| Objective:In this study,nutritional risk screening 2002 and patient subjectiv e global assessment were used to evaluate the nutritional status of esophageal cancer patients before and after chemoradiotherapy.The relationship between ser um 25(OH)D3 and nutritional status and its prognostic significance were investi gated.Methods:Patients with esophageal cancer who were admitted to the departm ent of thoracic oncology of the First Affiliated Hospital of Zunyi Medical Univ ersity and the Second Affiliated Hospital of Zunyi Medical University from Fe bruary 2019 to January 2021 were enrolled.Their survival status was followed up by telephone and outpatient visits with the end point being February 4,2021,nutritional status,nutritive index and 25(OH)D3 level were collected before and a fter treatment.In our hospital,20ng/m L was taken as the reference value,accordin g to the pre-treatment 25(OH)D3 level,the p-atients were divided into deficien cy group(25(OH)D3<20ng/ml)and 25(OH)D3≥20ng/ml group.SPSS software(25.0)was used to compare the nutritional status、nutritive index、25(OH)D3concentrations pretherapy and post-treatment by paired t tes tand P<0.05 was s ignificant,Chi-squared Test was used to analyze the relationship between 25(OH)D3 and patients’clinical characteristics、nutritional status and nutritional indexe s.Cox proportional risk model was used to analyze the prognostic factors of e sophageal cancer patients;Kaplan-Meier method was used to calculate overall su rvival(OS)and progression-free survival(PFS),Log-Rank test was used to co mpare the differences of survival time between different groups;the receiver op erating characteristic curve(ROC)was plotted and the area under the curve wa s calculatedto verify the prognostic value of 25(OH)D3 in esophageal cancer p atients.Meanwhile,according to the changes of 25(OH)D3 concentration after tr eatment,patients were divided into 25(OH)D3 increased group and 25(OH)D3decreased group.Spearman correlation method was used to analyze the correlat ion between the change 25(OH)D3 after treatment and nutritional indicators in the two groups,so as to evaluate the association strength between 25(OH)D3 a nd nutritional indicators.Results:A total of 66 patients with esophagea·l cancer completed the observ ation study,of which 60 patients(90.9%)were male.post-treatment:body weight,BMI,hemoglobin,albumin,prealbumin,25(OH)D3 all decreased in varying degrees,the difference was statistically significant(P<0.05).BMI decreased in 44 patie nts and increased in 22 patients after treatment;Among patients with BMI<18.5kg/m~2,BMI decreased in 5 cases and increased in 8 cases,among patients wit h BMI≥18.5 kg/m~2,BMI decreased in 39 cases and increased in 14 cases.Pati ents without nutritional risk before treatment(NRS2002<3)had higher nutrition al risk after treatment(P<0.05);the PG-SGA scores of patients with suspected malnutrition(PG-SGA2-3),moderate malnutrition(PG-SGA4-8)and severe m alnutrition(PG-SGA≥9)were lower before treatment than after treatmen(P<0.05).25(OH)D3 deficiency accounted for 22.7%of patients,25(OH)D3 was closel y correlated with patients age(P=0.002),treatment(P=0.024),BMI(P=0.002),albu min(P=0.001).Univariate analysis showed PG-SGAscore,BMI,albumin and 25(O H)D3 were significantly correlated with the prognosis of esophageal cancer pati ents(all P<0.05),the multivariate analysis showed that PG-SGA≥9(OS:P=0.035;PFS:P=0.008)might be an risk factor for the prognosis of esophageal cancer p atients;25(OH)D3≥20ng/ml(OS:P=0.045)might be an protective factor for the prognosis of esophageal cancer patients;the area under ROC curve calculated w as 0.69(95%CI:0.544-0.835,P=0.041)confirming the role of 25(OH)D3 in OS assessment;Kaplan-Meier survival analysis showed that patients in the 25(O H)D3≥20ng/ml group had significantly longer overall survival(Log-Rankx~2=14.68,P=0.001)and progression-free survival(Log-Rankx~2=6.03,P=0.014).Mean while,Spearman correlation analysis showed that 25(OH)D3 concentration was positively correlated with BMI,hemoglobin and prealbumin in patients with inc reased vitamin D after treatment,but negatively correlated with PG-SGA score and NRS2002.In patients with decreased vitamin D after treatment,25(OH)D3concentration was positively correlated with body weight and hemoglobin.Conclusion:The nutritional status of patients with esophageal cancer decrease d after chemoradiotherapy;25(OH)D3 was correlated with nutritional status;Th e deficiency the 25(OH)D3,the worse the survival of the patients before treat ment,the worse the prognosis of the patients with severe malnutrition before tre atment.25(OH)D3 and PG-SGA scores before treatment may be independent pro gnostic factors of esophageal cancer after chemoradiotherapy. |
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