肺癌患者營養(yǎng)治療課件

晚期肺癌患者營養(yǎng)支持治疔北京大學(xué)第三醫(yī)院腫瘤化療科梁莉晚期肺癌患者營養(yǎng)支持治疔1晚期肺癌治療現(xiàn)狀化療營養(yǎng)支持治療可以增加耐受性,減少不良反應(yīng)·放療·靶向治療(EGFR、ALK、ROS1、C-MET針對(duì)免疫檢測點(diǎn)的治療(PD-1、PD-L1….晚期肺癌治療現(xiàn)狀2化療前體重丟失大于5%者生存期縮短sweightlessbeforeche0.2.is5%weightlossbeforechemotherapy>s%weightlossduringchemotherapy摘自孫凌宇教授幻燈化療前體重丟失大于5%者生存期縮短357例腫瘤患者營養(yǎng)評(píng)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摘自孫凌宇教授幻燈57例腫瘤患者營養(yǎng)評(píng)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.摘自孫凌宇教授幻燈FrequencyofVariablesAffecti5營養(yǎng)治療使存在營養(yǎng)丌良的化療患者獲益延長生存提高生活質(zhì)量06121824303642485460WeeksPN+Chemotherapy-relatedsideeffectsPN+(=42)PN-(n=40)P-valtMucositis(%▲▲A▲Diarrhoea(%)<0.02000Polyneuropathy(%6Leucopoenia(%)NSSurvivaltime[month]降低化療副反應(yīng)SignificancelevelP<0.0570EssenbreisMHeroldAlolorectalDis.2010Oct;12(10Online):e190-199營養(yǎng)治療使存在營養(yǎng)丌良的化療患者獲益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肺癌患者營養(yǎng)治療課件11肺癌患者營養(yǎng)治療課件12肺癌患者營養(yǎng)治療課件13肺癌患者營養(yǎng)治療課件14肺癌患者營養(yǎng)治療課件15肺癌患者營養(yǎng)治療課件16肺癌患者營養(yǎng)治療課件17肺癌患者營養(yǎng)治療課件18肺癌患者營養(yǎng)治療課件19肺癌患者營養(yǎng)治療課件20肺癌患者營養(yǎng)治療課件21肺癌患者營養(yǎng)治療課件22肺癌患者營養(yǎng)治療課件23肺癌患者營養(yǎng)治療課件24肺癌患者營養(yǎng)治療課件25肺癌患者營養(yǎng)治療課件26肺癌患者營養(yǎng)治療課件27肺癌患者營養(yǎng)治療課件28肺癌患者營養(yǎng)治療課件29肺癌患者營養(yǎng)治療課件30肺癌患者營養(yǎng)治療課件31肺癌患者營養(yǎng)治療課件32肺癌患者營養(yǎng)治療課件33肺癌患者營養(yǎng)治療課件34肺癌患者營養(yǎng)治療課件35肺癌患者營養(yǎng)治療課件36肺癌患者營養(yǎng)治療課件37晚期肺癌患者營養(yǎng)支持治疔北京大學(xué)第三醫(yī)院腫瘤化療科梁莉晚期肺癌患者營養(yǎng)支持治疔38晚期肺癌治療現(xiàn)狀化療營養(yǎng)支持治療可以增加耐受性,減少不良反應(yīng)·放療·靶向治療(EGFR、ALK、ROS1、C-MET針對(duì)免疫檢測點(diǎn)的治療(PD-1、PD-L1….晚期肺癌治療現(xiàn)狀39化療前體重丟失大于5%者生存期縮短sweightlessbeforeche0.2.is5%weightlossbeforechemotherapy>s%weightlossduringchemotherapy摘自孫凌宇教授幻燈化療前體重丟失大于5%者生存期縮短4057例腫瘤患者營養(yǎng)評(píng)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摘自孫凌宇教授幻燈57例腫瘤患者營養(yǎng)評(píng)估41FrequencyofVariablesAffectingPatients'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.摘自孫凌宇教授幻燈FrequencyofVariablesAffecti42營養(yǎng)治療使存在營養(yǎng)丌良的化療患者獲益延長生存提高生活質(zhì)量06121824303642485460WeeksPN+Chemotherapy-relatedsideeffectsPN+(=42)PN-(n=40)P-valtMucositis(%▲▲A▲Diarrhoea(%)<0.02000Polyneuropathy(%6Leucopoenia(%)NSSurvivaltime[month]降低化療副反應(yīng)SignificancelevelP<0.0570EssenbreisMHeroldAlolorectalDis.2010Oct;12(10Online):e190-199營養(yǎng)治療使存在營養(yǎng)丌良的化療患者獲益43ORIGINALARTICLEEarlyWeightLossduringChemoradiotherapyHasaDetrimentalImpactonoutcomeinNSCLCKarinJC.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%betweenthestartandthirdweekofRTORIGINALARTICLE44AdvancedstageNSCLC(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)45Table2.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,nonamallcelllungcancernototherw