肺癌患者营养治疗课件

晚期肺癌患者营养支持治疔北京大学第三医院肿瘤化疗科梁莉晚期肺癌患者营养支持治疔1晚期肺癌治疗现状化疗营养支持治疗可以增加耐受性,减少不良反应·放疗·靶向治疗(EGFR、ALK、ROS1、C-MET针对免疫检测点的治疗(PD-1、PD-L1….晚期肺癌治疗现状2化疗前体重丢失大于5%者生存期缩短sweightlessbeforeche0.2.is5%weightlossbeforechemotherapy>s%weightlossduringchemotherapy摘自孙凌宇教授幻灯化疗前体重丢失大于5%者生存期缩短357例肿瘤患者营养评估DistributionaccordingtothesiteofCancerFrequencyofSeverityofMalnutrition(P(Lip/oralcavity23(4035%SGAsCOLLarynx9(15.79%)BonetumeLymphoma20351%)BMlIClassificationofParticipantsaSGA-BCategonesSeverelyunderweight(15-16)Underweight(16-185)14(2456%)Overweight(25-30)3(526%)Obeseclass1(30-35)1(.5Sharmad,etal.asianPacJCancerprev.2015摘自孙凌宇教授幻灯57例肿瘤患者营养评估4FrequencyofVariablesAffectingPatients'NutritionalStatus(PG-SGAScore)ClinicalcharacteristicsNumberofpatientsUnchanged9(15.79%)Lessthanusual46(8070%22(3860%42(7368g10%13(281%3=57(1228%Weightunchanged15(26.32%)PhysicalactiRarelyoutofbed1(1.75%)Lessthanhalftheda21(3684%Fairlynormalactivities24(42.11%)Morethanhalfthedayinbed/chair10(17-549b)NormalnolimitationPhysicalExaminationSevere14(2456%)21(3684%Mild11(19.30%)11(19.30%)Sharmad.etal.AsianPacJCancerPrev.2015.摘自孙凌宇教授幻灯FrequencyofVariablesAffecti5营养治疗使存在营养丌良的化疗患者获益延长生存提高生活质量06121824303642485460WeeksPN+Chemotherapy-relatedsideeffectsPN+(=42)PN-(n=40)P-valtMucositis(%▲▲A▲Diarrhoea(%)<0.02000Polyneuropathy(%6Leucopoenia(%)NSSurvivaltime[month]降低化疗副反应SignificancelevelP<0.0570EssenbreisMHeroldAlolorectalDis.2010Oct;12(10Online):e190-199营养治疗使存在营养丌良的化疗患者获益6ORIGINALARTICLEEarlyWeightLossduringChemoradiotherapyHasaDetrimentalImpactonoutcomeinNSCLCKarinJC.Sanders,MD,aLizzaE.Hendriks.MD,EstherG.C.Troost,MDPhD,dGerbenpBootsma.MDPhD.RuudM.A.HoubenMSccAnnemieMWJSchols,PhD,Anne-MarieCDingemans,MD,PhDDepartmentofrespiratoryMedicine,NUTRIMSchoolofNutritionandTranslationalResearchinMetabolism,MaastrichtUniversityMedicalCentre,Maastricht,TheNetherlandsepartmentofRespiratoryMedicine,GROWSchoolforOncologyandDevelopmentalBiology,MaastrichtUniversityedicalCentre.Maastricht.TheNetherlandsDepartmentofRadiationOncology(MAASTROClinic),GROWSchoolforOncologyandDevelopmentalBiology,MaastrichtniversityMedicalCentre,Maastricht,TheNetherlandsReceived17November2015;revised16February2016;accepted21February2016Availableonline-29February201Theaimofthisstudywastoassesstheeffectofearlyweightlossbeforetheonsetofradiationsphagitisonoverallsurvival(OS)inpatientswithnon-smallcelllungcancertreatedwithconcurrentchemoradiotherapy.Earlyweightlosswasdefinedasweightlossofmorethan5%betweenthestartandthirdweekofRTORIGINALARTICLE7AdvancedstageNSCLC(n=287)HistologyAnothermalignancyNeuroendocrinewithin5years(n=15)carcinoma(n=5)Preexistingswallowing>5%weightlosspriordifficulties(n=11)totreatment(n=58)20%WeightnotrecordedDiscontinuedCCRTPriortotreatment(n=9)StartrT(n=9)(n=14)Week3RT(n=15)<5%weightlosspriortotreatment(n=151)<5%earlyweightloss>5%earlyweightlossn=125)(n=26)Figure1.FlowchartdetailingthestudypopulationAdvancedstageNSCLC(n=287)8Table2.ComparisonofClinicalandTreatmentCharacteristicsbetweenPatientswithNoEarlyWeightLossandwithEarly<5%EarlyWeight>5%EarlyWeightCharacteristicoss(n=125)Loss(n-260.2763ightchangebeforetreat-0.58±12ightchangeduringinductionchemotherapy,kg-0.27±2.6076±3.10.077WHOPS.376Charlsoncomorbidityinde4±1.8Diseasestage,x52.80.21361,50.195T3.T4Clinicalnodalstatus.Histologicaldiagnosis,4.642.3Adenocarcinomargecellcarcin20.8Totaldoseradiotherapy,Gy655(60.169.0)0,132Grosstumorvolume79.9651.2-158.2181.7(43.5280.8)0.24820.0(14.0-26.318,2(16.5-29.2Median(interquartilerange)ldHealthOrganizationperformancescoreor;N,node:NSCLCNOS,nonamallcelllungcancernototherwisespecifiedTable2.ComparisonofClinica9WeightLoss,WeightLoss%(n=125)%(n=26)pvalueP=0.017neutropenicfever2.0ofRT,grade>2erapy:RT,radiotherapy.Table4.MultivariateAnalysesforPredictorsofOverallSurvivalVariable29-3293Pvalue95%cAgeatdiagnosis1.3530.8892.06CategorieweigntlossWHOPS1.8881.201-2.960.006Clinicaltumorstatus3040.839-2.0270.238eTxcT1,cT2Clinicalnodalstatus2.8831.382-6.015Histologicaldiagnosis1.6350.9502.8140.076LogrnkD18681.095-3.1870.022earlyweightloss如,曰WHOPS,worldHealthOrganizationperformancescore:HR,hazardratio:CI.WeightLoss,WeightLoss10肺癌患者营养治疗课件11肺癌患者营养治疗课件12肺癌患者营养治疗课件13肺癌患者营养治疗课件14肺癌患者营养治疗课件15肺癌患者营养治疗课件16肺癌患者营养治疗课件17肺癌患者营养治疗课件18肺癌患者营养治疗课件