Abstract：Objective To explore the application of nutritional risk screening before TACE in patients with liver cancer and its influence on the curative effect, quality of life and prognosis. Methods From January 2013 to December 2018, 180 patients with advanced liver cancer treated by TACE were selected from Beijing Shijitan Hospital affiliated to Capital Medical University. According to nutrition risk screening 2002 (NRS 2002), the study population was divided into two groups：one group with nutrition risk (NRS 2002≥ 3 points) and another group without nutrition risk (NRS 2002<3 points). Further, the basic clinical characteristics, physical and biochemical indexes reflecting nutritional status, therapeutic effect, complications and quality of life scores were compared between the two groups. Kaplan Meier method was used to analyze the survival of the patients, and the incidence of other clinical end-point events such as gastrointestinal hemorrhage and hepatic encephalopathy were compared. Results Among the 180 patients who met the inclusion criteria, there were 85 patients without nutritional risk and 95 patients with nutritional risk. The incidence of nutritional risk was 52.8%. There were statistical differences in triceps skinfold thickness, upper arm muscle circumference, body mass index, and albumin between the two groups of patients (P<0.05). There was no statistically significant difference between total protein and preprotein in the two groups of patients (P>0.05). There was no significant difference in clinical effectiveness and postoperative complications of TACE in treating tumors between the two groups of patients (P>0.05). The quality of life score in patients without nutritional risk was higher than that of patients with nutritional risk (P<0.05). The 3-year survival rate of patients with nutritional risk was 54.74%； the 3-year survival rate of patients without nutritional risk was 68.24%, which was statistically significant (HR=0.61, P=0.05, 95%CI=0.38~0.98). The incidence of hepatic encephalopathy, hypoalbuminemia, and anemia was statistically different between the two groups (P<0.05). There was no statistical difference between the incidence of upper gastrointestinal bleeding and obstruction of portal vein thrombosis (P>0.05). Conclusions Nutritional risk screening is of great significance for patients undergoing TACE surgery. Nutritional risk is closely related to clinical outcomes, so it is particularly important to screen for patients with nutritional risks as early as possible and to provide interventions.
赵灵利，李婷婷，吴一凡，严炫晖，张裕. 肝癌患者行肝动脉化疗栓塞术前营养风险筛查的应用研究[J]. 肿瘤代谢与营养电子杂志, 2020, 7(1): 80-85.
Zhao Lingli, Li Tingting, Wu Yifan, Yan Xuanhui, Zhang Yu. Application of nutritional risk screening in liver cancer patients underwent transcatheter arterial chemoembolization. Electron J Metab Nutr Cancer, 2020, 7(1): 80-85.
1.El-Serag HB. Epidemiology of virial hepatitis and hepatocellular carcinoma. Gastroenterology.2012；142(6)：1264-1273.
2.朱笑生,刘文超.原发性肝癌全球流行情况和危险因素的新进展.现代肿瘤医学.2018；26 (14)：2297-2301.
3.Verslype C, Rosmorduc O, Rougier P. Hepatocellular carcinoma：ESMO-ESDO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol.2012；23(suppl7)：vii41-vii48.
4.Huo YR, Eslick GD. Transcatheter arterial chemoembolization plus radiotherapy compared with chemoembolization alone for hepatocellular carcinoma：a systematic review and Meta-analysis. JAMA Oncol.2015；1(6)：756-765.
5.Murata S, Mine T, Sugihara F, et al. Interventional treatment for unresectable hepatocellular carcinoma. World J Gastroenterol.2014；20(37)：13453-13465.
6.Huhmann BB, Cunningham RS. Importance of nutritional screening in treatment of cancer-related weight loss. Lancet Oncol.2005；6(5)：334-343.
7.Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr.2017；36(5)：1187-1196.
8.Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002)：a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003；22(3)：321-336.
9.中华医学会. 临床诊疗指南——肠外肠内营养学分册. 北京：人民卫生出版社, 2008.
10.于康. 营养风险筛查是临床营养管理的基础. 中华健康管理学杂志.2014；8(6)：361-363.
11.Therasse P, Eisenhauer EA, Verweij J. RECIST revisited：a review of validation studies on tumor assessment. Eur J Cancer.2006；42(8)：1031-1039.
12.Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992；30 (6)：473-483.
13.Sieghart W, Hucke F, Peck-Radosavljevic M. Transarterial chemoembolization：modalities, indication, and patient selection.J Hepatol. 2015；62(5)：1187-1195.
14.Hao MZ, Lin HL, Chen QZ, et al. Safety and efficacy of transcatheter arterial chemoembolization with embospheres in treatment of hepatocellular carcinoma. J Dig Dis.2017；18(1)：31-39.
15.周信达,汤钊猷,余业勤,等.影响肝癌预后的有关因素分析.中华内科杂志.1996；(8)：527-529.
16.Mantzorou M, Koutelidakis A, Theocharis S, et al. Clinical value of nutritional status in cancer：what is its impact and how it affects disease progression and prognosis? Nutr Cancer.2017；69(8)：1151-1176.
17.崔红元,朱明炜,许静涌,等.外科肝癌患者的体组成和能量代谢及其与营养状态的相关性.中华临床营养杂志.2017；25(3)：147-152.
18.André VG, Eduard C, Xavier H，et al. ESPEN guidelines on parenteral nutrition：gastroenterology.Clin Nutr. 2006；25(2)：260-274.
19.中华医学会肝病学分会,中华医学会消化病学分会,杨云生,等.终末期肝病临床营养指南.临床肝胆病杂志.2019；(6)：1222-1230.
20.唐中权.原发性肝癌营养不良三级诊断的营养筛查手段和评价工具.肿瘤代谢与营养电子杂志.2019；6(1)：120-124.
21.杨欢欢,胡敏予.原发性肝癌患者营养状况和临床结局关系的研究进展.基层医学论坛.2017；21(16)：2130-2133.
