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Valaire R, Garden F, Razmovski‐Naumovski V. Are measures and related symptoms of cachexia recorded as outcomes in gastrointestinal cancer chemotherapy clinical trials? J Cachexia Sarcopenia Muscle 2024; 15:1146-1156. [PMID: 38533530 PMCID: PMC11154796 DOI: 10.1002/jcsm.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/30/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Cachexia is prevalent in gastrointestinal cancers and worsens patient outcomes and chemotherapy compliance. We examined to what extent registered gastrointestinal cancer chemotherapy clinical trials record measures and related symptoms of cachexia as outcomes, and whether these were associated with trial characteristics. METHODS Four public trial registries (2012-2022) were accessed for Phase II and/or III randomized controlled pancreatic, gastric, and colorectal cancer chemotherapy trial protocols. Trial outcome measures of overall survival and toxicity/side effects, and those related to cachexia [physical activity, weight/body mass index (BMI), dietary limitations, caloric intake, lean muscle mass] and symptoms (appetite loss, diarrhoea, pain, fatigue/insomnia, constipation, nausea, vomiting, and oral mucositis) were extracted, along with the number and types of performance status and patient-reported outcomes (PROs) tools. Data were summarized descriptively. Chi-square tests examined associations between outcomes and trial characteristics (cancer type, trial location, funding source, PROs tools, and commencement year). Statistical significance was set at P < 0.05. RESULTS We included 540 trial protocols (pancreatic (35.2%), colorectal (33.3%) and gastric (31.5%)), with most trials from Europe (44.1%). Trial lead investigator was from academia (28.3%), industry (27.6%) and government (26.3%). Allied health professional involvement (26.9%) occurred at eligibility. Adjuvant therapy in trials was mainly treatment-related (68.1%). Additional medication included anti-nausea (2.2%) and analgesia (0.9%). Trial protocols mostly recorded overall survival (90.4%) and toxicity (78.9%), and the symptoms appetite loss (26.1%) and diarrhoea (19.1%), with the other symptoms recorded in <10% of the trials. Reporting of physical activity (P = 0.001), dietary limitations (P = 0.002), lean muscle mass (P = 0.027), appetite loss (P < 0.001), pain (P = 0.001), nausea (P = 0.012), and oral mucositis (P = 0.049) varied depending cancer type. Toxicity/side effects (P = 0.022), physical activity (P < 0.001), appetite loss, nausea, and vomiting (all P < 0.001), diarrhoea (P = 0.010), pain (P = 0.001), fatigue/insomnia (P = 0.001) varied depending on the trial location. Trial funding was predominantly from private/industry (34.3%) and influenced the reporting of overall survival (P = 0.049), weight/BMI (P = 0.005), caloric intake (P = 0.015), and pain (P = 0.031). Performance status and PROs tools were mentioned in 91.2% and 46.3% of the trials, respectively. Trials that incorporated PROs tools were more likely to report cachexia related outcomes, except for overall survival, lean muscle mass, and oral mucositis. The proportion of trials measuring weight/BMI increased with trial commencement year (P = 0.04). CONCLUSIONS Cachexia-related outcomes were under-recorded in gastrointestinal cancer chemotherapy trials. As trial patients experience a high symptom burden, cachexia-relevant measures and symptoms should be assessed throughout the trial, and integrated with primary endpoints to support their progress.
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Affiliation(s)
- Ross Valaire
- Faculty of Medicine & Health, South West Sydney Clinical CampusesUniversity of New South Wales (UNSW) SydneyKensingtonNSWAustralia
| | - Frances Garden
- Faculty of Medicine & Health, South West Sydney Clinical CampusesUniversity of New South Wales (UNSW) SydneyKensingtonNSWAustralia
| | - Valentina Razmovski‐Naumovski
- Faculty of Medicine & Health, South West Sydney Clinical CampusesUniversity of New South Wales (UNSW) SydneyKensingtonNSWAustralia
- School of MedicineWestern Sydney UniversityCampbelltownNSWAustralia
- Ingham Institute of Applied Medical ResearchSydneyNSWAustralia
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Ticha A, Hyspler R, Molnarova V, Priester P, Tomasova A, Filip S. Sipping as a Nutritional Supplement in Ambulatory Palliative Oncology Care: A Pilot Study with Noninvasive Methods. J Med Food 2023; 26:943-950. [PMID: 37831915 DOI: 10.1089/jmf.2023.0033] [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] [Indexed: 10/15/2023] Open
Abstract
Objective: The implementation of nutritional support is a basic need of patients in palliative oncological care. This pilot study optimized the use of sipping to improve the nutritional status of cancer patients in palliative care. Materials and Method: The pilot study included 63 patients, 61.3 years of age on average (range: 32-82 years of age). The patients were assigned to either group A (no nutritional support n = 39 patients) or group B (sipping as nutritional support n = 24 patients). The patients were evaluated through by noninvasive methods: body weight, waist and arm circumference, and triceps skinfold, bioimpedance analysis, and dynamometry. Quality of life was assessed through modified questionnaires. Results: In contrast with group A, group B did not have a significant weight loss, that is, A: 81.9 ± 15.8-80.5 ± 15.8 kg (P = .028) and B: 73.9 ± 14.9-73 ± 16 kg. Body mass index A: 29 ± 5-28.5 ± 5 kg/m2 (P = .007) and B: 25.3 ± 4.7-25 ± 4.9 kg/m2 (P = .614). Waist circumference A: 93.5 ± 15.1-92.5 ± 14.8 cm (P = .008) and B: 80.1 ± 13.2-80.6 ± 12.3 cm (P = .234). Triceps skinfold A: 12.3 ± 7.2-11 ± 6.7 mm (P = .001) and B: 8.2 ± 6.1-7.9 ± 5.7 mm (P = .207). Fat free mass A: 54.8 ± 11.5-52.8 ± 11.6 kg (P = .018) and B: 54.7 ± 10.9-52.8 ± 11.5 kg (P = .207). Significantly lower dynamometer values were recorded in both groups; A: 25.6 ± 10.4-23.1 ± 10.3 kg (P = .010) and B: 27.4 ± 9.9-24.3 ± 9.1 kg (P = .009). In contrast to group B, the patients in group A showed slight variations in their health status, thus decreasing their scores into the significance limit (P = .072). Conclusion: Our results suggest that providing nutritional support in the form of sipping (∼12 g proteins, 300 kcal) on a daily basis prevents the loss of active tissue mass in palliative oncology patients. Based on these results, we recommend the inclusion of this simple nutritional support to prevent malnutrition in cancer patients in palliative care. The clinical study was registered by the internal ethics committee under the heading of its approval - Institutional Ethics Committee of the Hradec Králové Faculty Hospital, number 201311S2OP.
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Affiliation(s)
- Alena Ticha
- Department of Clinical Biochemistry and Diagnostic, University Hospital, Hradec Kralove, Czech Republic
- Department of Research and Development, University Hospital, Hradec Kralove, Czech Republic
| | - Radomir Hyspler
- Department of Clinical Biochemistry and Diagnostic, University Hospital, Hradec Kralove, Czech Republic
- Department of Research and Development, University Hospital, Hradec Kralove, Czech Republic
| | - Veronika Molnarova
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Peter Priester
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Adela Tomasova
- Department of Clinical Biochemistry and Diagnostic, University Hospital, Hradec Kralove, Czech Republic
| | - Stanislav Filip
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
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Aung YM, Aktas A, Shroff V, Kadakia K, Waldman J, Walsh D. Nutrition assessment defects in cancer clinical trials. BMJ Support Palliat Care 2023:spcare-2023-004638. [PMID: 37940367 DOI: 10.1136/spcare-2023-004638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Ye Myint Aung
- Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Aynur Aktas
- Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Vishal Shroff
- Internal Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Kunal Kadakia
- Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jake Waldman
- Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Declan Walsh
- Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
- Hemby Family Foundation Endowed Chair in Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
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Huang JX, Liu B, Cong XF, Guan YJ, Zhang YQ, Song W, Li Z, Liu ZL, Wang NY. Anti-cancer treatment within two weeks serves as a risk factor for clinical outcomes among cancer patients with COVID-19. Front Oncol 2023; 13:1193082. [PMID: 37675234 PMCID: PMC10478212 DOI: 10.3389/fonc.2023.1193082] [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: 03/24/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in infections among patients with cancer. Our study aimed to investigate the potential adverse impact of anti-cancer treatments within 2 weeks of COVID-19 infection on clinical outcomes in patients with cancer. Methods This retrospective cohort study analyzed 70 cancer patients with COVID-19 infection from the First Hospital of Jilin University in Changchun City, Jilin Province, between March and June 2022. Data on demographic characteristics, vaccination status, COVID-19 clinical classification, symptoms, complications, tumor-related characteristics, laboratory examinations and medical interventions were extracted from electronic medical record. The primary outcome of our study was Intensive Care Unit (ICU) admission. Logistic regression model was performed to investigate the association between anti-cancer treatments within 2 weeks after COVID-19 infection and the risk of ICU admission. Results Of the 70 patients enrolled in this study, 37 received anti-cancer treatments within 2 weeks after COVID-19 infection. Patients receiving anti-cancer treatment were more likely to experience non-mild COVID-19, require oxygen therapy, develop acute respiratory distress syndrome (ARDS) and exhibit elevated inflammatory levels. The risk of ICU admission (P<0.001) and 30-day mortality after reverse transcriptase polymerase chain reaction (RT-PCR) negative conversion (P=0.007) was significantly higher in patients receiving anti-cancer treatments. In multivariate Logistic regression analysis, non-mild classification of COVID-19, anti-cancer treatments within 2 weeks and ECOG > 1were all independently associated with ICU admission after adjusting for confounder factors. The risk of ICU admission rose to 43.63 times (95% confidence interval=1.31-1452.94, P=0.035) in patients receiving anti-cancer treatments within 2 weeks. Conclusion Anti-cancer treatments within 2 weeks of COVID-19 infection increase the risk of ICU admission and 30-day mortality after RT-PCR negative conversion in patients with cancer. It may be recommended to postpone cancer-related treatments for more than 2 weeks in cancer patients with COVID-19 infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nan-Ya Wang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Kuhn MA, Gillespie MB, Ishman SL, Ishii LE, Brody R, Cohen E, Dhar SI, Hutcheson K, Jefferson G, Johnson F, Rameau A, Sher D, Starmer H, Strohl M, Ulmer K, Vaitaitis V, Begum S, Batjargal M, Dhepyasuwan N. Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2023; 168:571-592. [PMID: 36965195 DOI: 10.1002/ohn.302] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx. METHODS Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible. RESULTS The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus. CONCLUSION Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.
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Affiliation(s)
- Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey L Ishman
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa E Ishii
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA
| | - Ezra Cohen
- Moores Cancer Center at UC San Diego Health, La Jolla, California, USA
| | | | - Kate Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Gina Jefferson
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Anais Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - David Sher
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Karen Ulmer
- Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA
| | - Vilija Vaitaitis
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA
| | - Sultana Begum
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Misheelt Batjargal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Song M, Zhang Q, Song C, Liu T, Zhang X, Ruan G, Tang M, Zhang X, Xie H, Zhang H, Ge Y, Li X, Zhang K, Yang M, Li Q, Liu X, Lin S, Xu Y, Li B, Li X, Wang K, Xu H, Li W, Shi H. Handgrip weakness, systemic inflammation indicators, and overall survival in lung cancer patients with well performance status: A large multicenter observational study. Cancer Med 2022; 12:2818-2830. [PMID: 36073671 PMCID: PMC9939150 DOI: 10.1002/cam4.5180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/14/2022] [Accepted: 05/28/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Systemic inflammation and handgrip weakness have been used to predict mortality in many cancers. The purpose of current study was to evaluate the association of co-occurrence of inflammation indicators and handgrip weakness with overall survival (OS) of lung cancer (LC) patients with good performance status. METHODS The cutoff points for handgrip strength (HGS) and the four inflammation indicators were calculated using Maxstat. The time-dependent receiver operating characteristic curve and C-index were used to select optimal inflammation indicator for predicting OS of LC patients. The Cox proportional hazard regression model was used to calculate the hazard ratio (HR) of mortality. Kaplan-Meier curves were constructed to evaluate the association of indicators and the OS of LC patients. RESULTS Among the 1951 patients, the mean ± standard deviation (SD) age was 60.6 ± 9.9 years, and 1300 (66.6%) patients were male. In patients with good performance status (PS), handgrip weakness (HR, 1.49; 95% confidence interval [95% CI], 1.30-1.70, p < 0.001) and low advanced lung cancer inflammation index (ALI) (HR, 2.05; 95%CI, 1.79-2.34, p < 0.001), high systemic immune-inflammation index (SII) (HR, 1.91; 95%CI, 1.66-2.19, p < 0.001), high platelet: lymphocyte ratio (PLR) (HR, 1.60; 95%CI, 1.40-1.82, p < 0.001), or high neutrophil: lymphocyte ratio (NLR) (HR, 2.01; 95%CI, 1.76-2.30, p < 0.001) were associated with increased mortality risk of LC patients. ALI had better C-index (0.624) and time-AUC in the prediction of OS in LC patients with good PS than other three combinations. The co-occurrence of handgrip weakness and low ALI more than doubled the risk of death in LC with good PS (HR, 2.44; 95% CI, 2.06-2.89, p < 0.001). CONCLUSION In LC patients who have good PS, patients with combined handgrip weakness and low ALI have the worst prognosis. THE TRIAL REGISTRATION NUMBER ChiCTR1800020329.
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Affiliation(s)
- Mengmeng Song
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Qi Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Chunhua Song
- Department of Epidemiology and StatisticsHenan Key Laboratory of Tumor Epidemiology College of Public Health, Zhengzhou UniversityZhengzhouHenanChina
| | - Tong Liu
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Xi Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Meng Tang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Xiaowei Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Hailun Xie
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Heyang Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Xiangrui Li
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Kangping Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Ming Yang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Qinqin Li
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina,Liaocheng UniversityLiaochengChina
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Shiqi Lin
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Yu Xu
- The First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Bo Li
- Affiliated Hospital of Yunnan UniversityKunmingChina
| | - Xiaogang Li
- Affiliated Hospital of Yunnan UniversityKunmingChina
| | - Kunhua Wang
- Yunnan UniversityKunmingChina,General Surgery Clinical Medical Center of Yunnan ProvinceKunmingChina
| | - Hongxia Xu
- Department of NutritionDaping Hospital & Research Institute of Surgery, Third Military Medical UniversityChongqingChina
| | - Wei Li
- Cancer Center of the First Hospital of Jilin UniversityChangchunChina
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
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