肺癌患者营养治疗课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,晚期肺癌患者营养支持治疔,北京大学第三医院肿瘤化疗科梁莉,晚期肺癌患者营养支持治疔,1,晚期肺癌治疗现状,化疗,营养支持治疗可以增加耐受性,减少不良反应,放疗,靶向治疗(EGFR、ALK、ROS1、C-MET,针对免疫检测点的治疗(PD-1、PD-L1.,晚期肺癌治疗现状,2,化疗前体重丢失大于5%者生存期缩短,s weight less before che,0.2.is5%weight loss before chemotherapy,s% weight loss during chemotherapy,摘自孙凌宇教授幻灯,化疗前体重丢失大于5%者生存期缩短,3,57例肿瘤患者营养评估,Distribution according to the site of Cancer,Frequency of Severity of Malnutrition(P(,Lip/oral cavity,23(4035%,SGA sCOL,Larynx,9(15.79%),Bone tume,Lymphoma,20351%),BM,lI Classification of Participants,aSGA-B,Categones,Severely underweight(15-16),Underweight(16-185),14(2456%),Overweight (25-30),3(526%),Obese class 1(30-35),1(.5,Sharma d, et al. asian Pac J Cancer prev. 2015,摘自孙凌宇教授幻灯,57例肿瘤患者营养评估,4,Frequency of Variables Affecting Patients,Nutritional Status(PG-SGA Score),Clinical characteristics,Number of patients,Unchanged,9(15.79%),Less than usual,46(8070%,22(3860%,42(7368g,10%,13(281%,3=5,7(1228%,Weight unchanged,15(26.32%),Physical acti,Rarely out of bed,1(1.75%),Less than half the da,21(3684%,Fairly normal activities,24(42.11%),More than half the day in bed/chair 10(17-549b),Normal no limitation,Physical Examination,Severe,14(2456%),21(3684%,Mild,11(19.30%),11(19.30%),Sharma d. et al. Asian Pac J Cancer Prev. 2015.,摘自孙凌宇教授幻灯,Frequency of Variables Affecti,5,营养治疗使存在营养丌良的化疗患者获益,延长生存,提高生活质量,06121824303642485460,Weeks,PN+,Chemotherapy-related side effects,PN+(=42) PN-(n= 40) P-valt,Mucositis(%,A,Diarrhoea (%),0.020,00,Polyneuropathy (% 6,Leucopoenia( %),NS,Survival time month,降低化疗副反应,Significance level P5% weight loss prior,difficulties(n=11),to treatment(n=58)20%,Weight not recorded,Discontinued CCRT,Prior to treatment(n=9),Start rT(n=9),(n=14),Week 3 RT(n=15),5%weight loss prior to treatment(n=151),5% early weight loss,n=125),(n=26),Figure 1. Flowchart detailing the study population,Advanced stage NSCLC (n=287),8,Table 2. Comparison of Clinical and Treatment Characteristics between Patients with No Early Weight Loss and with Early,5% Early Weight,Characteristic,oss(n=125),Loss(n- 26,0.276,3,ight change before treat,-0.5812,ight change during induction chemotherapy, kg,-0.272.6,0763.1,0.077,WHO PS.,376,Charlson comorbidity inde,41.8,Disease stage, x,52.8,0.213,61,5,0.195,T3. T4,Clinical nodal status.,Histological diagnosis,4.6,42.3,Adenocarcinoma,rge cell carcin,20.8,Total dose radiotherapy, Gy,655(60.169.0),0,132,Gross tumor volume,79.9651.2-158.2,181.7(43.5280.8),0.248,20.0(14.0-26.3,18,2(16.5-29.2,Median (interquartile range),ld Health Organization performance score,or;N, node: NSCLC NOS, non amall cell lung cancer not otherwise specified,Table 2. Comparison of Clinica,9,Weight Loss, Weight Loss,%(n=125)%(n=26) p value,P=0.017,neutropenic fever,2.0,of RT, grade 2,erapy: RT, radiotherapy.,Table 4. Multivariate Analyses for Predictors of Overall,Survival,Variable,29-3 293P value,95%c,Age at diagnosis,1.353,0.8892.06,Categorie weignt loss,WHO PS,1.888,1.201-2.96,0.006,Clinical tumor status,304,0.839-2.027,0.238,eTx cT1, cT2,Clinical nodal status,2.883,1.382-6.015,Histological diagnosis,1.635,0.9502.814,0.076,Logrnk D,18681.095-3.1870.022,early weight loss,如,曰,WHO PS, world Health Organization performance score: HR, hazard ratio: CI.,Weight Loss, Weight Loss,10,肺癌患者营养治疗课件,11,肺癌患者营养治疗课件,12,肺癌患者营养治疗课件,13,肺癌患者营养治疗课件,14,肺癌患者营养治疗课件,15,肺癌患者营养治疗课件,16,肺癌患者营养治疗课件,17,肺癌患者营养治疗课件,18,肺癌患者营养治疗课件,19,肺癌患者营养治疗课件,20,肺癌患者营养治疗课件,21,肺癌患者营养治疗课件,22,肺癌患者营养治疗课件,23,肺癌患者营养治疗课件,24,肺癌患者营养治疗课件,25,肺癌患者营养治疗课件,26,肺癌患者营养治疗课件,27,肺癌患者营养治疗课件,28,肺癌患者营养治疗课件,29,肺癌患者营养治疗课件,30,肺癌患者营养治疗课件,31,肺癌患者营养治疗课件,32,肺癌患者营养治疗课件,33,肺癌患者营养治疗课件,34,肺癌患者营养治疗课件,35,肺癌患者营养治疗课件,36,肺癌患者营养治疗课件,37,