| Objective:To analyze the changes of traditional nutritional indicators,including body mass index(BMI),serum albumin(ALB),hemoglobin(HB),total lymphocyte count(TLC),and geriatric nutritional risk index(GNRI),after therapy in patients with esophageal squamous cell carcinoma(ESCC)who received radiation therapy.Besides,to investigate the prognostic value of triglycerides*total cholesterol*body weight index(TCBI).Materials and methods:We retrospectively analyzed a total of 191 patients with ESCC underwent radiation therapy,treated with or without esophagectomy in the department of Radiation Oncology of the First Affiliated Hospital of Soochow University from 2010 to 2015.The clinical data before and after treatment were collected,and their survival status was followed up by telephone.The follow-up endpoint was 2019,June.According to the TCBI value on admission[TCBI=serum triglycerides(mg/dL)× total cholesterol(mg/dL)× weight(kg)/1000],patients were divided into TCBI low-value group and TCBI high-value group.The dynamic analysis of nutritional status before and after treatment was compared using a paired t-test with a test level of α=0.05.The χ2 test was used to analyze the relationship between TCBI and clinical characteristics of patients.The Kaplan-Meier method was used to calculate the overall survival(OS).The log-Rank test was adopted to compare the differences in survival between different groups.The Cox proportional hazards model was used to carry out univariate and multivariate analyses to identify prognostic factors for the overall survival(OS).Receiver operating characteristic(ROC)curves were applied to verify the accuracy of TCBI for survival prediction.Results:1.Patients with esophageal cancer had different degrees of malnutrition before and after treatment.The weight,BMI,serum albumin,hemoglobin,total lymphocyte count,and GNRI all decreased after treatment to varying degrees.The differences were statistically significant(all P<0.05).2.The mean pre-radiotherapy TCBI of all patients was 1082±945(range:236-9794).The cutoff value of the TCBI was set at 749.41.36%patients had a TCBI of<749.TCBI<749 was the low-value group,and TCBI≥749 was the high-value group.TCBI was associated with age(χ2=2.207,P=0.016),treatment(χ2=4.235,P=0.040),geriatric nutritional risk index(GNRI,χ2=8.795,P=0.003),triglycerides(χ2=11.370,P<0.001),total cholesterol(χ2=30.218,P<0.001)and body weight(χ2=11.076,P<0.001).Univariate analysis suggested that TCBI was significantly associated with the OS,as well as some other factors:sex,N stage,GNRI,treatment,triglycerides,total cholesterol,body weight(all P<0.05).Furthermore,multivariate Cox regression analysis showed that TCBI(HR=1.664;95%CI 1.166-2.376;P=0.005)was an independent risk prognostic factor for OS in patients with ESCC.Finally,the results of ROC curves indicated that TCBI can be used as predictive factor for OS in patients with ESCC receiving radiotherapy.The area under the curve was calculated by the ROC curve was 0.619,the sensitivity was 0.742,and the specificity was 0.496(P=0.007).Survival analysis showed that the median OS of patients in the TCBI high-value group was 42 months,and the 1-year and 3-year survival rates were 86.6%and 52.7%,significantly higher than that in the TCBI low-value group(20 months,68.4%and 29.1%,respectively)(χ2=12.286,P<0.001).Subgroup analysis showed that among patients with radical radiation therapy,survival was lower in patients with lower TCBI than higher values(P=0.004).Conclusion:Nutritional status of esophageal cancer patients declined during radiotherapy.TCBI was a simple and reliable predictor of the post-therapy survival in patients with ESCC.The lower the TCBI score,the poorer the survival prognosis of the patient was. |
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