| Part IApplication and clinical significance of the preoperative nutritional risk screening in hepatocellular carcinoma patients underwent TACEObjectiveTo evaluate the nutritional risk of hepatocellular carcinoma who underwent TACE and analyze the relationship between nutritional risk and its clinical outcomes and clinical parameters, further analysis the influencing factors.MethodsThis is a prospective and descriptive study,148 patients who hospitalized and underwent TACE between Feb 2014 to July 2014 were enrolled. Compare the differences between sex, age, etiology, BMI, ALB, PA, Child-Pugh classification and BCLC staging according to the screening results, essential information will be collected after admission, nutritional risk screening in them will be done by using NRS-2002, calculate patients’BMI, also analysis the effect on the hospitalization time, medical costs, postoperative complications, and survival rates. All of them were followed up within three months, totally of 18 months. Logistic regression analysis was used to analyze the influencing factors of nutritional risk.Results1. Results of nutritional risk screening:148 patients were recruited, according to NRS-2002, there were no significant differences of the prevalence of nutritional risk of sex (male 51.64% versus female 46.15%, P>0.05) and the etiology of hepatocellular carcinoma (P>0.05), but difference exited in ages (age<65 44.44% versus age≥65 63.27%, P<0.05). There was no statistical difference among BMI classification of the prevalence of the nutritional risk (BMI<18.5kg/m2 was 58.82%,18.5kg/m2≤BMI<24kg/m2 was 49.55%, BMI>24 kg/m2 was 50.00%, P>0.05). Patients with nutritional risk showed a lower mean serum ALB (33.77±6.10 g/L versus 42.32±4.10 g/L, P<0.01) and PA (98.40±32.34 mg/L versus 155.98±35.39 mg/L, P<0.01). The incidence rate of nutritional risk was 32% for Child-pugh grading A, and 89.58% for Child-pugh grading B (P<0.05). In Barcelona clinical liver cancer staging system, prevalence rate was 40.00% for phase A,46.43% for phase B and 58.21% for phase C (P<0.05).2. Results of clinical outcomes:Patients with nutritional risk showed a longer hospital staying(6.47±2.02 days versus 5.07±1.60 days, P<0.05) and higher hospitalization expenses (￥21194.46±4806.03 versus ￥16306.60±3458.16, P<0.05)than non-nutritional risk patients. There were no significant differences in the occurrence the complications between the two groups (65.75% versus 76%, P=0.171). The cumulative survival probability of patients at 6,12 and 18 months were:89%,79% and 58% respectively. Kaplan-Meier survival analysis and univariate log-rank test showed that NRS-2002 was significantly associated with the survival rates(P<0.05).3. Results of Logistic regression analysis:It was showed that Barcelona clinical liver cancer staging system, ALB and PA were significant related to the incidence of nutritional risk, but etiology, Child-pugh grading and BMI were not the independent determinants of nutritional risk of patients with hepatocellular carcinoma.4. Preoperation nutritional support rate was 20.27%(30 patients), and parenteral nutrition was applied to all of them.Conclusion1. The incidence of preoperation nutritional risk was 50.68%, more attention should be paid to the preoperation nutritional risk screening for patients underwent TACE.2. Longer hospital staying, higher hospitalization expenses and lower survival rates were observed in patients’who were at nutritional risk, but it did not associated with the appearance of complications after TACE, the results still need further study.3. Nutritional risk was associated with patients’ age, liver function, Barcelona clinical liver cancer staging system, ALB and PA, but was not associated with sex, etiology and BMI. Logistic regression showed that he influencing factors of nutritional risk were Barcelona clinical liver cancer staging system, ALB and PA.Part ⅡStudy on the effect of nutritional care interventions to the patients with hepatocellular carcinoma who underwent TACEObjectives1. To understand the nutritional and dietary requirements of patients with hepatocellular carcinoma who underwent TACE.2. To investigate and describe the quality of life of patients with liver cancer after they received interventional therapy. To explore whether such interventions will have a positive effect on patients’liver function, the incidence rate of nutritional risk and quality of life after discharge.MethodsTotally 142 patients from the department of gastroenterology, general surgery department and intervention therapy department who had undergone TACE from Dec 2013 to Apr 2014 were collected. Self-made questionnaires had been used to investigate the patients’ nutritional and dietary requirements and the health education methods they wanted. According the results,105 patients from the department of gastroenterology who had undergone TACE from June 2014 to Jan 2015 were selected and randomly divided into the interventional group (n=52) and the control group (n=53). A nutritional care intervention program had been made. The interventional group received the nutritional care intervention program, whereas the control group only received usual therapy and care. The sociodemographic characteristics, liver function parameters (ALT, AST, GGT and ALB), nutritional risk and quality of life (tested by EORTC QLQ-C30) were collected at baseline,1-month and 3-month after discharge.Results1. Interventional therapy patients had a high level of demand for nutrition knowledge. The greatest demand was the perioperative notes about diet (98.60%), which is followed by the recommended or restricted food (95.80%) and the key point of prevention of complications (88.70%). Both of the elderly and the young patients preferred the brochures, one-to-one health education pattern and experience exchanges(P>0.05).2. After TACE at the first month and the third month, there were no significant differences when comparing to the baseline data(P>0.05). For the ALB, both of the two groups declined at first and then rose again, the interventional group had a higher level of ALB than the control group when compared at the third month. (P=0.048).3. Both of the two groups had a poor quality of life after the interventional therapy. The score of global health status was low, the highest score of functional scales was social functioning while the lowest is emotion functioning; for the symptoms scales nausea and vomiting gradually released at the end of the therapy, but pain and fatigue would still had a negative effect on patients’ quality of life; for the six single scales, appetite loss and insomnia had the worst impact, and both were under the economic burden.4. After the nutritional care intervention, the incidence rate interventional group of nutritionao risk was 50%,50% and 44% when measured at admission, first month and the third month, the incidence rate control group of nutritionao risk was 52%,54% and 50% when measured at admission, first month and the third month The interventional group had an increase in appetite (P<0.05) and an improvement in constipation (P<0.05), all of the functional scales made a progress in some degree (P<0.05) compared by EORTC QLQ-C30. Conclusion1. TACE can cause liver function injury, and it will back to the preoperation level at one month. Nutrition care program can improve ALB level. The results still need to be validated by expanding the sample size and the intervention time.2. Patients who have undergone TACE have a poor quality of life. According to the EORTC QLQ-C30 scale, the lowest is emotion functioning of the functional areas; pain and fatigue is the continuous negative influencing factors of the symptoms scales; losing appetite pose the greatest problem of the six single items.3. After there month of the intervention, there was no statistical differences between two groups, but a decline trend was viewed for interventional group. Also can provide TACE patients with a good quality of life on some level, especially on promoting appetite and improving constipation (P<0.05). Longer duration of intervention can improve patients’ physical function, role function, emotional function, social function and cognitive function. |
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