Background: Acute gastrointestinal (GI) toxicity is a frequent adverse effect of pelvic radiotherapy (RT) in prostate cancer and predicts chronic complications. Identifying predictive factors, especially modifiable ones, is essential to guide supportive interventions.Methods: This prospective observational non-randomized cohort included 32 patients with prostate cancer treated with pelvic RT. Patient-reported GI symptoms were measured using the EORTC QLQ-PRT20 module, and clinician-reported toxicity was graded with CTCAE v5.0. Associations between GI outcomes and clinical, demographic, and lifestyle variables—including the systemic immune-inflammation index (SII) and the Diet Quality Index (DQI)—were examined using uni- and multivariable models.Results: Ninety-one percent of patients reported worsening GI symptoms during RT (median QLQ-PRT20 score increased from 4.2 to 26.8,p< 0.0001). In our final model, higher SII values were independently associated with greater symptom worsening (p= 0.001), whereas obesity (p= 0.03) and higher diet quality (p= 0.015) were protective. No significant interactions were found between SII and BMI or DQI, although diet quality partially attenuated the association between SII and symptom progression. Clinician-reported grade ≥ 2 GI toxicity occurred in 41% of patients and was significantly less frequent in obese individuals (adjusted OR = 0.04, 95% CI 0.0009–0.57,p= 0.02), with higher SII tending to increase risk and higher DQI showing a protective trend.Conclusions: In this exploratory analysis, systemic inflammation was associated with increased GI symptom burden, whereas obesity appeared to mitigate both patient- and clinician-reported outcomes. Higher dietary quality was similarly protective for patient-reported symptoms and showed a non-significant protective trend for clinician-reported toxicity. These findings highlight the interplay between metabolic and inflammatory status in shaping RT-related GI outcomes and support integrating nutritional and inflammatory profiling to guide personalized preventive strategies.
背景：急性胃肠道毒性是前列腺癌盆腔放疗中常见的不良反应，并可预示慢性并发症。识别预测因素，尤其是可干预因素，对于指导支持性干预至关重要。 方法：这项前瞻性观察性非随机队列研究纳入了32例接受盆腔放疗的前列腺癌患者。采用EORTC QLQ-PRT20模块评估患者报告的胃肠道症状，使用CTCAE v5.0标准对临床医生报告的毒性进行分级。通过单变量和多变量模型分析胃肠道结局与临床、人口统计学及生活方式变量（包括全身免疫炎症指数和膳食质量指数）之间的关联。 结果：91%的患者在放疗期间报告胃肠道症状加重（QLQ-PRT20评分中位数从4.2升至26.8，p<0.0001）。在最终模型中，较高的SII值与症状加重独立相关（p=0.001），而肥胖（p=0.03）和较高的膳食质量（p=0.015）具有保护作用。尽管膳食质量部分减弱了SII与症状进展之间的关联，但未发现SII与BMI或DQI存在显著交互作用。41%的患者出现临床医生报告的≥2级胃肠道毒性，肥胖患者发生率显著较低（校正OR=0.04，95%CI 0.0009–0.57，p=0.02），较高SII值倾向于增加风险，较高DQI值则显示保护趋势。 结论：本探索性分析表明，全身性炎症与胃肠道症状负担加重相关，而肥胖似乎能改善患者报告和临床医生报告的结局。较高的膳食质量对患者报告症状同样具有保护作用，并对临床医生报告的毒性显示出非显著的保护趋势。这些发现凸显了代谢状态与炎症状态在影响放疗相关胃肠道结局中的相互作用，支持整合营养与炎症评估以指导个体化预防策略。
肿瘤(癌症)患者之家