营养指标对鼻咽癌放射性颅底坏死患者创面修复影响的回顾性分析

doi:10.6040/j.issn.1673-3770.0.2024.244

摘要/Abstract

摘要： 目的探讨鼻咽癌放射性颅底坏死患者相关营养指标对创面修复成功与否的影响,并为临床提供指导。方法回顾性分析因放射性颅底坏死而接受内镜下颅底坏死组织清除并组织创面修复术的100例临床资料完整病例。采用单因素和多因素Logistic回归分析营养指标对手术创面修复的影响。同时使用检验来分析修复成功与术后颈内动脉出血之间的关系,并采用连续性校正的检验处理理论频数1≤T<5情况。结果单因素分析显示,正常体质量［体质量指数(body mass index, BMI)=(18.5~23.9)kg/m²］患者的手术修复成功率是低体质量(BMI<18.5 kg/m²)患者的6.43倍(OR=6.43, P<0.001),而肥胖患者(BMI≥24 kg/m²)的成功率是低体质量患者的27倍(OR=27.00, P=0.003)。此外总蛋白(OR=1.10, P=0.035)、白蛋白(OR=1.29, P=0.001)、总胆固醇(OR=1.69, P=0.019)和血红蛋白(OR=1.04, P=0.005)均与手术修复成功显著相关。尽管外周血淋巴细胞计数与手术修复成功有一定关联(OR=2.32, P=0.068),但其差异没有统计学意义。控制营养状况评分(controlling nutritional status, CONUT)评分≥2的患者手术修复成功率显著降低(OR=0.20, P=0.042)。多因素分析进一步校正了混杂因素后,正常体质量和肥胖患者的手术修复成功率仍显著高于低体质量患者(OR分别为9.99、77.14,P均<0.001)。然而,其他营养指标的独立影响在多因素分析中减弱。此外,修复成功组在3个月之后的颈内动脉出血率显著低于修复失败组(4.62% vs. 28.57%,P=0.002)。结论本研究的结论表明,BMI是影响手术创面修复成功的重要因素,其中正常体质量和肥胖患者的手术修复成功率显著高于低体质量患者。此外总蛋白、白蛋白、总胆固醇和血红蛋白等营养指标也与手术修复成功显著相关,而较高的CONUT评分则与成功率降低相关。然而在多因素分析中,BMI的独立影响仍然显著,而其余营养指标的独立影响有所减弱。修复成功组在3个月之后的颈内动脉出血率显著低于修复失败组,提示手术修复成功可能降低术后并发症的风险。

关键词: 鼻咽癌, 放射性颅底坏死, 营养, 内镜手术, 颈内动脉

Abstract: Objective The aim of this study was to investigate the influence of relevant nutritional indicators on the success of trauma repair in patients with nasopharyngeal carcinoma with osteoradionecrosis of the skull base, and to provide clinical guidance. Methods We retrospectively analyzed 100 clinically documented complete cases who underwent endoscopic removal of necrotic tissue from the skull base and tissue trauma repair for skull base osteoradionecrosis. The effects of nutritional indicators on surgical wound repair were analyzed using univariate and multivariate Logistic regression. Also chi-square tests were used to analyze the relationship between repair success and postoperative internal carotid artery hemorrhage, and continuity-corrected chi-square tests were used to deal with the theoretical frequency 1≤T < 5 cases. Results Univariate analysis showed that the success rate of surgical repair in normal-weight ［body mass index(BMI)=(18.5-23.9)kg/m²］ patients was 6.43 times higher(OR=6.43, P<0.001)than that in low-body-weight(BMI<18.5 kg/m²)patients, whereas the success rate in obese patients(BMI≥24 kg/m²)was weight patient by 27 times(OR=27.00, P=0.003). In addition, total protein(OR=1.10, P=0.035), albumin(OR=1.29, P=0.001), total cholesterol(OR=1.69, P=0.019), and hemoglobin(OR=1.04, P=0.005)were significantly associated with successful surgical repair. Although peripheral blood lymphocyte count was associated with successful surgical repair(OR=2.32, P=0.068), the difference did not reach statistical significance. Surgical repair success was significantly lower in patients with a Controlling Nutrition Status(CONUT)score of ≥2(OR=0.20, P=0.042). After multivariate analysis further corrected for confounders, surgical repair success rates remained significantly higher in normal-weight and obese weight than in low-weight patients(OR=9.99 and 77.14, respectively; both P<0.001). However, the independent effects of other nutritional indicators were diminished in the multivariate analysis. In addition, the rate of internal carotid artery bleeding after three months was significantly lower in the successful repair group than in the failed repair group(4.62% vs. 28.57%, P=0.002). Conclusion The findings of this study suggest that BMI is a important factor that influencing the success of surgical wound repair, with normal weigh and obese patients having significantly higher surgical repair success rates than low weight patients. In addition, nutritional indices such as total protein, albumin, total cholesterol, and hemoglobin were also significantly associated with surgical repair success, whereas higher CONUT scores were associated with lower success rate. However the independent effect of BMI remained significant in the multivariate analysis, while the independent effects of the remaining nutritional metrics were attenuated. The rate of internal carotid artery bleeding after three months was significantly lower in the successful repair group than in the failed repair group, suggesting that successful surgical repair may reduce the risk of postoperative complications.

Key words: Nasopharyngeal carcinoma, Skull base osteoradionecrosis, Nutrition, Endoscopic surgery, Internal carotid artery

中图分类号:

R766.3

孙芳,谢楚波,邱前辉. 营养指标对鼻咽癌放射性颅底坏死患者创面修复影响的回顾性分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 59-68.

SUN Fang, XIE Chubo, QIU Qianhui. Retrospective analysis of nutritional indexes and their impact on wound healing in patients with radiation-induced skull base osteoradionecrosis after treatment with nasopharyngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 59-68.

参考文献 33

[1]	Almomani MH, Zulfiqar H, Nagalli S. Nasopharyngeal Carcinoma(NPC, Lymphoepithelioma)[M]. Treasure Island(FL): StatPearls Publishing,2024
[2]	Wong KCW, Hui EP, Lo KW, et al. Nasopharyngeal carcinoma: an evolving paradigm[J]. Nat Rev Clin Oncol, 2021, 18(11): 679-695. doi:10.1038/s41571-021-00524-x
[3]	Mao YP, Tang LL, Chen L, et al. Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy[J]. Chin J Cancer, 2016, 35(1): 103. doi:10.1186/s40880-016-0167-2
[4]	Deng J, He Y, Sun XS, et al. Construction of a comprehensive nutritional index and its correlation with quality of life and survival in patients with nasopharyngeal carcinoma undergoing IMRT: a prospective study[J]. Oral Oncol, 2019, 98: 62-68. doi:10.1016/j.oraloncology.2019.09.014
[5]	Pan XX, Wang CH, Li R, et al. Applicability of the nutrition risk screening 2002 combined with a patient-generated subjective global assessment in patients with nasopharyngeal carcinoma[J]. Cancer Manag Res, 2020, 12: 8221-8227. doi:10.2147/CMAR.S261945
[6]	Li XY, Sun XS, Liu SL, et al. The development of a nomogram to predict post-radiation necrosis in nasopharyngeal carcinoma patients: a large-scale cohort study[J]. Cancer Manag Res, 2019, 11: 6253-6263. doi:10.2147/CMAR.S197841
[7]	Tian YM, Guan Y, Xiao WW, et al. Long-term survival and late complications in intensity-modulated radiotherapy of locally recurrent T1 to T2 nasopharyngeal carcinoma[J]. Head Neck, 2016, 38(2): 225-231. doi:10.1002/hed.23880
[8]	Hirose K, Sato M, Kato T, et al. Profile analysis of adverse events after boron neutron capture therapy for head and neck cancer: a sub-analysis of the JHN002 study[J]. J Radiat Res, 2022, 63(3): 393-401. doi:10.1093/jrr/rrac012
[9]	Leonetti JP, Weishaar JR, Gannon D, et al. Osteoradionecrosis of the skull base[J]. J Neurooncol, 2020, 150(3): 477-482. doi:10.1007/s11060-020-03462-3
[10]	Huang WB, Wong STS, Chan JYW. Role of surgery in the treatment of osteoradionecrosis and its complications after radiotherapy for nasopharyngeal carcinoma[J]. Head Neck, 2018, 40(2): 369-376. doi:10.1002/hed.24973
[11]	Li WP, Zhang HK, Lu HY, et al. Clinical outcomes of salvage endoscopic nasopharyngectomy for patients with advanced recurrent nasopharyngeal carcinoma[J]. Front Oncol, 2021, 11: 716729. doi:10.3389/fonc.2021.716729
[12]	高俊潇, 邱前辉. 黏膜瓣在鼻咽癌放疗后鼻内镜手术修复颅底组织缺损中的应用[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 46-50. doi:10.6040/j.issn.1673-3770.0.2019.049 GAO Junxiao, QIU Qianhui. Efficacy of endoscopic surgery using two types of flaps to reconstruct the skull base after radiotherapy for nasopharyngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 46-50. doi:10.6040/j.issn.1673-3770.0.2019.049
[13]	李峰, 蔡泽虹, 许卫华, 等. 鼻黏膜瓣在鼻咽癌放疗后鼻咽颅底骨质裸露修复中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(10): 929-934. doi:10.13201/j.issn.2096-7993.2021.10.014 LI Feng, CAI Zehong, XU Weihua, et al. Clinical application of nasal mucosa flap in the repair of nasopharyngeal skull base bone exposure after radiotherapy for nasopharyngeal carcinoma[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(10): 929-934. doi:10.13201/j.issn.2096-7993.2021.10.014
[14]	Ghaly P, Iliopoulos J, Ahmad M. The role of nutrition in wound healing: an overview[J]. Br J Nurs, 2021, 30(5): 38-42. doi:10.12968/bjon.2021.30.5.S38
[15]	方积乾. 卫生统计学[M]. 7版. 北京:人民卫生出版社, 2016:399
[16]	Ignacio de Ulíbarri J, González-Madro o A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population[J]. Nutricion hospitalaria, 2005, 20(1): 38-45
[17]	Demir M, Demircan NC. The CONUT score is prognostic in esophageal cancer treated with chemoradiotherapy[J]. Saudi J Gastroenterol, 2023, 29(2): 119-126. doi:10.4103/sjg.sjg_384_22
[18]	Lin Q, Lin SC, Chen W, et al. Controlling Nutritional Status(CONUT)score is a prognostic marker for laryngeal cancer patients with curative resection[J]. Head Neck, 2022, 44(12): 2834-2841. doi:10.1002/hed.27206
[19]	何悦, 侯劲松, 李晓光, 等. 下颌骨放射性骨坏死临床诊疗专家共识[J]. 中国口腔颌面外科杂志, 2017, 15(5): 445-456. doi:10.19438/j.cjoms.2017.05.015 HE Yue, HOU Jinsong, LI Xiaoguang, et al. Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible[J]. China Journal of Oral and Maxillofacial Surgery, 2017, 15(5): 445-456. doi:10.19438/j.cjoms.2017.05.015
[20]	茆松, 唐如, 刘世贤, 等. 鼻咽癌放射性颅底骨坏死的治疗现状与进展 [J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(11): 1354-8. 10.3760/cma.j.cn115330-20211108-00725
[21]	兰桂萍, 翁敬锦, 李敏, 等. 鼻咽癌放疗后放射性颅底坏死的临床分型分期及治疗策略 [J]. 临床耳鼻咽喉头颈外科杂志, 2024, 38(6): 490-5. 10.13201/j.issn.2096-7993.2024.06.007
[22]	高可雷, 章华, 谢志海, 等. 颞肌瓣在鼻咽癌放疗后肿瘤或坏死灶切除术后修复重建中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(11): 1288-1293. doi:10.3760/cma.j.cn115330-20211206-00774 GAO Kelei, ZHANG Hua, XIE Zhihai, et al. Application of temporalis muscle flap in repair and reconstruction after the resection of tumor or necrotic foci following radiotherapy of nasopharyngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2022, 57(11): 1288-1293. doi:10.3760/cma.j.cn115330-20211206-00774
[23]	中国抗癌协会肿瘤营养专业委员会, 中华医学会肠外肠内营养学分会. 鼻咽癌患者的营养治疗共识[J]. 肿瘤代谢与营养电子杂志, 2021, 8(6): 600-604 Chinese Society of Nutritional Oncology, Chinese Society for Parenteral and Enteral Nutrition. Expert opinion on nutritional treatment for patients with nasopharyngeal carcinoma[J]. Electron J Metab Nutr Cancer, 2021, 8(6): 600-604
[24]	Ivkovic N, Martinovic D, Kozina S, et al. Quality of life and aesthetic satisfaction in patients who underwent the “commando operation” with pectoralis major myocutaneus flap reconstruction-a case series study[J]. Healthcare, 2022, 10(9): 1737. doi:10.3390/healthcare10091737
[25]	Bozzetti F, Cotogni P. Nutritional issues in head and neck cancer patients[J]. Healthcare, 2020, 8(2): 102. doi:10.3390/healthcare8020102
[26]	Wu CY, Lin YH, Lo WC, et al. Nutritional status at diagnosis is prognostic for pharyngeal cancer patients: a retrospective study [J]. Eur Arch Otorhinolaryngol, 2022, 279(7): 3671-3678. doi:10.1007/s00405-021-07222-5
[27]	Miao JJ, Wang L, Ong EHW, et al. Effects of induction chemotherapy on nutrition status in locally advanced nasopharyngeal carcinoma: a multicentre prospective study[J]. J Cachexia Sarcopenia Muscle, 2023, 14(2): 815-825. doi:10.1002/jcsm.13196
[28]	Xu H, Liu L, Xie JW, et al. A pre-operative high-protein diet can improve the serum albumin levels of patients undergoing total knee arthroplasty[J]. Chin Med J, 2023, 136(4): 491-493. doi:10.1097/CM9.0000000000002209
[29]	Irungu CW, Oburra HO, Ochola B. Prevalence and predictors of malnutrition in nasopharyngeal carcinoma[J]. Clin Med Insights Ear Nose Throat, 2015, 8: 19-22. doi:10.4137/CMENT.S12119
[30]	Chakraborty S, Doktorova M, Molugu TR, et al. How cholesterol stiffens unsaturated lipid membranes[J]. Proc Natl Acad Sci USA, 2020, 117(36): 21896-21905. doi:10.1073/pnas.2004807117
[31]	Ezeani IU, Ugwu ET, Adeleye FO, et al. Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study[J]. Endocr Regul, 2020, 54(3): 207-216. doi:10.2478/enr-2020-0023
[32]	Peng W, Yao MH, Zou K, et al. Postoperative controlling nutritional status score is an independent risk factor of survival for patients with small hepatocellular carcinoma: a retrospective study[J]. BMC Surg, 2021, 21(1): 338. doi:10.1186/s12893-021-01334-9
[33]	Wang X, Yang M, Ge YZ, et al. Association of systemic inflammation and malnutrition with survival in nasopharyngeal carcinoma undergoing chemoradiotherapy: results from a multicenter cohort study[J]. Front Oncol, 2021, 11: 766398. doi:10.3389/fonc.2021.766398

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed