patients: analysis of the head and neck cancer registry of Japan[J]. Int J Clin Oncol, 2024,29(3):241-247.
[23] LUAN C, TSAI Y, YANG H, et al. Pretreatment prognostic nutritional index as a prognostic marker in head and neck cancer: a systematic review and meta-analysis[J]. Scientific reports, 2021,11(1):17117.
[24] BORSETTO D, TOMASONI M, PAYNE K, et al. Prognostic significance of cd4+ and cd8+ tumor-infiltrating lymphocytes in head and neck squamous cell carcinoma: a meta-analysis[J]. Cancers, 2021,13(4):781.
[25] NAYEL H, EL-GHONEIMY E, EL-HADDAD S. Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation[J]. Nutrition, 1992,8(1):13-18.
[26] ZHAO H, WU L, YAN G, et al. Inflammation and tumor progression: signaling pathways and targeted intervention[J]. Signal Transduct Target Ther, 2021,6(1):263.
[27] ZHAO H, XU L, TANG P, et al. Geriatric Nutritional Risk Index and Survival of Patients With Colorectal Cancer: A Meta-Analysis[J]. Front Oncol, 2022,12:906711.
[28] FASANO M, D'ONOFRIO I, BELFIORE M P, et al. Head and neck squamous cell carcinoma in elderly patients: role of radiotherapy and chemotherapy[J]. Cancers (Basel), 2022,14(3):472.
[29] XU J, SUN Y, GONG D, et al. Predictive Value of Geriatric Nutritional Risk Index in Patients with Colorectal Cancer: A Meta-Analysis[J]. Nutr Cancer, 2023,75(1):24-32.
[30] YUAN F, YUAN Q, HU J, et al. Prognostic role of pretreatment geriatric nutritional risk index in colorectal cancer patients: a meta-analysis[J]. Nutr Cancer, 2023,75(1):276-285.
[31] 罗蓓蓓, 贺丹, 江雪, 等. 放化疗前预后营养指数、体质指数及N分期在鼻咽癌患者预后预测中的应用价值探索[J/CD]. 肿瘤代谢与营养电子杂志, 2023,10(6):786-792.
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