老年营养风险指数与肌少症整合用于接受同步放化疗的鼻咽癌预后评估：一项大规模长期回顾性研究
Integration of geriatric nutritional risk index and sarcopenia for prognostic assessment in nasopharyngeal carcinoma receiving concurrent chemoradiotherapy: a large-scale long-term retrospective study.
文献信息
| PMID | 42760365 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Wei-Qiong Ni |
| 作者单位 | Department of Radiation Oncology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 鼻咽癌（NPC）是一种异质性恶性肿瘤，在接受同步放化疗（CCRT）的患者中，即使处于相同疾病分期，生存结局也存在显著差异。本研究旨在开发并验证一种整合老年营养风险指数（GNRI）和肌少症的新型预后模型，以预测接受CCRT的NPC患者的总生存期（OS）。
方法： 我们对862例接受CCRT治疗的NPC患者进行了大规模、长期回顾性分析。评估了治疗前GNRI和肌少症状态，并根据这两个因素将患者分为恶病质风险组。单因素和多因素Cox回归分析确定了独立预后预测因素，并将其纳入列线图以进行个体化OS预测。
结果： 被归类为高恶病质风险（低GNRI或存在肌少症）的患者与低恶病质风险组相比，OS显著较差（HR=0.607，95% CI：0.428-0.861，P=0.005）。多因素分析显示，年龄>45岁、晚期T分期、淋巴结受累和高恶病质风险独立预测较差的OS。与传统的肿瘤-淋巴结-转移（TNM）分期系统（C指数=0.639，95% CI：0.574-0.704）相比，该列线图显示出良好的区分度（C指数=0.715，95% CI：0.643-0.787）。
结论： 结合GNRI、肌少症和临床病理因素的预后模型能有效对接受CCRT的NPC患者进行风险分层。这种整合方法在预测OS方面优于传统分期，并支持将全面的营养和身体成分评估纳入常规临床实践，以指导个体化治疗策略。
英文摘要
BACKGROUND: Nasopharyngeal carcinoma (NPC) is a heterogeneous malignancy with significant variability in survival outcomes among patients receiving concurrent chemoradiotherapy (CCRT), even within the same disease stage. This study aimed to develop and validate a novel prognostic model integrating the geriatric nutritional risk index (GNRI) and sarcopenia to predict overall survival (OS) in NPC patients undergoing CCRT.
METHODS: We conducted a large-scale, long-term retrospective analysis of 862 NPC patients treated with CCRT. Pretreatment GNRI and sarcopenia status were assessed, and patients were stratified into cachexia risk groups based on these two factors. Univariate and multivariate Cox regression analyses identified independent prognostic predictors, which were incorporated into a nomogram for individualized OS prediction.
RESULTS: Patients classified as high cachexia risk (low GNRI or presence of sarcopenia) exhibited significantly poorer OS compared to the low cachexia risk group (HR = 0.607, 95% CI: 0.428-0.861, P = 0.005). Multivariate analysis revealed that age > 45 years, advanced T stage, nodal involvement, and high cachexia risk independently predicted worse OS. The nomogram demonstrated favorable discrimination (C-index = 0.715, 95% CI: 0.643-0.787) compared to the traditional tumor-node-metastasis (TNM) staging system (C-index = 0.639, 95% CI: 0.574-0.704).
CONCLUSIONS: A prognostic model combining GNRI, sarcopenia, and clinicopathological factors effectively stratifies risk in NPC patients receiving CCRT. This integrated approach improves upon conventional staging in predicting OS and supports incorporating comprehensive nutritional and body composition assessments into routine clinical practice to guide personalized treatment strategies.