Association Of Nutrition And Platinum-based Chemotherapy In Non-small Cell Lung Cancer Patients

Objectives:The aims of this study were to 1)form understanding of clinical features and nutritional status of treatment-naive patients with non-small cell lung cancer(NSCLC) in The Tumor Hospital of Yunnan Province through collecting clinical datas retrospectively; 2)detect the association of nutrition and platinum-based chemotherapy so that nutrition problems relate to NSCLC patients recieving first-line chemotherapy would be payed more attention to as well as adding clinical evidences to future stydies.Methods:Clinical datas of patients firstly admitted to The Third Affiliated Hospital of Kunming Medical College(The Tumor Hospital of Yunnan Province) between 06/01/2014 and 12/31/2014 who were diagnosed of NSCLC was cllected.345 patients were included. Record relative information and laboratory indicators at 7 points of time:before the 1st/2nd/3rd/4th cycle of chemotherapy and after the 2nd/3rd/4th cycle of chemotherapy. Useful datas will be analyzed with SPSS 20.0 software to find out characteristics of demography and baseline nutrition status of patients with NSCLC in our Province, to evaluate how changes in nutrition status effected platinum-based chemotherapy.Results:345 treatment-naive patients with NSCLC were included among which 124(35.9%) at stage Ⅲ,157(45.5%) at stage IV,55(16.0%) at stage Ⅰ/Ⅱ and 9 (2.6%)uncertain.60.9% of patients were adenocarcinoma while 33.9% were squamous cell carcinoma and 5.2% were others. Cancer was metastatic in 74.8% of patients.1.baseline nutrition statusECOG>2 in 31(9.0%) patients, ECOG≤2 in 314 patients(91.0%).119 patients(34.5%) had nutritional risk(NRS≥3) while 68 patients(58.1%)without nutrition risk(NRS<3). The percentage of patients with NRS^3 in metastatic patients was 58.1%(68), significantly higher than that of patients without metastatic(P=0.001).29 patients(8.5%) with BMK18.5 and 313 patients(91.5%) with BMI≥18.5,3 patients’BMI were not available(<1%). BMI mean value in metastatic patients(21.82 ± 2.77) were significantly lower than that without metastasis(20.50±3.11)(P=0.039). Age, gender and histology had no effect on incidence of malnutrition(BMI< 18.5).Concentration of albumin, prealbumin, total protein and lymphocyte counts showed to be under the lower limit in part of NSCLC patients when hospitalized at the first time, the incidence is 11.8%,23.3%,20.9%,60.9%, respectively.15.9% of men and 11.3% of women had their hemoglobin under the lower limit.20.0% and 19.8% of patients had their LDH and creatinine exceed the upper limit.The mean value of albumin and prealbumin is significantly lower in these groupsrage ≥60/stage Ⅲ/Ⅳ/with metastasis/NRS≥3/BMI<18.8(P<0.05).2.the association of nutrition and chemotherapy246 patients(71.3%) of all,198 patients (70.5%) of stage Ⅲ/Ⅳ,95 patients(60.5%) of stage IV recieved chemotherapy among included cases. There were more patients of stage IV recieved drug therapy than those of stage Ⅰ/Ⅱ/Ⅲ(P<0.001). In the patients with stage III/IV disease,102 cases(36.3%) completed at least 4 cycles of treatment while 83 patients(29.5%) did not accept drug therapy at all.Whether the patients recieved chemotherapy may be ralative with the levels of total protein, albumin, prealbumin and LDH which reflected patients nutrition status. In the groups with total protein≤65g/L, albumin≤34g/L, prealbmin≤170mg/L and LDH> 245U/L, the percentage of accepting chemotherapy were significantly lower than the opposite group(P=0.013,P<0.001,P=0.001,P=0.005).Among the stage Ⅲ/Ⅳ cases, in the groups with albumin≤34g/L, prealbmin≤ 170mg/L, LDH>245U/L and NRS≥3, the percentage of accepting chemotherapy were significantly lower than the opposite groups(P=0.003, P=0.002, P=0.014, P=0.006). Number of cycles completion were less in these groups mentioned above compared to opposite groups(P=0.003, P<0.001, P=0.003, P=0.006).Analyzing the datas of 7 points of time:before the 1st/2nd/3rd/4th cycle of chemotherapy and after the 2nd/3rd/4th cycle of chemotherapy.Total protein and albumin decreased obviously after the 2nd/3rd/4th cycle of treatment than before(P<0.05). Mean value of blood prealbumin increased after completing three cycles’chemotherapy(P<0.05). Cr was highest after the 4th cycle(P<0.05). Hemoglobin and platelete counts fall to the lowest after the 4th cycle, too(P<0.05). Every time patients completed systamatic drug therapy at the 2nd/3rd/4th cycle, reducement of TP,ALB occured afterwards(P<0.05). Mean values of white blood cells counts, neutrophile cells and lymphocite absolute value was not associated with chemotherapy.The incidence of malnutrition(BMI< 18.5) reduced gradually along with chemotherapy but did not differ from each other. Incidence of malnutrition was not relate to what kind of platinum drugs used in the treatment.Conclusions:There were about 35% of treatment-naive patients with NSCLC exsisting nutritional risk in Yunnan Province. The sensitivity of detecting malnutrition using Body Mass Index was relatively lower than NRS 2002. Patients of late-stage and metastasis may exist higher possibility of experiencing potential nutrition problems. Laboratary indicators recorded at the baseline condition associated with patients’ nutrition status, the levels of different markers may be related to whether the patients would recieve chemotherapy later. Patients’ nutrition status deteriorated after every completion of treatment cycle, while the general condition tend not to be worse but becoming to be more steady than expected. The laborotary indicators may be helpful to the nutrition status assessment among patients with NSLCL. It is of vital importance to combine clinical features with nutrition screening and laborotary indicators to early assess nutrition status of patients with NSCLC on the purpose of improving their quality of life and survival prognosis.