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Zhang Y, Meng Z, Lu M, Ruan S, Zhou J, Zhang M, Huang Y, Chen K, Luo X, Xie CK, Zheng C. Study of the significance of the combination of the fibrinogen-albumin ratio and sarcopenia in predicting the prognosis of laryngeal cancer patients undergoing radical surgery. BMC Cancer 2024; 24:1265. [PMID: 39394062 PMCID: PMC11468157 DOI: 10.1186/s12885-024-13039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 10/07/2024] [Indexed: 10/13/2024] Open
Abstract
OBJECTIVE This study aims to investigate how the impact of preoperative sarcopenia and inflammatory markers for laryngeal cancer patients and develop a new scoring system to predict their prognosis. MATERIALS AND METHODS Patients who underwent laryngectomy for laryngeal cancer (LC) from December 2015 to December 2020 at the Second Affiliated Hospital of Fujian Medical University were included. Independent prognostic factors were determined using univariate and multivariate analyses. A new scoring system (SFAR) was established based on FAR and preoperative sarcopenia, and statistically analyzed. RESULTS 198 cases included in this study that met the admission criteria. Multivariate analysis shown that preoperative sarcopenia, pTNM stage, and FAR were independent prognostic factors for laryngeal cancer. Based on these three indicators, we developed the SFAR scoring system. Multivariate analysis showed that SFAR was an independent predictor of laryngeal cancer (p < 0.001). SFAR was then incorporated into a prognostic model that included T-stage and N-stage, and a column-line graph was generated to accurately predict its survival. CONCLUSION Systemic inflammation and sarcopenia are significantly associated with postoperative prognosis in laryngeal cancer. A new scoring system (SFAR) had implications for improving the prognosis of patients undergoing surgery for laryngeal cancer.
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Affiliation(s)
- Yizheng Zhang
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China
| | - Zhiyong Meng
- Department of Ophthalmology, Shaowu Municipal Hospital of Fujian Province, Shaowu, Nanping, Fujian, 354000, China
| | - Ming Lu
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China
| | - Shenjiong Ruan
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China
| | - Jiao Zhou
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China
| | - Mingchen Zhang
- Department of Ophthalmology, Shaowu Municipal Hospital of Fujian Province, Shaowu, Nanping, Fujian, 354000, China
| | - Yanjun Huang
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China
| | - Kehui Chen
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China
| | - Xinyuan Luo
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China
| | - Cheng-Ke Xie
- Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, 350045, China.
| | - Chaohui Zheng
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362000, China.
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Haruna K, Minami S, Miyoshi N, Fujino S, Mizumoto R, Toyoda Y, Hayashi R, Kato S, Takeda M, Sekido Y, Hata T, Hamabe A, Ogino T, Takahashi H, Uemura M, Yamamoto H, Doki Y, Eguchi H. Examination of Sarcopenia with Obesity as a Prognostic Factor in Patients with Colorectal Cancer Using the Psoas Muscle Mass Index. Cancers (Basel) 2024; 16:3429. [PMID: 39410049 PMCID: PMC11482590 DOI: 10.3390/cancers16193429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 09/27/2024] [Accepted: 10/03/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Sarcopenia, the age-related loss of muscle mass, is a negative prognostic factor in gastrointestinal cancer. Sarcopenia combined with visceral obesity (sarcopenic obesity) is associated with poor outcomes. We explored the influence of obesity and other factors on the prognosis of patients with colorectal cancer diagnosed with sarcopenia. Methods: We enrolled 211 patients with colorectal cancer diagnosed with preoperative sarcopenic obesity who underwent radical resection at Osaka University Hospital between January 2009 and January 2012. Muscle mass was assessed using the psoas muscle mass index. Obesity was evaluated by measuring the visceral fat area in the umbilical region. Patients were categorized into two groups: sarcopenia with obesity (SO) and sarcopenia without obesity (non-SO). Overall survival, cancer-specific survival, and cancer-related relapse-free survival (CRRFS) were compared between the two groups. Patient characteristics, including age, sex, body mass index, serum albumin, C-reactive protein, tumor markers, prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and geriatric nutritional risk index (GNRI), were also analyzed. Results: CRRFS was significantly shorter in the SO group than in the non-SO group (p = 0.028). PNI, mGPS, and GNRI were not identified as significant prognostic factors for CRRFS. Multivariate analysis highlighted sarcopenic obesity, elevated carcinoembryonic antigen levels, and unfavorable histological types as significant predictors of poor CRRFS outcomes. Conclusions: Sarcopenic obesity is an independent predictor of poor prognosis in patients with CRC. Thus, interventions aimed at increasing muscle mass and reducing visceral fat could potentially improve the prognosis of these patients.
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Affiliation(s)
- Kengo Haruna
- Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 545-0871, Japan; (K.H.); (S.M.); (S.F.); (R.M.); (R.H.); (S.K.)
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Soichiro Minami
- Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 545-0871, Japan; (K.H.); (S.M.); (S.F.); (R.M.); (R.H.); (S.K.)
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Norikatsu Miyoshi
- Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 545-0871, Japan; (K.H.); (S.M.); (S.F.); (R.M.); (R.H.); (S.K.)
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Shiki Fujino
- Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 545-0871, Japan; (K.H.); (S.M.); (S.F.); (R.M.); (R.H.); (S.K.)
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Rie Mizumoto
- Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 545-0871, Japan; (K.H.); (S.M.); (S.F.); (R.M.); (R.H.); (S.K.)
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Yuki Toyoda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Rie Hayashi
- Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 545-0871, Japan; (K.H.); (S.M.); (S.F.); (R.M.); (R.H.); (S.K.)
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Shinya Kato
- Department of Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 545-0871, Japan; (K.H.); (S.M.); (S.F.); (R.M.); (R.H.); (S.K.)
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Mitsunobu Takeda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Yuki Sekido
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Tsuyoshi Hata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Atsushi Hamabe
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Takayuki Ogino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | | | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Hirofumi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (Y.T.); (M.T.); (Y.S.); (T.H.); (A.H.); (T.O.); (M.U.); (H.Y.); (Y.D.); (H.E.)
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Broekman M, Genders CMS, Geitenbeek RTJ, Havenga K, Kruijff S, Klaase JM, Viddeleer AR, Consten ECJ. Unraveling the role of computed tomography derived body composition metrics on anastomotic leakages rates in rectal cancer surgery: A protocol for a systematic review and meta-analysis. PLoS One 2024; 19:e0307606. [PMID: 39046997 PMCID: PMC11268673 DOI: 10.1371/journal.pone.0307606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Anastomotic leakage is a major concern following total mesorectal excision for rectal cancer, affecting oncological outcomes, morbidity an treatment costs. Body composition has been suggested to influence anastomotic leakage rates. However, literature on how body composition impact anastomotic leakage rates is conflicting. This systematic review aims to evaluate the role of computed tomography derived body composition metrics on anastomotic leakage rates in rectal cancer patients. METHODS Databases PubMed/MEDLINE, Cochrane Library, web of science, and EMBASE, will be systematically searched for papers from January 2010 onwards. Study selection, data collection and quality assessment will be independently performed by three research fellows. Outcomes described in three or more studies will be included in the meta-analysis. The Q-test and I2 statistic will be used to assess statistical heterogeneity between studies. Publication bias will be examined by visual inspection of funnel plots and quantified by Egger's test. Sensitivity analyses will be conducted to examine the robustness of the meta-analysis. Reporting of the findings will be in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. CONCLUSIONS This systematic review will synthesize the current evidence and will identify knowledge gaps. Results of the systematic review will aid health care professional in pre-operative decision making and will be distributed through a peer-reviewed publication and presentation of results at international meetings. TRIAL REGISTRATION PROSPERO protocol number: CRD42023471537.
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Affiliation(s)
- Mark Broekman
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | | | - Ritchie T. J. Geitenbeek
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Klaas Havenga
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Joost M. Klaase
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Alain R. Viddeleer
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther C. J. Consten
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
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Zheng B, Chen J, Gong X. Plasma 25-hydroxyvitamin D deficiency in the peri-operative period is associated with survival outcome in colorectal cancer patients: a meta-analysis. BMC Surg 2024; 24:180. [PMID: 38867218 PMCID: PMC11167935 DOI: 10.1186/s12893-024-02473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
AIM Surgery had a significant impact on 25-hydroxyvitamin D (25-(OH)D) levels. Uncertainty still existed regarding the effects of peri-operative 25(OH)D deficiency on colorectal cancer (CRC) patients' prognosis. The purpose of the present study was to explore the potential association between the peri-operative 25(OH)D deficiency and the survival outcome of CRC. METHODS Seven electronic databases [including PubMed, EMBASE, Web of Science, The Cochrane Library, OvidMEDLINE(R), China National Knowledge Infrastructure (CNKI) and Wangfang data] were searched without language limitations. The primary outcomes were overall survival and all-cause mortality. Secondary outcomes were the incidence of 25(OH)D deficiency and risk variables for low 25(OH)D level in the peri-operative period. RESULTS 14 eligible studies were obtained with 9324 patients for meta-analysis. In the peri-operative period, the pooled incidence of blood 25(OH)D deficiency was 59.61% (95% CI: 45.74-73.48). The incidence of blood 25(OH)D deficiency post-operatively (66.60%) was higher than that pre-operatively (52.65%, 95% CI: 32.94-72.36). Male (RR = 1.09, 95% CI: 1.03-1.16), rectum tumor (RR = 1.23, 95% CI: 1.03-1.47), spring and winter sampling (RR = 1.24, 95% CI: 1.02-1.49) were the risk factors for the 25(OH)D deficiency. The association between the low 25(OH)D post-operatively and short-term overall survival (HR = 0.43, 95% CI: 0.24-0.77) was most prominent, while a low 25(OH)D pre-operatively (HR = 0.47, 95% CI: 0.31-0.70) was more significantly associated with long-term all-cause mortality than that after surgery. CONCLUSION Peri-operative 25(OH)D impacted the CRC patients' prognosis. Due to possible confounding effects of systemic inflammatory response (SIR), simultaneous measurement of vitamin D and SIR is essential for colorectal survival.
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Affiliation(s)
- Baojia Zheng
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jianchang Chen
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaohua Gong
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
- The Second People's Hospital of Xiangzhou District, Zhuhai, China.
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Zhang KL, Zhou MM, Wang KH, Weng M, Zhou FX, Cui JW, Li W, Ma H, Guo ZQ, Li SY, Chen JQ, Wu XH, Zhao QC, Li JP, Xu HX, Shi HP, Song CH. Integrated neutrophil-to-lymphocyte ratio and handgrip strength better predict survival in patients with cancer cachexia. Nutrition 2024; 122:112399. [PMID: 38493542 DOI: 10.1016/j.nut.2024.112399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Systemic inflammation and skeletal muscle strength play crucial roles in the development and progression of cancer cachexia. In this study we aimed to evaluate the combined prognostic value of neutrophil-to-lymphocyte ratio (NLR) and handgrip strength (HGS) for survival in patients with cancer cachexia. METHODS This multicenter cohort study involved 1826 patients with cancer cachexia. The NLR-HGS (NH) index was defined as the ratio of neutrophil-to-lymphocyte ratio to handgrip strength. Harrell's C index and receiver operating characteristic (ROC) curve analysis were used to assess the prognosis of NH. Kaplan-Meier analysis and Cox regression models were used to evaluate the association of NH with all-cause mortality. RESULTS Based on the optimal stratification, 380 women (NH > 0.14) and 249 men (NH > 0.19) were classified as having high NH. NH has shown greater predictive value compared to other indicators in predicting the survival of patients with cancer cachexia according to the 1-, 3-, and 5-y ROC analysis and Harrell's C index calculation. Multivariate survival analysis showed that higher NH was independently associated with an increased risk of death (hazard ratio = 1.654, 95% confidence interval = 1.389-1.969). CONCLUSION This study demonstrates that the NH index, in combination with NLR and HGS, is an effective predictor of the prognosis of patients with cancer cachexia. It can offer effective prognosis stratification and guidance for their treatment.
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Affiliation(s)
- Kai-Lun Zhang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ming-Ming Zhou
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Kun-Hua Wang
- Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Weng
- Department of Clinical Nutrition, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fu-Xiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiu-Wei Cui
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Hu Ma
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zeng-Qing Guo
- Department of Medical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Su-Yi Li
- Department of Nutrition and Metabolism of Oncology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jun-Qiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiang-Hua Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qing-Chuan Zhao
- Department of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ji-Peng Li
- Department of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hong-Xia Xu
- Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Han-Ping Shi
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chun-Hua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China.
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Qin X, Sun J, Liu M, Zhang L, Yin Q, Chen S. The effects of oral nutritional supplements interventions on nutritional status in patients undergoing colorectal cancer surgery: A systematic review. Int J Nurs Pract 2024; 30:e13226. [PMID: 38128910 DOI: 10.1111/ijn.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/10/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The high incidence of malnutrition in patients undergoing colorectal cancer surgery can lead to unplanned weight loss, sarcopenia and reduced grip strength to the extent that it can seriously affect the prognosis of colorectal cancer patients. OBJECTIVE This study investigated the effect of oral nutritional supplements (ONS) on the prevalence of grip strength, unplanned weight loss and sarcopenia in patients undergoing colorectal cancer surgery. METHODS We systematically searched randomized controlled studies from CINAHL, PubMed, Embase, Cochrane and Web of Science and three Chinese databases (CNKI, Wan-Fang database, VIP database) from database creation to September 2023. The risk of bias in individual studies was assessed using the Cochrane Collaboration tool, and the certainty of evidence was assessed using the five GRADE criteria. Statistical analysis was performed using the RevMan 5.3 software, and information that could not be meta-analysed was reviewed in the form of a literature summary. RESULTS Eleven papers met the inclusion criteria with a combined sample size of 1070 cases, including 532 cases in the trial group and 538 cases in the control group. Four papers reported the effect of ONS on grip strength and included very low-quality evidence supporting no effect of ONS on grip strength. Ten studies reported the effect of ONS on body weight and body mass index (BMI) and included very low-quality evidence supporting a positive ONS on weight and BMI changes. Meta-analysis showed a significant reduction in weight loss (12-15 weeks) and BMI loss (12-15 weeks) in patients with colorectal cancer in the ONS group. The effect of ONS on the prevalence of sarcopenia after hospital discharge was reported in two studies, and meta-analysis showed a significant reduction in the prevalence of postoperative sarcopenia in colorectal cancer patients in the ONS group, but the quality of evidence was low. CONCLUSIONS This study showed that the use of ONS in patients undergoing surgery for colorectal cancer improved patient weight loss and BMI reduction and reduced the prevalence of postoperative sarcopenia but did not improve patient grip strength. The quality of evidence for inclusion in the article was low or very low, and further studies are needed to provide better evidence.
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Affiliation(s)
- Xiaohong Qin
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Meiling Liu
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lianjie Zhang
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Qing Yin
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Si Chen
- The First Hospital of Jilin University, Changchun, Jilin, China
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Wu J, Chi H, Kok S, Chua JM, Huang XX, Zhang S, Mah S, Foo LX, Peh HY, Lee HB, Tay P, Tong C, Ladlad J, Tan CH, Khoo N, Aw D, Chong CX, Ho LM, Sivarajah SS, Ng J, Tan WJ, Foo FJ, Teh BT, Koh FH. Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery. Ann Coloproctol 2024; 40:3-12. [PMID: 37004990 PMCID: PMC10915526 DOI: 10.3393/ac.2022.01207.0172] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 04/04/2023] Open
Abstract
Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.
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Affiliation(s)
- Jingting Wu
- Division of Surgery, Sengkang General Hospital, Singapore
| | - Hannah Chi
- Division of Surgery, Sengkang General Hospital, Singapore
| | - Shawn Kok
- Department of Radiology, Sengkang General Hospital, Singapore
| | - Jason M.W. Chua
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore
| | - Xi-Xiao Huang
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore
| | - Shipin Zhang
- Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore
| | - Shimin Mah
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Li-Xin Foo
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Hui-Yee Peh
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Hui-Bing Lee
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Phoebe Tay
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Cherie Tong
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Jasmine Ladlad
- Division of Surgery, Sengkang General Hospital, Singapore
| | | | | | - Darius Aw
- Division of Surgery, Sengkang General Hospital, Singapore
| | | | | | | | - Jialin Ng
- Division of Surgery, Sengkang General Hospital, Singapore
| | | | - Fung-Joon Foo
- Division of Surgery, Sengkang General Hospital, Singapore
| | - Bin-Tean Teh
- Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore
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Kemper M, Melling N, Krause L, Kühn K, Graß JK, Izbicki JR, Gerdes L, Adam G, Yamamura J, Molwitz I. Muscle quality, not quantity, is associated with outcome after colorectal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107098. [PMID: 37832179 DOI: 10.1016/j.ejso.2023.107098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Emerging evidence suggests that deconditioned patients benefit most from prehabilitation before colorectal cancer surgery. So far, selecting patients with poor muscle status and high perioperative risk remains challenging. Therefore, this study evaluates the potential of the CT-derived Skeletal Muscle Index (SMI), representing muscle mass, and of the Muscle Radiation Attenuation (MRA), a measure of muscle quality, for risk stratification in colorectal cancer patients. METHODS In this retrospective, single-center observational study, 207 patients with resection of colorectal adenocarcinoma between January 2016 and December 2020 were included. The Charlson comorbidity index (CCI), postoperative complications, length of hospital stay, and survival were recorded. Data were analyzed using multivariable linear, logistic, and Cox proportional hazards regression models adjusted for age, sex, BMI, CCI, neoadjuvant therapy, tumor stage, and surgery type. RESULTS An increase of the MRA was associated with fewer postoperative complications (anastomotic leakage and pneumonia) and lesser severity according to the Clavien-Dindo classification, shorter hospital stays, and prolonged survival (Hazard ratio: 0.63 [95%CI: 0.49-0.81], p < 0.001). No relevant associations were found between the SMI and postoperative complications, length of hospital stay, or survival. CONCLUSION The easy-to-raise MRA serves as a more reliable tool than the SMI for identifying high-risk patients with poor muscle status before colorectal surgery. Those patients may benefit most from prehabilitation, which has to be proven in future interventional trials.
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Affiliation(s)
- Marius Kemper
- Department of General, Visceral and Thoracic Surgery, Germany.
| | | | - Linda Krause
- Institute of Medical Biometry and Epidemiology, Germany
| | - Kjell Kühn
- Department of General, Visceral and Thoracic Surgery, Germany
| | | | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, Germany
| | - Laura Gerdes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Evidia Group, Berlin, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Xie T, Li L, Yang X, Wu X, Wang M, Chen W, Dong Q, Chen X, Li J. Effect of perioperative airway management on postoperative outcomes of colorectal cancer patients with sarcopenia. Eur J Oncol Nurs 2023; 66:102418. [PMID: 37713967 DOI: 10.1016/j.ejon.2023.102418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/16/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND It is common for colorectal cancer patients to have sarcopenia as a comorbidity, which has been shown to have a negative impact on prognosis after surgery. This study explored whether implementing a novel care program could improve postoperative outcomes in colorectal cancer patients with sarcopenia. METHODS We retrospectively analyzed the clinical data of patients diagnosed with sarcopenia before undergoing radical colorectal cancer surgery. We divided the patients into two groups according to the time point of program implementation and, compared the clinical characteristics and postoperative outcomes of these two groups. RESULTS A total of 227 patients were included in the study. The baseline clinical characteristics of the two groups were similar. Compared with the control group, patients in the implementation group had a significantly lower rate of total complications (18.5% vs. 30.3%, P = 0.041), a significantly lower rate of pulmonary complications (2.8% vs. 10.9%, P = 0.017), and a significantly shorter postoperative hospital stay (12 days vs. 14 days, P = 0.001). Implementation of perioperative airway management (P = 0.018) was shown to be a protective factor against pulmonary complications in colorectal cancer patients with sarcopenia. CONCLUSION The perioperative airway management program implemented at our center was easy to perform and can effectively improve short-term postoperative outcomes in colorectal cancer patients with sarcopenia.
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Affiliation(s)
- Tingting Xie
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liyuan Li
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiangxiang Yang
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofen Wu
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minmin Wang
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weizhe Chen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiantong Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaolei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Jiang Li
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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10
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Saino Y, Kawase F, Nagano A, Ueshima J, Kobayashi H, Murotani K, Inoue T, Nagami S, Suzuki M, Maeda K. Diagnosis and prevalence of sarcopenic obesity in patients with colorectal cancer: A scoping review. Clin Nutr 2023; 42:1595-1601. [PMID: 37480796 DOI: 10.1016/j.clnu.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND & AIMS Sarcopenic obesity (SO) is associated with worse outcomes in patients with colorectal cancer (CRC); however, the diagnostic methods and prevalence of SO vary among studies. Therefore, we conducted this scoping review to investigate the diagnosis of SO in CRC, identify the associated problems, and determine its prevalence. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. A literature search was performed by two independent reviewers on studies that diagnosed SO in CRC using the MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web (in Japanese) databases. Observational, longitudinal, cross-sectional, and clinical trials written in English or Japanese as of July 2022 were included. Studies that did not define SO were excluded from the analysis. The study protocol was pre-registered in Figshare. RESULTS In total, 670 studies were identified, 22 of which were included. Eighteen studies used sarcopenia in combination with obesity to diagnose SO. Sarcopenia was mainly diagnosed using skeletal muscle mass index (SMI), and only one combined with grip strength or gait speed. Obesity was diagnosed based on the body mass index (BMI; n = 11), followed by visceral fat area (VFA; n = 5). The overall prevalence of SO in patients with CRC was 15% (95%CI, 11-21%). The prevalence of SO in surgical resection and colorectal cancer liver metastases was 18% (95%CI, 12-25%) and 11% (95%CI, 3-36%), respectively. CONCLUSIONS SO in patients with CRC was mainly diagnosed based on a combination of SMI and BMI, and muscle strength and body composition were rarely evaluated. The prevalence of SO was approximately 15%, depending on the diagnostic methods used. Since SO in patients with CRC is associated with poor prognosis, further research on diagnostic methods for the early detection of SO and its clinical outcomes is needed.
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Affiliation(s)
- Yoko Saino
- Department of Clinical Nutrition, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan; Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota, Aichi 444-2351, Japan.
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan.
| | - Junko Ueshima
- Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa, Tokyo 141-8625, Japan.
| | - Haruko Kobayashi
- General Incorporated Association Manabi Public Library, 306 Wakabadai, Meito, Nagoya, Aichi 465-0015, Japan.
| | - Kenta Murotani
- Biostatistics Center, Kurume University. 67, Asahimachi, Kurume, Fukuoka 830-0011, Japan.
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami, Kita-ku, Niigata 950-3198, Japan.
| | - Shinsuke Nagami
- Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama 701-0193, Japan.
| | - Mizue Suzuki
- Department of Rehabilitation, Faculty of Allied Health Sciences, Yamato University, 2-5-1 Katayama, Suita, Osaka 564-0082, Japan.
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan.
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Kovač MB, Pavlin T, Čavka L, Ribnikar D, Spazzapan S, Templeton AJ, Šeruga B. The trajectory of sarcopenia following diagnosis of prostate cancer: A systematic review and meta-analysis. J Geriatr Oncol 2023; 14:101594. [PMID: 37482497 DOI: 10.1016/j.jgo.2023.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Sarcopenia is a common skeletal muscle disorder in older people. Here we explore the prevalence of sarcopenia and its impact on men with prostate cancer. MATERIALS AND METHODS We searched PubMed, Embase, and Web of Science databases for relevant studies with an explicit definition of sarcopenia in men with prostate cancer which were published between years 2000 and 2022. Prevalence of sarcopenia and its association with time to biochemical recurrence (BCR), progression-free survival (PFS), non-cancer mortality, overall survival (OS), and treatment-related complications in men with prostate cancer were explored. The summary prevalence, hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated. RESULTS A total of 24 studies comprising 3,616 patients with early and advanced prostate cancer were included. The prevalence of sarcopenia and sarcopenic obesity was 43.8% (95% CI 19.2%-68.5%) and 24.0% (95% CI 5.0%-43.1%), respectively. Sarcopenia was not associated with a shorter time to BCR (HR 0.89, 95% CI 0.64-1.23, p = 0.48), a shorter PFS (HR 1.20, 95% CI 0.73-1.97, p = 0.48), or a shorter OS (HR 1.29, 95% CI 0.90-1.85, p = 0.16). In contrast, sarcopenia was significantly associated with a higher non-cancer mortality (HR 1.85, 95% CI 1.23-2.80, p = 0.003). In four out of five studies eligible for assessment, sarcopenia was not associated with an increased risk of treatment-related complications. DISCUSSION Sarcopenia increases the risk of death from other causes in men with prostate cancer. Patients with prostate cancer should be assessed and managed for sarcopenia in everyday clinical practice.
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Affiliation(s)
- Milena Blaž Kovač
- Ljubljana Community Health Centre, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Pavlin
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Luka Čavka
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Department of Oncology, University Medical Center Maribor, Maribor, Slovenia
| | - Domen Ribnikar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Simon Spazzapan
- S.O.C. Oncologia Medica e Prevenzione Oncologica, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Arnoud J Templeton
- St. Clara Research, St. Claraspital Basel and Faculty of Medicine, University of Basel, Switzerland
| | - Boštjan Šeruga
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
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Thormann M, Hinnerichs M, Barajas Ordonez F, Saalfeld S, Perrakis A, Croner R, Omari J, Pech M, Zamsheva M, Meyer HJ, Wienke A, Surov A. Sarcopenia is an Independent Prognostic Factor in Patients With Pancreatic Cancer - a Meta-analysis. Acad Radiol 2023; 30:1552-1561. [PMID: 36564257 DOI: 10.1016/j.acra.2022.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES Sarcopenia is defined as skeletal muscle loss and can be assessed by cross-sectional imaging. Our aim was to establish the effect of sarcopenia on relevant outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) in curative and palliative settings based on a large patient sample. MATERIALS AND METHODS MEDLINE library, EMBASE and SCOPUS databases were screened for the associations between sarcopenia and mortality in patients with PDAC up to March 2022. The primary endpoint of the systematic review was the hazard ratio of Sarcopenia on survival. 22 studies were included into the present analysis. RESULTS The included 22 studies comprised 3958 patients. The prevalence of sarcopenia was 38.7%. Sarcopenia was associated with a higher prevalence in the palliative setting (OR 53.23, CI 39.00-67.45, p<0.001) compared to the curative setting (OR 36.73, CI 27.81-45.65, p<0.001). Sarcopenia was associated with worse OS in the univariable (HR 1.79, CI 1.41-2.28, p<0.001) and multivariable analysis (HR 1.62, CI 1.27-2.07, p<0.001) in the curative setting. For the palliative setting the pooled hazards ratio showed that sarcopenia was associated with overall survival (HR 1.56, CI 1.21-2.02, p<0.001) as well as in multivariable analysis (HR 1.77, CI 1.39-2.26, p<0.001). Sarcopenia was not associated with a higher rate of post-operative complications in univariable analysis (OR 1.10, CI 0.70-1.72, p = 0.69). CONCLUSION Sarcopenia occurs in 38.7% of patients with pancreatic cancer, significantly more in the palliative setting. Sarcopenia is associated with overall survival in both settings. The assessment of sarcopenia is therefore relevant for personalized oncology. Sarcopenia is not associated with postoperative complications.
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Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120.
| | - Mattes Hinnerichs
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Felix Barajas Ordonez
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Sylvia Saalfeld
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Aristoteles Perrakis
- Department of General - Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General - Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Marina Zamsheva
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Germany
| | - Hans-Jonas Meyer
- Department for Radiology, University Clinic Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
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Li Q, An T, Wu J, Lu W, Wang Y, Li J, Yang L, Chen Y, Lin L, Yang Z. The impact of sarcopenia on the outcome of patients with left-sided colon and rectal cancer after curative surgery. BMC Cancer 2023; 23:640. [PMID: 37430182 PMCID: PMC10332026 DOI: 10.1186/s12885-023-11073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/14/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The impact of sarcopenia on the outcome of patients with left-sided colon and rectal cancer has not been exhaustively investigated. Thus, the present study was performed to evaluate the effect of sarcopenia on the outcome of patients with left-sided colon and rectal cancer. METHODS Patients with pathologically diagnosed stage I, II and III left-sided colon or rectal cancer who had undergone curative surgery between January 2008 and December 2014 were retrospectively reviewed. The psoas muscle index (PMI) identified by 3D-image analysis of computed tomographic images was the criterion used to diagnose sarcopenia. The cut-off value recommended by Hamaguchi (PMI value < 6.36 cm2/m2 for men and < 3.92 cm2/m2 for women) was adopted to confirm the diagnosis of sarcopenia. According to the PMI, each patient was divided into the sarcopenia group (SG) or the nonsarcopenia group (NSG). Then, the SG was compared with the NSG in terms of postoperative outcomes. RESULTS Among the 939 patients included, 574 (61.1%) were confirmed to have preoperative sarcopenia. Initially, it was demonstrated that the SG was not significantly different from the NSG in terms of most baseline characteristics except for a lower body mass index (BMI) (P < 0.001), a larger tumour size (P < 0.001) and more weight loss (more than 3 kg in the last three months) (P = 0.033). The SG had a longer hospital stay after surgery (P = 0.040), more intraoperative blood transfusions (P = 0.035), and higher incidence of anastomotic fistula (P = 0.027), surgical site infection (SSI) (P = 0.037) and hypoalbuminemia (P = 0.022), 30-day mortality (P = 0.042) and 90-day mortality (P = 0.041). The SG had significantly worse overall survival (OS) (P = 0.016) and recurrence-free survival (RFS) (P = 0.036) than the NSG. Subsequently, Cox regression analysis revealed that preoperative sarcopenia was an independent predictive factor for worse OS (P = 0.0211, HR = 1.367, 95% CI: 1.049-1.782) and RFS (P = 0.045, HR = 1.299, 95% CI: 1.006-1.677). CONCLUSION Preoperative sarcopenia adversely affects the outcome of patients with left-sided colon and rectal cancer, and preoperative nutrition supplementation may help us improve their long-term and short-term outcomes.
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Affiliation(s)
- Qi Li
- Department of Medical Oncology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, People's Republic of China
| | - Tailai An
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen North Road 1017, Luohu District, Shenzhen, 518000, Guangdong, People's Republic of China
| | - Jianbin Wu
- Department of Medical Oncology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, People's Republic of China
| | - Weiqi Lu
- Department of Gastrointestinal Surgery, The First Hospital, Guangzhou University of Traditional Chinese Medicine, Jichang Road 16, Baiyun District, Guangzhou, 510400, Guangdong, People's Republic of China
| | - Yan Wang
- Department of Radiology, Shenzhen People's Hospital, Dongmen North Road 1017, Luohu District, Shenzhen, 518000, Guangdong, People's Republic of China
| | - Jia Li
- The First Department of Surgery, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, People's Republic of China
| | - Lina Yang
- Department of Medical Oncology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, People's Republic of China
| | - Yiqi Chen
- Department of Medical Oncology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, People's Republic of China
| | - Lizhu Lin
- Department of Medical Oncology, The First Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Jichang Road 16, Baiyun District, Guangzhou, 510400, Guangdong, People's Republic of China.
| | - Zhenjiang Yang
- Department of Medical Oncology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, People's Republic of China.
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Gao S, Xie H, Wei L, Liu M, Liang Y, Wang Q, Tang S, Gan J. Serum creatinine/cystatin C ratio as a prognostic indicator for patients with colorectal cancer. Front Oncol 2023; 13:1155520. [PMID: 37409249 PMCID: PMC10319047 DOI: 10.3389/fonc.2023.1155520] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Background This study aimed to explore the relationship between creatinine/cystatin C ratio and progression-free survival (PFS) and overall survival (OS) in colorectal cancer (CRC) patients undergoing surgical treatment. Methods A retrospective analysis was conducted on 975 CRC patients who underwent surgical resection from January 2012 to 2015. Restricted three-sample curve to display the non-linear relationship between PFS/OS and creatinine-cystatin C ratio. Cox regression model and Kaplan-Meier method were used to evaluate the effect of the creatinine-cystatin C ratio on the survival of CRC patients. Prognostic variables with p-value ≤0.05 in multivariate analysis were used to construct prognostic nomograms. The receiver operator characteristic curve was used to compare the efficacy of prognostic nomograms and the traditional pathological stage. Results There was a negative linear relationship between creatinine/cystatin C ratio and adverse PFS in CRC patients. Patients with low creatinine/cystatin C ratio had significantly lower PFS/OS than those with high creatinine/cystatin C ratio (PFS, 50.8% vs. 63.9%, p = 0.002; OS, 52.5% vs. 68.9%, p < 0.001). Multivariate analysis showed that low creatinine/cystatin C ratio was an independent risk factor for PFS (HR=1.286, 95%CI = 1.007-1.642, p=0.044) and OS (HR=1.410, 95%CI=1.087-1.829, p=0.010) of CRC patients. The creatinine/cystatin C ratio-based prognostic nomograms have good predictive performance, with a concordance index above 0.7, which can predict the 1-5-year prognosis. Conclusion Creatinine/cystatin C ratio may be an effective prognostic marker for predicting PFS and OS in CRC patients, aid in pathological staging, and along with tumour markers help in-depth prognostic stratification in CRC patients.
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Affiliation(s)
- Shunhui Gao
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Nanning, Nanning, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Hailun Xie
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Lishuang Wei
- Department of Geriatric Respiratory Disease Ward, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Mingxiang Liu
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Yanren Liang
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Qiwen Wang
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jialiang Gan
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
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15
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Chen M, Wang X, Han M, Li Y, Yu N, Long X, Chen W. Temporal and periorbital depressions identified by 3D images are correlated with malnutrition phenotypes in cancer patients: A pilot study. Front Nutr 2023; 10:1115079. [PMID: 36992909 PMCID: PMC10042485 DOI: 10.3389/fnut.2023.1115079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/10/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundPrompt diagnosis of malnutrition and appropriate interventions can substantially improve the prognosis of patients with cancer; however, it is difficult to unify the tools for screening malnutrition risk. 3D imaging technology has been emerging as an approach to assisting in the diagnosis of diseases, and we designed this study to explore its application value in identifying the malnutrition phenotype and evaluating nutrition status.MethodsHospitalized patients treating with maintenance chemotherapy for advanced malignant tumor of digestive system were recruited from the Department of Oncology, whose NRS 2002 score > 3. Physical examination and body composition data of patients at risk for malnutrition were analyzed by physicians trained to complete a subjective global assessment. The facial depression index was recognized using the Antera 3D® system, temporal and periorbital depression indexes were acquired using the companion software Antera Pro. This software captures quantitative data of depression volume, affected area, and maximum depth of temporal and periorbital concave areas.ResultsA total of 53 inpatients with malnutrition-related indicators were included. The volume of temporal depression was significantly negatively correlated with upper arm circumference (r = −0.293, p = 0.033) and calf circumference (r = −0.285, p = 0.038). The volume and affected area of periorbital depression were significantly negatively correlated with fat mass index (r = −0.273, p = 0.048 and r = −0.304, p = 0.026, respectively) and percent body fat (r = −0.317, p = 0.021 and r = −0.364, p = 0.007, respectively). The volume and affected area of temporal depression in patients with muscle loss phenotype (low arm circumference/low calf circumference/low handgrip strength/low fat-free mass index) were significantly higher than those in patients without muscle loss. Moreover, patients with fat mass loss phenotype (low fat mass index) showed a significant increase in the volume and affected area of periorbital depression.ConclusionThe facial temporal region, and periorbital depression indicators extracted by 3D image recognition technology were significantly associated with the phenotype of malnutrition-related muscle and fat loss and showed a trend of grade changes in the population of different subjective global assessment nutritional classifications.
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Affiliation(s)
- Moxi Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xue Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Meifen Han
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yunzhu Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
- Xiao Long,
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Wei Chen,
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Systemic inflammation with sarcopenia predicts survival in patients with gastric cancer. J Cancer Res Clin Oncol 2023; 149:1249-1259. [PMID: 35435489 DOI: 10.1007/s00432-022-03925-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/12/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The levels of platelet-related inflammation indicators and sarcopenia have been reported to affect the survival of patients with cancer. To evaluate the prognostic influence of platelet count (PLT), platelet lymphocyte ratio (PLR), and systemic immune inflammation index (SII), and SII combined with sarcopenia on the survival of patients with gastric cancer (GC). METHODS A total of 1133 patients with GC (812 male and 321 female, average age: 59.43 years) were evaluated. Receiver-operating characteristic curves were used to determine the best cutoff values of PLT, PLR, and SII, and univariate and multivariate Cox risk regression models were used to evaluate whether SII is an independent predictor of overall survival (OS). The prognostic SS (SII-sarcopenia) was established based on SII and sarcopenia. Finally, a comprehensive analysis of the prognostic SS was performed. RESULTS SII had the strongest prognostic effect. The SII and OS of patients with GC were in an inverted U-shape (adjusted HR = 1.07; 95% CI 0.97-1.19; adjusted P = 0.179). In patients with SII > 1800, SII was negatively correlated with OS (adjusted HR = 0.57; 95% CI 0.29-1.12; adjusted P = 0.102), however, there is no statistical difference. Interestingly, a high SS was associated with a poorer prognosis. The higher the SS score was, the worse the OS (P < 0.001). CONCLUSION SII is an independent prognostic indicator of GC, and high SII is related to poor prognosis. A higher SS score had worse survival. Thus, the prognostic SS is a reliable predictor of OS in patients with GC.
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Xie H, Ruan G, Wei L, Zhang H, Ge Y, Zhang Q, Lin S, Song M, Zhang X, Liu X, Li X, Zhang K, Yang M, Tang M, Song CH, Gan J, Shi HP. Hand grip strength-based cachexia index as a predictor of cancer cachexia and prognosis in patients with cancer. J Cachexia Sarcopenia Muscle 2023; 14:382-390. [PMID: 36447437 PMCID: PMC9891920 DOI: 10.1002/jcsm.13139] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/24/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The cachexia index is a useful predictor for cancer cachexia and prognostic assessment. However, its use is limited because of high testing costs and complicated testing procedures. Thus, in this study, we aimed to develop a hand grip strength (HGS)-based cancer cachexia index (H-CXI) as a potential predictor of cancer cachexia and prognosis in patients with cancer. METHODS Here, 14 682 patients with cancer were studied, including the discovery (6592), internal validation (2820) and external validation (5270) cohorts. The H-CXI was calculated as [HGS (kg)/height (m)2 × serum albumin (g/L)]/neutrophil-to-lymphocyte ratio. The Kaplan-Meier method was used to create survival curves, and the log-rank test was used to compare time-event relationships between groups. A Cox proportional hazard regression model was used to determine independent risk factors for overall survival (OS). Logistic regression analysis was used to assess the association of the H-CXI with short-term outcomes and cancer cachexia. RESULTS There was a significant non-linear relationship between the H-CXI and OS in all cohorts. Patients with a low H-CXI had significantly lower OS than those with a high H-CXI in the discovery cohort (6-year survival percentage: 55.72% vs. 76.70%, log-rank P < 0.001), internal validation cohort (6-year survival percentage: 55.81% vs. 76.70%, log-rank P < 0.001), external validation cohort (6-year survival percentage: 56.05% vs. 75.48%, log-rank P < 0.001) and total cohort (6-year survival percentage: 55.86% vs. 76.27%, log-rank P < 0.001). Notably, the prognostic stratification effect of the H-CXI in patients with advanced-stage disease was more significant than that in patients with early-stage disease. The multivariate Cox proportional risk regression model confirmed that a low H-CXI negatively affected the prognosis of patients with cancer in the discovery cohort [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.71-0.80, P < 0.001], internal validation cohort (HR 0.79, 95 %CI 0.72-0.86, P < 0.001), external validation cohort (HR 0.84, 95% CI 0.79-0.89, P < 0.001) and total cohort (HR 0.80, 95% CI 0.77-0.83, P < 0.001). Multivariate logistic regression models showed that a low H-CXI was an independent risk factor predicting adverse short-term outcomes and cancer cachexia in patients with cancer. CONCLUSIONS The simple and practical H-CXI is a promising predictor for cancer cachexia and prognosis in patients with cancer.
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Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Lishuang Wei
- Department of Geriatric Respiratory Disease Ward, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Heyang Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Shiqi Lin
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Mengmeng Song
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Xi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Xiangrui Li
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Kangping Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Ming Yang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Meng Tang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Chun-Hua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhenzhou, China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
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Xie H, Wei L, Gao S, Liu M, Liang Y, Yuan G, Wang Q, Xu Y, Tang S, Gan J. Prognostic significance of sarcopenia diagnosed based on the anthropometric equation for progression-free survival and overall survival in patients with colorectal cancer. Front Nutr 2023; 10:1076589. [PMID: 36819674 PMCID: PMC9928878 DOI: 10.3389/fnut.2023.1076589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
Background The purpose of this study was to investigate the prognostic significance of sarcopenia diagnosed based on anthropometric equations for progression-free survival (PFS) and overall survival (OS) in patients with colorectal cancer (CRC). Methods A total of 1,441 CRC patients who underwent surgical treatment between January 2012 and December 2016 were enrolled in this study. Sarcopenia was diagnosed according to validated anthropometric equations. The Kaplan-Meier method with the log-rank test was used to estimate the survival curve. Cox proportional hazards regression models with forward selection were used to evaluate risk factors affecting the prognosis of CRC patients. R package "survival" was used to build the prognostic nomograms to predict 1-5 years of PFS and OS in CRC patients. The concordance index (C-index) and calibration curve were used to evaluate the prognostic accuracy of the prognostic nomogram. Results Two hundred and seventy-one patients (18.8%) were diagnosed with sarcopenia. Sarcopenia was significantly associated with advanced age, large tumor size, and high mortality. Compared with the non-sarcopenia patients, the PFS of sarcopenia patients was worse (5-year PFS, 48.34 vs. 58.80%, p = 0.003). Multivariate survival analysis showed that patients with sarcopenia had a higher risk (23.9%) of adverse PFS (HR, 1.239; 95%CI: 1.019-1.505, p = 0.031) than patients without sarcopenia. The OS of patients with sarcopenia was significantly worse than that of patients without sarcopenia (5-year OS: 50.92 vs. 61.62%, p = 0.001). In CRC patients, sarcopenia was independently associated with poor OS (HR: 1.273, 95%CI: 1.042-1.556, p < 0.001). Moreover, sarcopenia effectively differentiated the OS of CRC patients in the normal carcinoembryonic antigen (CEA) subgroup but not in the high CEA subgroup. Notably, sarcopenia can provide effective prognostic stratification in CRC patients at different pathological stages. Nomograms that integrated prognostic features were built to predict the risk of adverse outcomes in CRC patients. The C-index and calibration curves showed that these nomograms had good prediction accuracy. Internal validation confirmed that our nomogram has wide application potential. Conclusion Sarcopenia diagnosed based on anthropometric equations is an independent risk factor for PFS and OS in CRC patients.
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Affiliation(s)
- Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Lishuang Wei
- Department of Geriatric Respiratory Disease Ward, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Shunhui Gao
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Mingxiang Liu
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Yanren Liang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Guanghui Yuan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Qiwen Wang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Yansong Xu
- Department of Emergency Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,*Correspondence: Jialiang Gan ✉
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China,Shuangyi Tang ✉
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Cai M, Gao Z, Liao J, Jiang Y, He Y. Frailty affects prognosis in patients with colorectal cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:1017183. [PMID: 36408138 PMCID: PMC9669723 DOI: 10.3389/fonc.2022.1017183] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background The prevalence of colorectal cancer has remained high. Most patients have already developed into the middle and advanced stage when they are diagnosed with colorectal cancer, and a small number of them are accompanied by metastasis. In recent years, frailty has been recognized as an important factor affecting the prognosis of colorectal cancer. The aim of this study was to assess the value of frailty on prognosis in patients with colorectal cancer after treatment. Method We systematically searched PubMed, Embase, Web Of Science databases up until March2022. A total of 18 studies were retrieved that met the inclusion criteria, including 9 prospective studies and 9 retrospective studies. Frailty screening tools, proportion of frail patients, and outcomes of colorectal cancer patients after treatment were recorded. Result 18 studies were included with a total of 352,535 participants. Regardless of differences in frailty screening and treatment approaches, outcomes for frailty patients were less favorable in all studies. Compared with the non-frail group, the frail group had higher mortality, more serious complications, more postoperative blood transfusions and delirium, and more support outside the home. Conclusion Although there is no uniform standard for frailty screening, assessing the frailty of colorectal cancer patients is of great significance for predicting prognosis of patients after treatment.
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Jang MK, Park S, Park C, Doorenbos AZ, Go J, Kim S. Body composition change during neoadjuvant chemotherapy for breast cancer. Front Oncol 2022; 12:941496. [PMID: 36091109 PMCID: PMC9458921 DOI: 10.3389/fonc.2022.941496] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSarcopenia is receiving attention in oncology as a predictor of increased chemotherapy toxicities. Research into body composition change during neoadjuvant chemotherapy for breast cancer is both urgently needed and generally lacking. This study assessed sarcopenia prevalence before and after neoadjuvant chemotherapy using CT imaging, evaluated body composition changes during neoadjuvant chemotherapy, and determined predictors of sarcopenia status after neoadjuvant chemotherapy for breast cancer.Materials and MethodsIn this retrospective, descriptive study, we used data collected from 2017 to 2020 to measure body composition parameters on cross-sectional CT slices for 317 Korean women with breast cancer patients before and at completion of neoadjuvant chemotherapy. Changes in skeletal muscle index, visceral fat index, subcutaneous fat index, and sarcopenia were assessed and correlated, and multivariate logistic regression was conducted to identify predictive factors associated with sarcopenia status at completion of neoadjuvant chemotherapy.ResultsOf the 80 breast cancer patients (25.2%) who had sarcopenia before beginning neoadjuvant chemotherapy, 64 (80.0%) retained their sarcopenia status after chemotherapy. Weight, body mass index, body surface area, and visceral fat index showed significant increases after neoadjuvant chemotherapy; notably, only skeletal muscle index significantly decreased, showing a reduction of 0.44 cm2/m2 (t (316) = 2.15, p <.5). Lower skeletal muscle index at baseline was associated with greater loss of muscle mass during neoadjuvant chemotherapy (r = −.24, p <.001). Multivariate logistic regression showed that baseline sarcopenia status was the only significant predictor of sarcopenia status after neoadjuvant chemotherapy (p <.001). Specifically, the log odds of sarcopenia after neoadjuvant chemotherapy were 3.357 higher in the baseline sarcopenia group than in the group without baseline sarcopenia (β = 3.357, p <.001).ConclusionSarcopenia during neoadjuvant chemotherapy can be obscured by an increasing proportion of fat in body composition if clinical assessment focuses on only body mass index or body surface area rather than muscle mass. For breast cancer patients who have sarcopenia when they begin neoadjuvant chemotherapy, the risk of muscle mass loss during treatment is alarmingly high. To reduce masking of muscle mass loss during treatment, comprehensive evaluation of body composition, beyond body surface area assessment, is clearly needed.
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Affiliation(s)
- Min Kyeong Jang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
- *Correspondence: Min Kyeong Jang,
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Park
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Ardith Z. Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
- Department of Medicine, University of Illinois Cancer Center, Chicago, IL, United States
| | - Jieon Go
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Sue Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
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Comprehensive comparison of the prognostic value of systemic inflammation biomarkers for cancer cachexia: a multicenter prospective study. Inflamm Res 2022; 71:1305-1313. [PMID: 35962796 DOI: 10.1007/s00011-022-01626-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 01/08/2023] Open
Abstract
AIMS Systemic inflammation plays an important role in cancer cachexia. However, among the systemic inflammatory biomarkers, it is unclear which has optimal prognostic value for cancer cachexia. METHODS The Kaplan-Meier method was used and the log-rank analysis was performed to estimate survival differences between groups. Cox proportional hazard regression analyses were conducted to assess independent risk factors for all-cause mortality. RESULTS The C-reactive protein-to-albumin ratio (CAR) was the optimal prognostic assessment tool for patients with cancer cachexia, with 1-, 3-, and 5-year predictive powers of 0.650, 0.658, and 0.605, respectively. Patients with a high CAR had significantly lower survival rates than those with a low CAR. Moreover, CAR can differentiate the prognoses of patients with the same pathological stage. Cox proportional risk regression analyses showed that a high CAR was an independent risk factor for cancer cachexia. For every standard deviation increase in CAR, the risk of poor prognosis for patients with cancer cachexia was increased by 20% (hazard ratio = 1.200, 95% confidence interval = 1.132-1.273, P < 0.001). CONCLUSIONS CAR is an effective representative of systemic inflammation and a powerful factor for predicting the life function and clinical outcome of patients with cancer cachexia.
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Comparison of absolute and relative handgrip strength to predict cancer prognosis: A prospective multicenter cohort study. Clin Nutr 2022; 41:1636-1643. [DOI: 10.1016/j.clnu.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
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Thormann M, Omari J, Pech M, Damm R, Croner R, Perrakis A, Strobel A, Wienke A, Surov A. Low skeletal muscle mass and post-operative complications after surgery for liver malignancies: a meta-analysis. Langenbecks Arch Surg 2022; 407:1369-1379. [PMID: 35583832 PMCID: PMC9283156 DOI: 10.1007/s00423-022-02541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/29/2022] [Indexed: 12/03/2022]
Abstract
Purpose To assess the influence of low skeletal muscle mass (LSMM) on post-operative complications in patients with hepatic malignancies grade (Clavien Dindo ≥ 3) undergoing resection. Methods MEDLINE, Cochrane, and SCOPUS databases were screened for associations between sarcopenia and major post-operative complications (≥ grade 3 according to Clavien-Dindo classification) after resection of different malignant liver tumors. RevMan 5.3 software was used to perform the meta-analysis. The methodological quality of the included studies was assessed according to the QUIPS instrument. Results The analysis included 17 studies comprising 3157 patients. Subgroup analyses were performed for cholangiocarcinoma (CCC), colorectal cancer (CRC) liver metastases, and hepatocellular carcinoma (HCC). LSMM as identified on CT was present in 1260 patients (39.9%). Analysis of the overall sample showed that LSMM was associated with higher post-operative complications grade Clavien Dindo ≥ 3 (OR 1.56, 95% CI 1.25–1.95, p < 0.001). In the subgroup analysis, LSMM was associated with post-operative complications in CRC metastases (OR 1.60, 95% CI 1.11–2.32, p = 0.01). In HCC and CCC sub-analyses, LSMM was not associated with post-operative complications in simple regression analysis. Conclusion LSMM is associated with major post-operative complications in patients undergoing surgery for hepatic metastases and it does not influence major post-operative complications in patients with HCC and CCC.
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Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Robert Damm
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Roland Croner
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Halle-Wittenberg, Germany
- Profile Area Clinical Studies & Biostatistics, Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Halle-Wittenberg, Germany
- Profile Area Clinical Studies & Biostatistics, Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Xie H, Ruan G, Zhang Q, Ge Y, Song M, Zhang X, Liu X, Lin S, Zhang X, Li X, Zhang K, Yang M, Tang M, Cong M, Shi H. Combination of Nutritional Risk Index and Handgrip Strength on the Survival of Patients with Cancer Cachexia: A Multi- Center Cohort Study. J Inflamm Res 2022; 15:1005-1015. [PMID: 35210808 PMCID: PMC8858023 DOI: 10.2147/jir.s352250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/04/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The nutritional risk index (NRI) and handgrip strength (HGS) are useful indicators of nutritional and physical status, respectively, both of them can predict the prognosis of many cancers; however, the predictive accuracy of a single indicator is unsatisfactory. Whether the combination of NRI and HGS could enhance the stratification of the prognosis of patients with cancer cachexia. PATIENTS AND METHODS The study population was randomly divided into training and validation cohorts. We combined NRI and HGS and constructed the NRI-HGS score. Restricted cubic splines were used to assess the associations between NRI, HGS, and all-cause mortality. The Kaplan-Meier method was used to calculate the survival probability of the patients. The Cox proportional hazards risk model was used to analyze survival and prognostic factors. RESULTS Low NRI and low HGS were independent predictors of poor prognosis in patients with cancer cachexia. The NRI-HGS score showed a better prognostic stratification than either NRI or HGS. The co-occurrence of low NRI and low HGS was associated with an approximately 1.8-fold increased risk of mortality. The NRI-HGS score could effectively distinguish patients with a poor prognosis at different pathological stages. Furthermore, we constructed a novel prognostic nomogram based on NRI and HGS. The concordance index and calibration plot confirmed that the nomogram had good prognostic accuracy. The area under the receiver operating characteristic curve of the nomogram reached >0.8, which was much higher than that of the traditional tumor-node-metastasis staging system. The nomogram provided better prognostic stratification for patients with cancer cachexia. CONCLUSION Low NRI and low HGS are independent prognostic indicators in cancer cachexia. The combination of NRI and HGS improve prognostic stratification for patients with cancer cachexia. Our study suggests combining nutritional and physical status in future cachexia research.
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Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Qi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Mengmeng Song
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Xi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Shiqi Lin
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Xiaowei Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Xiangrui Li
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Kangping Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Ming Yang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Meng Tang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
| | - Minghua Cong
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People’s Republic of China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, People’s Republic of China
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