| [Objection]To analyze the change of nutriture,fatigue,anxiety,depression during the initial,fourth-week and later stage of radiotherapy,and to explore their relationship with radiosensitivity and survival rate in patients with nasopharyngeal carcinoma,which can provide theoretical basis for clinical treatment.[Method]1.First part: Nasopharyngeal carcinoma patients(NPC)who received radiotherapy at radiology department in the first affiliated hospital of Fujian Medical University were recruited in this study from September,2013 to October,2016.Questionnaires were applied to collect the demographic characters and clinical records,and to investigate the patient status including nutrition,fatigue,anxiety and depression before radiotherapy,4weeks in radiotherapy and after radiotherapy.The differences of patient status in given time points were analyzed by Generalized Estimating Equations and analysis of variance of repeated measures.The differences in scorings of nutrition index,fatigue,anxiety and depression from nasopharyngeal carcinoma patients with different genders and different clinical stages of given time points were analyzed by two-factor repeated measures.2.Second part: nasopharyngeal carcinoma patients pathologically diagnosed at radiology department in the first affiliated hospital of Fujian Medical University were recruited in this study from September,2008 to October,2016.The nutrition,anxiety and depression states were investigated before radiotherapy and 4 weeks in radiotherapy,and the correlation between above results and radiosensitivity were analyzed by chi-square test.The cut-off point of nutrition index(NI)was determined to predictradiation sensitivity.3.Third part shared the same study subjects with the second part.Pre-radiotherapy status(nutrition,anxiety and depression)were investigated,and the differences in these three survival curves were analyzed by Long-rank test.Prognostic index(PI)and prognostic grouping were established by COX regression analysis.The differences in the degrees of dry mouth,impaired hearing,open mouth difficulty and neck fibrosis of different time after radiotherapy were compared by Kruskal-Wallis H test.Fisher's Exact Test was applied to compare the differences of the incidences of lower cranial nerves injury in different time after radiotherapy.[Result]The first part included 273 nasopharyngeal carcinoma patients1.NI scores in nasopharyngeal carcinoma patients after radiotherapy were lowered by 28.6% than pre-radiotherapy of average;NI scores in patients of ?~? stages were lowered by 26.2% than pre-radiotherapy in average,and lowered by 31.4% in patients of stage ?;four weeks during radiotherapy,poor nutritional status was observed in64.8% patients,and the rate reached to 72.5% after radiotherapy.2.The incidences of anxiety and depression before radiotherapy in nasopharyngeal carcinoma patients were 34.8% and 24.5% respectively,which were increased by 33.0%and 31.2% by the end of radiotherapy.Anxiety and depression onset were noticed earlier in female patients,and the incidences of anxiety and depression in females were1.30 times and 1.40 times of those in males after 4w in radiotherapy.The rates of anxiety and depression in patients of ?~? stages were increased by 30.6% and 30.7%than pre-radiotherapy,with 35.7% and 31.7% for patients of stage ?;the rates of anxiety and depression of ? stage were 1.18 times and 1.32 times than patients of?~? stages after 4w in radiotherapy.3.Fatigue was one of the side effects accompanied with radiotherapy.Till the four weeks after radiotherapy,serious fatigue occurred in 36.6% patients,and the rate achieved 57.1% after radiotherapy.The incidence of serious fatigue in females was higher than males in 4w radiotherapy;the incidence rate in female patients was 1.46 times of that in male patients after 4w in radiotherapy.The second part included 466 nasopharyngeal carcinoma patients4.In all 466 nasopharyngeal carcinoma patients,325 subjects were sensitive to radiation(69.7%)and 141 subjects were insensitive to radiation(30.3%).5.Pre-radiotherapy NI in nasopharyngeal carcinoma patients was an important factor for prediction of radiosensitivity.When NI=6 was set as the critical value in prediction,45.7% patients(pre-radiotherapy NI?6)were found insensitive to radiotherapy.The third part included 399 nasopharyngeal carcinoma patients6.COX regression analysis indicated that the independent prognostic factors were clinical staging(HR=2.655,95%CI:1.367~5.158,P=0.004),nutrition(HR=2.297,95%CI:1.231~4.288,P=0.009)and anxiety(HR=2.107,95%CI:1.154~3.847,P=0.015).7.COX predicting model of 5-year survival rate in nasopharyngeal carcinoma patients:)exp(428.0)5(PIXyearS,(28).PI<0.98 indicated favorable prognosis and a probability of 76.0% in 5-year survival rate;PI?0.98 indicated unfavorable prognosis and a probability of 63.6% in 5-year survival rate.8.With the progress of radiotherapy,dry mouth symptom was alleviated(P<0.05):grade ? dry mouth was reduced from 44.8% to 30.2% in 24 months after radiotherapy,with grade ? dry mouth from 14.9% to 0%.However,impaired hearing,open mouth difficulty and neck fibrosis were aggravated(P<0.05): the rates of grade ? impaired hearing,open mouth difficulty and neck fibrosis were increased within 6~48 month after radiotherapy by 13.0%,5.1% and 2.5%,respectively;while the rates of grade ?were 5.1%,0% and 1.3%.No statistical significance was found in lower cranial nerves injury rates of different times after radiotherapy(P>0.05).[Conclusion]1.Radiotherapy can cause the NI decrease in nasopharyngeal carcinoma patients,and the patients of stage ? are the high risk group for malnutrition during radiotherapy.2.Radiotherapy can aggravate the fatigue degree in nasopharyngeal carcinoma patients,and female patients are the high risk group for serious fatigue during radiotherapy.3.Radiotherapy can aggravate the degrees of anxiety and depression.Female or stage ? patients are the high risk group for anxiety and depression.Anxiety and depression onset are noticed earlier in female patients,and the anxiety onset is earlier in patients of stage ?,indicating that more attention need to be paid to the female and stage ? patients by medical personnel.4.Pre-radiotherapy NI in nasopharyngeal carcinoma patients is an important factor for prediction of radiosensitivity,and patients with NI?6 are the high risk group for radiation insensitivity.5.Poor nutritional status and anxiety before radiotherapy were the risk factors affecting patients' survival,and patients with PI?0.98 are the high risk group for unfavorable prognosis.6.The degree of dry mouth alleviate gradually after radiotherapy,but the degree of impaired hearing,open mouth difficulty and neck fibrosis aggravate gradually,indicating more emphasis should be drawn on the long-term radiation damage.It is significant not only reducing radiation injuries by pre-radiotherapy plan but also improving the survival quality in subsequent therapy. |
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