Background:Malnutrition is highly prevalent in patients with head and neck cancer, with relevant consequences in the treatment results.Methods:Multicenter observational study including 514 patients diagnosed with HNC. The morphofunctional assessment was carried out during the first 2 weeks of radiotherapy treatment. A correlation analysis between nutritional variables and groups of malnutrition, a multivariate logistic regression analysis, and a random forest analysis to select the most relevant variables to predict malnutrition were performed.Results:In total, 51.6% were undernourished (26.3% moderately and 25.3% severely). There was a negative correlation between morphofunctional variables and a positive correlation between hsCRP and well vs. moderate and well vs. severe malnutrition groups. The increase in different bioelectrical and ultrasound parameters was associated with a lower risk of moderate and severe malnutrition when groups with different degrees of malnutrition were compared. To predict the importance of morphofunctional variables on the risk of undernutrition, a nomogram, a random forest, and decision tree models were conducted. For the well vs. moderate, for the well vs. severe, and for the moderate vs. severe malnutrition groups, FFMI (cut-off < 20 kg/m2), BCMI (cut-off < 7.6 kg/m2), and RF-Y-axis (cut-off < 0.94 cm), respectively, were the most crucial variables, showing a greater probability of mortality in the two last comparisons.Conclusions:Malnutrition is very prevalent in HNC patients. Morphofunctional assessment with simple tools such as electrical impedance and muscle ultrasound allows an early nutritional diagnosis with an impact on survival. Therefore, these techniques should be incorporated into the daily clinical attention of patients with HNC.
背景：头颈癌患者中营养不良现象极为普遍，这对治疗结果产生了显著影响。 方法：本研究为多中心观察性研究，共纳入514例确诊头颈癌患者。在放疗治疗的前两周内进行形态功能评估。通过营养变量与营养不良组间的相关性分析、多变量逻辑回归分析以及随机森林分析，筛选出预测营养不良的最关键变量。 结果：总计51.6%的患者存在营养不良（26.3%为中度，25.3%为重度）。形态功能变量间呈负相关，而高敏C反应蛋白在营养良好组与中度营养不良组、营养良好组与重度营养不良组间呈正相关。比较不同营养不良程度组别时，多种生物电阻抗和超声参数的升高与中度和重度营养不良风险降低相关。为评估形态功能变量对营养不良风险的重要性，研究构建了列线图、随机森林及决策树模型。在营养良好组与中度营养不良组、营养良好组与重度营养不良组、中度与重度营养不良组的比较中，脂肪游离质量指数（临界值<20 kg/m²）、体细胞质量指数（临界值<7.6 kg/m²）和股直肌Y轴厚度（临界值<0.94 cm）分别成为最关键变量，后两项比较中这些变量显示出更高的死亡风险。 结论：头颈癌患者中营养不良极为常见。通过电阻抗和肌肉超声等简易工具进行形态功能评估，可实现早期营养诊断并影响生存预后。因此，这些技术应纳入头颈癌患者的日常临床诊疗中。
肿瘤(癌症)患者之家