Malnutrition and overall survival in older patients with cancer

Association between GLIM-diagnosed malnutrition and quality of life in older patients with cancer

BACKGROUND

Older patients with cancer have a higher risk for malnutrition and impaired quality of life (QoL). The present study aimed to investigate the relationship between malnutrition diagnosed according to the Global Leadership Initiative Malnutrition (GLIM) criteria and QoL across various tumor types, and to evaluate the combined prognostic value of malnutrition and QoL in predicting survival among older patients with cancer.

METHODS

This multicenter, observational cohort study included 5310 older patients with cancer and 2184 with malnutrition (moderate stage, n = 1023; severe stage, n = 1161). An empirical cumulative distribution curve was performed to illustrate the correlation between malnutrition and QoL. The primary objective was to investigate the association between malnutrition and QoL using logistic regression analysis. Survival analyses were performed to assess the combined prognostic value of malnutrition and QoL.

RESULTS

The median age of the patients (66.9% male, 33.1% female) was 70 years (interquartile range [IQR] 67-74 years) years. The median QoL score was highest in patients without malnutrition (91.88 [IQR 84.44-97.44]), followed by those with moderate (86.15 [IQR 76.18-93.85) and severe (82.31 [IQR 69.87-91.11]) malnutrition. Logistics regression revealed that the risk for developing impaired QoL increased 1.98 (95% confidence interval [CI] 1.64-2.38; P < 0.001) and 2.33 (95% CI 1.93-2.81; P < 0.001) times in patients with moderate and severe malnutrition, respectively. Kaplan-Meier curves showed that QoL in combination with GLIM criteria demonstrated a significant discriminative performance for survival and served as an independent prognostic factor among older patients with cancer, especially for lung and gastric cancers.

CONCLUSIONS

Malnutrition diagnosed according to the GLIM criteria was a predictor of impaired QoL. Additionally, the combination of QoL and malnutrition demonstrated utility for predicting survival outcomes in older patients with cancer.

Serum trace elements during treatment in pancreatic cancer patients and their associations with cancer prognosis

BACKGROUND & AIMS

In this study, we assessed serum trace element concentrations in patients with pancreatic cancer and compared the results to those of healthy controls and patients with chronic pancreatitis. We evaluated the association between trace element concentrations during cancer treatment and the risk of cancer progression and mortality in pancreatic cancer patients.

METHODS

A retrospective cohort study was conducted at a tertiary center in Korea. Serum trace element concentrations of cobalt (Co), copper (Cu), selenium (Se), and zinc (Zn) were measured at diagnosis using an inductively coupled plasma-mass spectrometry in 124 patients with pancreatic cancer, 50 patients with chronic pancreatitis, and 120 healthy controls. Trace elements were measured after a median of 282.5 (95% confidence interval [CI], 224.0-326.5) days from treatment initiation to assess changes in trace element concentrations during treatment.

RESULTS

Serum Co concentrations were significantly higher in patients with chronic pancreatitis and pancreatic cancer compared to healthy controls, while serum Se concentrations were significantly lower. During treatment, serum concentrations of Cu, Se, and Zn significantly decreased in patients with pancreatic cancer. During the follow-up (median 152.5; 95% CI, 142.8-160.0 months), 85.5% of patients experienced progression or relapse, and 84.7% of patients died. Patients with decreased Se and Zn concentrations during treatment had a higher mortality (hazard ratio [HR], 2.10; 95% CI, 1.31-3.38; P = 0.0020 for Se; HR, 1.72; 95% CI, 1.06-2.79; P = 0.0269 for Zn) compared to those with unchanged or increased trace element concentrations during treatment. Patients with a greater reduction in Zn concentrations during treatment had a higher mortality than those with a smaller reduction (HR, 1.59; 95% CI, 1.01-2.52; P = 0.0483). Patients whose Zn status changed from normal to deficient during treatment had an increased mortality (HR, 1.76; 95% CI, 1.16-2.67, P = 0.0084). Patients with multiple (≥2) trace element deficiencies after treatment had poorer outcomes than those with no or single trace element deficiency.

CONCLUSIONS

This study revealed that decreases in Se and Zn concentrations during cancer treatment were associated with adverse outcomes in terms of cancer progression and mortality in patients with pancreatic cancer. Further prospective investigations are recommended.

A Novel Nomogram to Predict Prognosis in Elderly Early-Stage Hepatocellular Carcinoma Patients After Ablation Therapy

Purpose

Hepatocellular carcinoma (HCC) is the predominant form of primary liver cancer. Early diagnosis is crucial for improving prognosis. Elderly HCC patients often have underlying liver diseases such as chronic hepatitis and cirrhosis, leading to impaired liver function and suboptimal liver reserve. Radiofrequency ablation (RFA) has rapidly become one of the most important methods for treating early-stage hepatocellular carcinoma (EHCC) due to its advantages, including minimal trauma, short operation time, less intraoperative bleeding, quick postoperative recovery, cost-effectiveness, and few postoperative-complications. However, the prognostic model for early recurrence after local ablation in elderly EHCC patients has not been widely evaluated. We have developed a prognostic model for the recurrence of local RFA in elderly EHCC patients. This is expected to provide a new early warning system for preventing early recurrence in elderly EHCC patients, prolonging patient's life, and improving overall quality of life.

Methods

In this study, we included 661 EHCC patients who underwent local ablation, dividing them into a Primary cohort and a Validation cohort in a 7:3 ratio. We characterized the cohorts and utilized the primary cohort to develop a prognostic nomogram model for recurrence after local ablation in elderly EHCC patients. Additionally, the validation cohort was used to assess the potential of the nomogram as a non-invasive biomarker for post-ablation recurrence in EHCC.

Results

The user-friendly nomogram incorporates common clinical variables including gender, BCLC stage, tumor number, tumor size, red blood cell (RBC), gamma-glutamyl transferase (GGT), and prothrombin time activity (PTA). The nomogram constructed using the identified seven variables exhibits robust discriminatory capabilities, favorable predictive performance, and noteworthy clinical utility.

Conclusion

We developed a user-friendly nomogram based on the BCLC stage classification, which may provide prognostic assessments for elderly EHCC patients at 1, 3, and 5 years post-RFA.

Effectiveness of prognostic nutritional index in predicting overall survival and evaluating immunotherapy response in anaplastic thyroid carcinoma

BACKGROUND

The prognostic value of nutritional status in anaplastic thyroid carcinoma (ATC) remains unclear. The Prognostic Nutritional Index (PNI) is a reliable indicator of overall nutritional and immune status, and it has emerged as a significant prognostic factor in various malignancies. This study aimed to explore the utility of PNI in ATC.

METHODS

We systematically reviewed ATC patients in our institute from January 2000 to June 2023 and categorized them into high and low PNI groups based on the median PNI value. Kaplan-Meier analysis and Cox regression were employed to assess the impact of PNI on overall survival, while ROC curve analysis evaluated the predictive value of PNI. Mimics software was used for three-dimensional reconstruction of pre- and post-immunotherapy tumor volumes, enabling the assessment of treatment response.

RESULTS

A total of 77 ATC patients were included in this study. Low baseline PNI was associated with significantly shorter overall survival (1-year survival rate: 5.26% vs 30.77%; median survival time: 5.30 months vs 8.87 months). The 1-year, 2-year, and 3-year AUC values for PNI were 0.82, 0.79, and 0.77, respectively. In the multivariate analysis, both PNI and tumor size emerged as independent prognostic factors for patient overall survival. Among ATC patients receiving 2-3 cycles of immunotherapy, an increase in post-treatment PNI levels was positively correlated with a reduction in tumor volume.

CONCLUSION

PNI is an independent predictor of overall survival and holds the potential to serve as a valuable indicator for assessing and predicting immunotherapy efficacy in ATC patients.

Predicting malnutrition in gastric cancer patients using computed tomography(CT) deep learning features and clinical data

OBJECTIVE

The aim of this study is using clinical factors and non-enhanced computed tomography (CT) deep features of the psoas muscles at third lumbar vertebral (L3) level to construct a model to predict malnutrition in gastric cancer before surgery, and to provide a new nutritional status assessment and survival assessment tool for gastric cancer patients.

METHODS

A retrospective analysis of 312 patients of gastric cancer were divided into malnutrition group and normal group based on Nutrition Risk Screening 2002(NRS-2002). 312 regions of interest (ROI) of the psoas muscles at L3 level of non-enhanced CT were delineated. Deep learning (DL) features were extracted from the ROI using a deep migration model and were screened by principal component analysis (PCA) and least-squares operator (LASSO). The clinical predictors included Body Mass Index (BMI), lymphocyte and albumin. Both deep learning model (including deep learning features) and mixed model (including selected deep learning features and selected clinical predictors) were constructed by 11 classifiers. The model was evaluated and selected by calculating receiver operating characteristic (ROC), area under curve (AUC), accuracy, sensitivity and specificity, calibration curve and decision curve analysis (DCA). The Cohen's Kappa coefficient (κ) was using to compare the diagnostic agreement for malnutrition between the mixed model and the GLIM in gastric cancer patients.

RESULT

The results of logistics multivariate analysis showed that BMI [OR = 0.569 (95% CI 0.491-0.660)], lymphocyte [OR = 0.638 (95% CI 0.408-0.998)], and albumin [OR = 0.924 (95% CI 0.859-0.994)] were clinically independent malnutrition of gastric cancer predictor(P < 0.05). Among the 11 classifiers, the Multilayer Perceptron (MLP)were selected as the best classifier. The AUC of the training and test sets for deep learning model were 0.806 (95% CI 0.7485-0.8635) and 0.769 (95% CI 0.673-0.863) and with accuracies were 0.734 and 0.766, respectively. The AUC of the training and test sets for the mixed model were 0.909 (95% CI 0.869-0.948) and 0.857 (95% CI 0.782-0.931) and with accuracies of 0.845 and 0.861, respectively. The DCA confirmed the clinical benefit of the both models. The Cohen's Kappa coefficient (κ) was 0.647 (P < 0.001). Diagnostic agreement for malnutrition between the mixed model and GLIM criteria was good. The mixed model was used to calculate the predicted probability of malnutrition in gastric cancer patients, which was divided into high-risk and low-risk groups by median, and the survival analysis showed that the overall survival time of the high-risk group was significantly lower than that of the low-risk group (P = 0.005).

CONCLUSION

Deep learning based on mixed model may be a potential tool for predicting malnutrition in gastric cancer patients.

Prognostic Nutritional Index as a Predictive Biomarker of Post-Operative Infectious Morbidity in Gynecological Cancer Patients: A Prospective Cohort Study

Malnutrition significantly impacts the post-operative process of gynecological cancer patients. A prominent variable for determining perioperative morbidity is the Prognostic Nutritional Index (PNI). To investigate PNI's predictive value on the risk of post-operative infections, we conducted a prospective cohort study involving women who underwent surgery for gynecological malignancies. Out of the 208 patients enrolled, 28 (13.5%) were malnourished and post-operative infections occurred in 43 patients. Notably, there was a significant difference in PNI between patients who developed infections and those who did not (p = 0.027), as well as between malnourished patients and those with normal nutritional status (p = 0.043). Univariate analysis showed that preoperative PNI predicts the risk of post-operative infections better than post-operative white blood cell count (AUC of 0.562 vs 0.375). However, the most accurate diagnostic results in the multivariate analysis were obtained from random forest and classification tree models (AUC of 0.987 and 0.977, respectively). Essentially, PNI and post-operative white blood cell count provided the best information gain according to rank probabilities. In conclusion, PNI appears to be a critical parameter that merits further investigation during the preoperative evaluation of gynecological malignancies.

Experiences of Family Caregivers Providing Home Care to Older Patients With Cancer: A Qualitative Study

BACKGROUND

Older patients with cancer receive anticancer therapy in outpatient settings, and care-related issues may occur after discharge, which often requires family caregivers (FCs) to play a significant role in providing cancer care at home. However, relatively few studies have been focused on exploring the care experiences of these FCs.

PURPOSE

The aim of this study was to explore the care experiences of FCs caring for older family members with cancer at home.

METHODS

A qualitative study design and in-depth individual interviews were used to explore the at-home care experiences of FCs of older patients with cancer. The research was conducted in chemotherapy outpatient settings of a medical center in northern Taiwan. Content analysis was used to analyze data. The analyses focused on first extracting meaningful units from the text and then inducting categories from these units and determining the major themes.

RESULTS

Twenty FCs were interviewed. The three themes identified included (a) increased information needs and challenges in diet preparation and treatment decision making, (b) personal and patient-induced emotional stress, and (c) life rebalancing through the care experience.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings highlight the educational requirements, especially related to meeting personal dietary needs and obtaining psychological support, for FCs caring for older patients with cancer to help them rebalance their life.

The risk of malnutrition and its clinical implications in older patients with cancer

AIM

Malnutrition is a common geriatric syndrome with multiple negative outcomes including mortality. However, there is a scarcity of literature that focuses on the relationship between malnutrition risk and its clinical implications on geriatric syndromes and mortality among cancer patients. The aim of this study is to determine the clinical importance of malnutrition risk in geriatric oncology practice.

METHOD

180 patients with cancer who were ≥ 65 years were included in the study. All patients were questioned in terms of geriatric syndromes, including polypharmacy, frailty, probable sarcopenia, fall risk, dynapenia, depression, cognitive impairment, insomnia, and excessive daytime sleepiness. Mini Nutritional Assessment scores > 23.5 and 17-23.5 were categorized as well-nourished and malnutrition risk, respectively.

RESULTS

Of the 180 patients (mean age 73.0 ± 5.6 years, female: 50%), the prevalence of malnutrition risk was 28.9%. There was no statistically significant difference between the groups in terms of age, gender, education, marital status, body mass index, and comorbidities except for chronic obstructive pulmonary disease (p > 0.05). After adjustment for age, sex, and body mass index; polypharmacy (odds ratio [OR]: 3.17; 95% confidence interval [CI], 1.48-6.81), reduced calf circumference (OR: 3.72; 95% CI, 1.22-11.38), fall risk (OR: 2.72; 95% CI, 1.03-7.23), depression (OR: 6.24; 95% CI, 2.75-14.18), insomnia (OR: 4.89; 95% CI, 2.16-11.05), and frailty (OR: 2.44; 95% CI, 1.75-3.40) were associated with malnutrition risk compared to well-nourished patients (p < 0.05). Median survival in patients with malnutrition risk was 21.3 months (range 14.1-28.4 95% CI) and median survival in patients who were defined as well nourished was not reached (p < 0.001).

CONCLUSION

The risk of malnutrition was associated with a higher risk for all-cause mortality in older patients with cancer, and was associated with many geriatric syndromes, including polypharmacy, fall risk, frailty, insomnia, and depression.

Oncological prognosis and morbidity of hepatectomy in elderly patients with hepatocellular carcinoma: a propensity score matching and multicentre study

PURPOSE

With increasing life expectancy, the number of elderly patients (≥ 65 years) with hepatocellular carcinoma (HCC) has steadily increased. Hepatectomy remains the first-line treatment for HCC patients. However, the prognosis of hepatectomy for elderly patients with HCC remains unclear.

METHODS

Clinical and follow-up data from 1331 HCC patients who underwent surgery between 2008 and 2020 were retrospectively retrieved from a multicentre database. Patients were divided into elderly (≥ 65 years) and non-elderly (< 65 years) groups, and PSM was used to balance differences in the baseline characteristics. The postoperative major morbidity and cancer-specific survival (CSS) of the two groups were compared and the independent factors that were associated with the two study endpoints were identified by multivariable regression analysis.

RESULTS

Of the 1331 HCC patients enrolled in this study, 363 (27.27%) were elderly, while 968 (72.73%) were not. After PSM, 334 matched samples were obtained. In the propensity score matching (PSM) cohort, a higher rate of major morbidity was found in elderly patients (P = 0.040) but the CSS was similar in the two groups (P = 0.087). Multivariate analysis revealed that elderly age was not an independent risk factor associated with high rates of major morbidity (P = 0.117) or poor CSS (P = 0.873). The 1-, 3- and 5-year CSS rates in the elderly and non-elderly groups were 91.0% versus 86.2%, 71.3% versus 68.8% and 55.9% versus 58.0%, respectively. Preoperative alpha fetoprotein (AFP) level, Child‒Pugh grade, intraoperative blood transfusion, extended hemi hepatectomy, and tumour diameter could affect the postoperative major morbidity and preoperative AFP level, cirrhosis, Child‒Pugh grade, macrovascular invasion, microvascular invasion (MVI), satellite nodules, and tumor diameter were independently and significantly associated with CSS.

CONCLUSION

Age itself had no significant effect on the prognosis of elderly patients with HCC after hepatectomy. Hepatectomy can be safely performed in elderly patients after cautious perioperative management.

The efficacy of fat-free mass index and appendicular skeletal muscle mass index in cancer malnutrition: a propensity score match analysis

Background

Reduced muscle mass (RMM) is a phenotypic criterion for malnutrition; the appendicular skeletal muscle mass index (ASMI) and fat-free mass index (FFMI) are both applicable indicators in the global leadership initiative on malnutrition (GLIM) guideline. However, their sensitivity and prognostic effect remain unclear.

Methods

Clinical data of 2,477 patients with malignant tumors were collected. Multi-frequency bioelectrical impedance analysis was used to obtain ASMI and FFMI. RMM was confirmed by ASMI (< 7.0 kg/m² for men and < 5.7 kg/m² for women) or FFMI (< 17 kg/m² for men and < 15 kg/m² for women). Propensity score match analysis and logistic regression analysis were used to evaluate the efficacy of FFMI and ASMI in diagnosing severe malnutrition and multivariate Cox regression analysis to determine the efficacy of RMM in predicting survival.

Results

In total, 546 (22.0%) and 659 (26.6%) participants were diagnosed with RMM by ASMI (RMM.ASMI group) and FFMI (RMM.FFMI group); 375 cases overlapped. Body mass index (BMI), midarm circumference, triceps skinfold thickness, and maximum calf circumference were all significantly larger in the RMM.FFMI group for both sexes (P < 0.05). A 1:1 matched dataset constructed by propensity score match contained 810 cases. RMM.FFMI was an influential factor of severe malnutrition with HR = 3.033 (95% CI 2.068-4.449, P < 0.001), and RMM.ASMI was a predictive factor of overall survival (HR = 1.318, 95% CI 1.060-1.639, P = 0.013 in the RMM.ASMI subgroup, HR = 1.315, 95% CI 1.077-1.607, P = 0.007 in the RMM.FFMI subgroup).

Conclusion

In general, RMM indicates negative clinical outcomes; when defined by FFMI, it predicts nutritional status, and when defined by ASMI, it is related to poor survival in cancer patients.

Geriatric nutritional risk index after neoadjuvant chemoradiotherapy and survival in older patients with advanced rectal cancer

PURPOSE

To investigate the clinical impact of malnutrition on the survival of older patients with advanced rectal cancer who underwent neoadjuvant chemoradiotherapy.

METHODS

We investigated the clinical significance of the geriatric nutritional risk index (GNRI) in 237 patients aged over 60 years with clinical stage II/III rectal adenocarcinoma who were treated with neoadjuvant long-course chemoradiotherapy or total neoadjuvant therapy followed by radical resection from 2004 to 2017. Pre-treatment and post-treatment GNRI were evaluated, with patients split into low (< 98) and high (≥ 98) GNRI groups. The prognostic impact of pre-treatment and post-treatment GNRI levels on overall survival (OS), post-recurrence survival (PRS), and disease-free survival (DFS) was evaluated using univariate and multivariate analyses.

RESULTS

Fifty-seven patients (24.1%) before neoadjuvant treatment and 94 patients (39.7%) after neoadjuvant treatment were categorized with low GNRI. Pre-treatment GNRI levels were not associated with OS (p = 0.80) or DFS (p = 0.70). Patients in the post-treatment low GNRI group had significantly poorer OS than those in the post-treatment high GNRI group (p = 0.0005). The multivariate analysis showed that post-treatment low GNRI levels were independently associated with poorer OS (hazard ratio, 3.06; 95% confidence interval, 1.55-6.05; p = 0.001). Although post-treatment GNRI levels were not associated with DFS (p = 0.24), among the 50 patients with recurrence, post-treatment low GNRI levels were associated with poorer PRS (p = 0.02).

CONCLUSION

Post-treatment GNRI is a promising nutritional score associated with OS and PRS in patients over 60 years with advanced rectal cancer treated with neoadjuvant chemoradiotherapy.

The prognostic value of controlling nutritional status (CONUT) score-based nomogram on extranodal natural killer/T cell lymphoma patients

Controlling nutritional status (CONUT) score as an original nutritional assessment tool can be used to assess the prognosis of patients with a variety of malignancies. However, the predictive power of CONUT in extranodal natural killer/T cell lymphoma (ENKTL) patients has never been demonstrated. Our retrospective multicenter study aimed to explore the prognostic value of CONUT in newly diagnosed ENKTL. A total of 1085 newly diagnosed ENKTL patients between 2003 and 2021 were retrospectively retrieved. Cox proportional hazard model was used to explore the prognostic factors of overall survival (OS). The survival rate of ENKTL was evaluated using Kaplan-Meier analysis, and log-rank test was applied to the difference between groups. We investigated the prognostic performance of CONUT, the International Prognostic Index (IPI), the Korean Prognostic Index (KPI), and the Prognostic Index of Natural Killer Cell Lymphoma (PINK) using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). The median age at diagnosis for the whole cohort was 47 years, and the male to female ratio was 2.2:1. The 5-year OS for all patients was 72.2%. Multivariable analysis showed that CONUT, age, bone marrow involvement, ECOG PS score, and Chinese Southwest Oncology Group and Asia Lymphoma Study Group ENKTL stage were identified as independent predictive factors for OS. Based on multivariable results, a prognostic nomogram was developed. Subgroup analysis demonstrated that patients with severe malnutrition had poorest clinical outcome. In addition, ROC curves and DCA analysis proved that compared with IPI, KPI, and PINK models, the CONUT score-based nomogram showed a better prognostic predictive efficiency of ENKTL. CONUT could effectively stratify the prognosis of ENKTL and the proposed nomogram based on CONUT was an effective prognostic model for prediction.

Prognostic Value of Nutritional Assessments on Overall Survival in Head and Neck Cancer Survivors with Radiation-Induced Brain Necrosis

Malnutrition is related to worsened prognosis, but the association between nutritional risk status and overall survival in radiation-induced brain necrosis (RN) has never been studied. We included consecutive patients who had received radiotherapy for head and neck cancer (HNC) and subsequently developed RN from 8 January 2005 through to 19 January 2020. The primary outcome was overall survival. We utilized three commonly-used nutritional assessments: the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and the COntrolling NUTritional Status (CONUT) measure, to quantify the baseline nutritional risk. A total of 398 eligible patients were included. During a median follow-up of 2.3 years, 42 (10.6%) patients died of any cause. Malnutrition at admission was associated with an increased risk of future death, as assessed by the GNRI (per 1-point decreased, HR 1.05, 95%CI 1.02-1.09, p = 0.001), the PNI (per 1-point decreased, HR 1.07, 95%CI 1.03-1.12, p = 0.002), and the CONUT (per 1-point increased, HR 1.22, 95%CI 1.08-1.37, p = 0.001). There were no nonlinear correlations between all three indices and post-RN survival. Among HNC survivors with RN, the assessment of nutritional risk by composite indices upon admission could help identify patients who might be at high risk of future death and deliver better nutritional management.

Clinical impacts of the concomitant use of L-asparaginase and total parenteral nutrition containing L-aspartic acid in patients with acute lymphoblastic leukemia

Introduction

L-asparaginase (ASNase) depletes L-asparagine and causes the death of leukemic cells, making it a mainstay for the treatment of acute lymphoblastic leukemia (ALL). However, ASNase's activity can be inhibited by L-aspartic acid (Asp), which competes for the same substrate and reduces the drug's efficacy. While many commercially used total parenteral nutrition (TPN) products contain Asp, it is unclear how the concomitant use of TPNs containing Asp (Asp-TPN) affects ALL patients treated with ASNase. This propensity-matched retrospective cohort study evaluated the clinical effects of the interaction between ASNase and Asp-TPN.

Methods

The study population included newly diagnosed adult Korean ALL patients who received VPDL induction therapy consisting of vincristine, prednisolone, daunorubicin, and Escherichia coli L-asparaginase between 2004 and 2021. Patients were divided into two groups based on their exposure to Asp-TPN: (1) Asp-TPN group and (2) control group. Data, including baseline characteristics, disease information, medication information, and laboratory data, were collected retrospectively. The primary outcomes for the effectiveness were overall and complete response rates. Relapse-free survival at six months and one year of treatment were also evaluated. The safety of both TPN and ASNase was evaluated by comparing liver function test levels between groups. A 1:1 propensity score matching analysis was conducted to minimize potential selection bias.

Results

The analysis included a total of 112 ALL patients, and 34 of whom received Asp-TPN and ASNase concomitantly. After propensity score matching, 30 patients remained in each group. The concomitant use of Asp-TPN and ASNase did not affect the overall response rate (odds ratio [OR] 0.53; 95% confidence interval [CI] = 0.17–1.62) or the complete response rate (OR 0.86; 95% CI = 0.29–2.59) of the ASNase-including induction therapy. The concomitant use of Asp-TPN and ASNase also did not impact relapse-free survival (RFS) at six months and one year of treatment (OR 1.00; 95% CI = 0.36–2.78 and OR 1.24; 95% CI, 0.50–3.12, respectively). The peak levels of each liver function test (LFT) and the frequency of LFT elevations were evaluated during induction therapy and showed no difference between the two groups.

Conclusion

There is no clear rationale for avoiding Asp-TPN in ASNase-treated patients.

Care needs of older patients with advanced cancer

PURPOSE OF REVIEW

This review summarized current research evidence examining care needs of older patients with advanced cancer in dealing with disease, treatment, and treatment-related side effects. It also identified gaps and directions for future research and practice.

RECENT FINDINGS

Older patients with advanced cancer need support from health professionals, family, friends, and other social network members in the management of physical symptoms and functioning, psychosocial and spiritual care, information provision, and practical resolution of daily problems. As older patients are affected by aging-related factors, they usually have unique patterns of care needs compared with younger patients.

SUMMARY

Currently, insufficient research evidence hinders a comprehensive understanding of care needs of older patients with advanced cancer, as well as potential influencing factors. Future efforts are needed to develop more sophisticated assessment methods and interventions to better understand and address care needs of older patients with advanced cancer.

Association of Controlling Nutritional Status Score With Adverse Outcomes in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis sought to examine the association between the controlling nutritional status (CONUT) score and adverse outcomes in patients with coronary artery disease (CAD). PubMed and Embase databases were searched for eligible studies from their inceptions to December 12, 2021 to identify studies investigating the association of the CONUT score with major adverse cardiovascular events (MACEs) and all-cause mortality in CAD patients. Twelve studies (36,198 CAD) patients satisfied the criteria. Comparison of the high with low CONUT score, the pooled multivariate adjusted risk ratios (RR) was 1.78 (95% confidence intervals [CI] 1.36-2.32) for MACEs and 1.45 (95% CI 1.27-1.66) for all-cause mortality, respectively. When compared with patients with normal nutrition, malnourished (defined by the CONUT score ≥2) patients conferred a 52% increased risk of MACEs. Additionally, per point CONUT score increment was associated with 15% and 11% higher risk of MACEs and all-cause mortality, respectively. Higher CONUT score independently predicts the MACEs all-cause mortality in CAD patients. Estimation of nutritional status using the CONUT score could be helpful for improving risk classification of CAD.

Prognostic value of the nutritional risk index in patients with newly diagnosed multiple myeloma

The nutritional risk index (NRI), which is based on weight and albumin levels, is closely associated with the prognosis of many cancers. However, its prognostic value has not been investigated in patients with newly diagnosed multiple myeloma (NDMM). We aimed to assess the association between the NRI and survival outcomes in patients with NDMM. We retrospectively collected and analyzed clinical and laboratory data from patients with NDMM between 2005 and 2019 at our center. Patients were stratified into the high NRI (> 89) and low NRI (≤ 89) groups for prognostic analysis. The NRI and other variables were also explored to evaluate their prognostic value for overall survival (OS). A total of 638 patients diagnosed with NDMM were retrospectively included. Patients in the high NRI group had a significantly better median OS than those in the low NRI group (64 months vs 43 months, p < 0.001). In the multivariate analysis, a high NRI was shown to be an independent prognostic factor for OS (hazard ratio, 0.758; 95% confidence interval, 0.587-0.977; p = 0.033). Age, performance status, transplant status, and lactate dehydrogenase level were also independent prognostic factors for OS. In conclusion, our study demonstrates that the NRI is a simple and useful predictor of survival outcomes in patients with NDMM.

Malnutrition diagnosed by the Global Leadership Initiative on Malnutrition criteria predicting survival and clinical outcomes of patients with cancer: A systematic review and meta-analysis

Objectives

Recently, some cohorts have looked into the use of Global Leadership Initiative on Malnutrition (GLIM) criteria in cancer patients. The objective of the current meta-analysis was to determine its utility in predicting clinical and survival outcomes for cancer patients.

Method

Searching and screening literature from PubMed, Web of Science and Embase until September 13, 2022 was performed by two researchers independently. According to the exclusion and inclusion criteria, articles reporting the impact of malnutrition diagnosed by GLIM on long-term survival and clinical outcomes were included. Data of interest were also extracted from the included papers. The stability of the pooled results was evaluated using sensitivity analysis. With the aid of subgroup analysis, heterogeneity was revealed. To assess publication bias, Egger's and Begg's tests were conducted. The influence of publication bias on the pooling risk estimate was examined using a trim-and-fill analysis.

Results

15 studies that qualified for our study were identified. Pooled hazard ratio (HR) from both multivariate and univariate regression analysis showed a worse overall survival in GLIM-defined malnourished cancer patients than those in well-nourished status. Meanwhile, disease-free survival was also poorer in malnourished patients. Moreover, pooled odds ratio (OR) demonstrated that malnourished cancer patients were more likely to develop overall postoperative complications, complications ≥ Clavien-Dindo grade IIa and complications ≥ Clavien-Dindo grade IIIa. Two articles reported negative relation between GLIM-defined malnutrition and 30-day readmission/mortality.

Conclusion

GLIM-defined malnutrition possesses value in predicting poorer survival and clinical outcomes for cancer patients.

Systematic review registration

[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=321094], identifier [CRD42022321094].

Implementation of an electronic solution to improve malnutrition identification and support clinical best practice

BACKGROUND

Routine malnutrition risk screening of patients is critical for optimal care and comprises part of the National Australian Hospital Standards. Identification of malnutrition also ensures reimbursement for hospitals to adequately treat these high-risk patients. However, timely, accurate screening, assessment and coding of malnutrition remains suboptimal. The present study aimed to investigate manual and digital interventions to overcome barriers to malnutrition identification for improvements in the hospital setting.

METHODS

Retrospective reporting on malnutrition identification processes was conducted through two stages: (1) manual auditing intervention and (2) development of a digital solution - the electronic malnutrition management solution (eMS). Repeated process audits were completed at approximately 6-monthly intervals through both stages between 2016 and 2019 and the results were analysed. In Stage 2, time investment and staff adoption of the digital solution were measured.

RESULTS

Overall, the combined effect of both regular auditing and use of the eMS resulted in statistically significant improvements across all six key measures: patients identified (97%-100%; p < 0.001), screened (68%-95%; p < 0.001), screened within 24 h (51%-89%; p < 0.001), assessed (72%-95%; p < 0.001), assessed within 24 h (66%-93%; p < 0.001) and coded (81%-100%; p = 0.017). The eMS demonstrated a reduction in screening time by over 60% with user adoption 100%. Data analytics enabled automated, real-time auditing with a 95% reduction in time taken to audit.

CONCLUSIONS

A single digital solution for management of malnutrition and automation of auditing demonstrated significant improvements where manual or combinations of manual and electronic systems continue to fall short.

A Digital Smartphone-Based Self-administered Tool (R+ Dietitian) for Nutritional Risk Screening and Dietary Assessment in Hospitalized Patients With Cancer: Evaluation and Diagnostic Accuracy Study

BACKGROUND

Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated.

OBJECTIVE

This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program.

METHODS

We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, κ value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian.

RESULTS

A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5%, 81.0%, and 76.7% and 69.3%, 84.5%, and 64.5%, respectively), and fair agreement (κ=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians.

CONCLUSIONS

The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528.

Global leaders malnutrition initiative-defined malnutrition affects long-term survival of different subgroups of patients with gastric cancer: A propensity score-matched analysis

As defined by the Global Leaders Malnutrition Initiative (GLIM), malnutrition is strongly associated with a lower quality of life and poor prognosis in gastric cancer patients. However, few studies have precisely explored the predictors of malnutrition, as defined by the GLIM, for overall survival (OS) after gastric cancer surgery in subgroups of patients stratified according to population characteristics. Our research aimed to analyze whether the predictors of malnutrition defined by the GLIM for postoperative OS in gastric cancer patients differ across subgroups. Patients who underwent radical gastric cancer surgery at our center between July 2014 and February 2019 were included in the study. Propensity score matching (PSM) was used to minimize bias. The study population was divided into malnourished and normal groups based on whether they were malnourished as defined by the GLIM. Univariate and multivariate analyses were performed to identify the risk factors affecting OS. The Kaplan–Meier curve and log-rank test were performed to determine the survival rate difference between subgroups. Overall, 1,007 patients were enrolled in the research. Multivariate analysis showed that malnutrition among the patients was 33.47%. Additionally, GLIM-defined malnutrition was an independent risk factor [hazard ratio (HR): 1.429, P = 0.001] for a shorter OS in gastric cancer patients. Furthermore, subgroup analysis showed that the GLIM was more appropriate for predicting OS in older aged patients (≥65 years), females, those with comorbidities (Charlson comorbidity index ≥ 2), and those with advanced gastric cancer (TNM stage = 3). GLIM-defined malnutrition affects the long-term survival of gastric cancer patients, especially older patients, females, patients with comorbidities, and patients with advanced gastric cancer.

Global Trends of Nutrition in Cancer Research: A Bibliometric and Visualized Analysis Study over the Past 10 Years

The increasing application of nutrition in cancer management has attracted a great deal of research interest in recent decades. Nutritional therapies, interventions, and assessments were known to have positive effects on reducing side effects from cancer therapy. In order to identify the global research output for nutrition in cancer research, a bibliometric analysis during the past 10 years was conducted to evaluate the current status of trends, gaps, and research directions as no bibliometric studies have been conducted regarding nutrition and cancer. After the data collection, a total of 1521 articles were chosen for this bibliometric study. The visualization analysis was performed with VOSviewer. The number of publications has grown continuously since a substantial spark was identified in 2019. The majority of the authors’ affiliations were in European countries. Four cancer types were recognized among the top 10 author keywords; they were breast cancer, head and neck cancer, colorectal cancer, and gastric cancer. The Nutrients journal was the most popular among the authors as the journal published 195 articles related to the topic. In conclusion, providing evidence-based nutritional solutions for various types of cancer is essential to nutrition and cancer research. Since it is presumed to have a growing number of cancer patients worldwide with the aging population, it is vital to continuously generate research finding effective nutrition therapies for cancer patients.

Prognostic Value of the Geriatric Nutritional Risk Index in Non-Small Cell Lung Cancer Patients: A Systematic Review and Meta-Analysis

Background

Novel evidence showed that the Geriatric Nutritional Risk Index (GNRI) may lead to poor prognosis of human cancers. Therefore, we conducted a meta-analysis to explore the impact of GNRI in lung cancer and its prognostic value.

Methods

We searched the databases of PubMed, Web of Science, Embase, Scopus, and Cochrane Library up to July 2021 for relevant research and merged the hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the association between GNRI and overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) in patients with lung cancer.

Results

Eight studies involving 2,399 patients were included in our primary meta-analysis. The results indicated that lower level of GNRI was associated with poorer OS, RFS, and CSS of lung cancer patients (OS: HR = 1.99, 95% CI: 1.68–2.35, p < 0.0001; RFS: HR = 2.34, 95% CI: 1.11–4.95, p = 0.0258; CSS: HR = 2.45, 95% CI: 1.43–4.18, p = 0.0011). The association was robust after subgroup analysis and sensitivity analysis.

Conclusions

GNRI may be a prognostic factor of lung cancer, which can lead to poorer survival. However, more prospective studies are necessary to confirm the results.

Systematic Review Registration

International Prospective Register of Systematic Reviews (PROSPERO), identifier CRD42021269574.

Influence of Malnutrition According to the GLIM Criteria on the Clinical Outcomes of Hospitalized Patients With Cancer

Background: Malnutrition is prevalent among patients with cancer. The Global Leadership Initiative on Malnutrition (GLIM) released new universal criteria for diagnosing malnutrition in 2019. The objectives of this study were to assess the prevalence of malnutrition in patients with cancer using the GLIM criteria, explore the correlation between the GLIM criteria, and clinical outcomes, and compare the GLIM criteria with subjective global assessment (SGA).

Methods: This retrospective analysis was conducted on 2,388 patients with cancer enrolled in a multicenter study. Nutritional risk was screened using the Nutritional Risk Screening-2002, and the nutritional status was assessed using SGA and GLIM criteria. Chi-square analysis and Wilcoxon rank sum test, stratified by age 65 years, were used to evaluate the effect of GLIM-defined malnutrition on clinical outcomes. Logistic regression analysis was used to analyze the nutritional status and complications, and the interrater reliability was measured using a kappa test.

Results: The prevalence of malnutrition defined by the GLIM criteria was 38.9% (929/2,388). GLIM-defined malnutrition was significantly associated with in-hospital mortality (P = 0.001) and length of hospital stays (P = 0.001). Multivariate logistic regression analysis showed GLIM-defined malnutrition significantly increased complications (odds ratio [OR] 1.716, 95% CI 1.227–2.400, P = 0.002). The GLIM criteria had a “moderate agreement” (kappa = 0.426) compared with the SGA.

Conclusions: The prevalence of malnutrition in hospitalized patients with cancer is high, and malnourishment in patients with cancer is associated with poorer clinical outcomes. The use of the GLIM criteria in assessing the nutritional status of inpatients with cancer is recommended and can be used as the basis for nutritional interventions.

Prevalence and Prognostic Value of Malnutrition Among Elderly Cancer Patients Using Three Scoring Systems

Background: Malnutrition is common in patients with cancer and is associated with adverse outcomes, but few data exist in elderly patients. The aim of this study was to report the prevalence of malnutrition using three different scoring systems and to examine the possible clinical relationship and prognostic consequence of malnutrition in elderly patients with cancer. Methods: Nutritional status was assessed by using controlling nutritional status (CONUT), the prognostic nutritional index (PNI), and the nutritional risk index (NRI). Quality-of-life (Qol) was assessed during admission by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30. Performance status (PS) was assessed by using the Eastern Cooperative Oncology Group (ECOG) classification. The relationship between nutritional status and overall survival and Qol were examined. Results: Data were available for 1,494 elderly patients with cancer (63.65% male), the mean age was 70.76 years. According to the CONUT, NRI, and PNI, 55.02, 58.70, and 11.65% patients were diagnosed with malnutrition, respectively. Worse nutritional status was related to older, lower BMI, lower hand grip strength, and more advanced tumor stage. All malnutrition indexes were correlated with each other (CONUT vs. PNI, r = -0.657; CONUT vs. NRI scores, r = -0.672; PNI vs. NRI scores, r = 0.716, all P < 0.001). During a median follow-up of 43.1 months, 692 (46.32%) patients died. For patients malnourished, the incidence rate (events-per-1,000person-years) was as follows: CONUT (254.18), PNI (429.91), and NRI (261.87). Malnutrition was associated with increased risk for all-cause mortality (adjust HR [95%CI] for CONUT: 1.09 [1.05-1.13], P < 0.001; PNI: 0.98[0.97-0.99], P < 0.001; NRI: 0.98 [0.98-0.99], P < 0.001). All malnutrition indexes improved the predictive ability of the TNM classification system for all-cause mortality. Deterioration of nutritional status was associated with deterioration in Qol parameters and immunotherapeutic response (P < 0.001). Conclusions: Malnutrition was prevalent in elderly patients with cancer, regardless of the assessment tools used, and associated with lower Qol and the immunotherapy response.

Malnutrition risk at solid tumor diagnosis: the malnutrition screening tool in a large US cancer institute

BACKGROUND

In cancer, malnutrition is common and negatively impacts tolerance and outcomes of anti-tumor therapies. The aim of this study was to evaluate the prevalence of malnutrition risk and compare the clinicodemographic features between those with high malnutrition screening tool (MST) scores (i.e., ≥ 2 of 5 = high risk for malnutrition, H-MST) to low scores (L-MST).

METHODS

A cohort of 3585 patients (May 2017 through December 2018), who completed the MST at least once at the time of diagnosis of any stage solid tumor, were analyzed. Logistic regression tested for associations between clinicodemographic factors, symptom scores, and H-MST prevalence.

RESULTS

The median age was 64 years (25-75 IQR, 55-72), with 62% females and 81% White. Most common tumor primary sites were breast (28%), gastrointestinal (GI) (21%), and thoracic (13%). Most had non-metastatic disease (80%). H-MST was found in 28%-most commonly in upper (58%) and lower GI (42%), and thoracic (42%) tumors. L-MST was most common in breast (90%). Multivariable regression confirmed that Black race (OR 1.9, 95% CI 1.5-2.4, p =  < 0.001), cancer primary site (OR 1.6-5.7, p =  < 0.001), stage IV disease (OR 1.8, 95% CI 1.4-2.2, p =  < 0.001), low BMI (OR 4.2, 95% CI 2.5-6.9 p =  < 0.001), and higher symptom scores were all independently associated with H-MST.

CONCLUSIONS

Twenty-eight percent of solid tumor oncology patients at diagnosis were at high risk of malnutrition. Patients with breast cancer rarely had malnutrition risk at diagnosis. Significant variation was found in malnutrition risk by cancer site, stage, race, and presence of depression, distress, fatigue, and trouble eating/swallowing.

Prognostic nutritional index predicts clinical outcomes in patients with cerebral venous sinus thrombosis

Background

Lower prognostic nutritional index (PNI) is related to the poor prognosis of cardiovascular diseases. However, little is known about PNI and its relationship with the prognosis of cerebral venous sinus thrombosis (CVST).

Methods

CVST patients were retrospectively identified from January 2013 till June 2019. Patients in the acute / subacute phase were selected as subjects. Poor prognosis was defined as a modified Rankin Scale (mRS) of 3–6. Multivariate logistic regression analysis was used to confirm if lower PNI was associated with a poor prognosis.

Results

A total of 297 subjects with follow-up data were enrolled. Thirty-three (11.1%) had a poor outcome. Multivariate logistic regression analysis suggested that PNI was an important predictive factor of poor outcome in acute/subacute CVST (odds ratio, 0.903; 95% CI, 0.833–0.978; P = 0.012). The optimal cut-off value for predicting the poor prognosis of PNI was 44.2. Kaplan-Meier analysis and log-rank test suggested that the lower the PNI value, the higher the mortality rate (P < 0.001). In addition, the nomogram that was set up showed that lower PNI was an index of poor prognosis. The c-index for acute/subacute patients with CVST was 0.872.

Conclusion

Lower PNI is correlated with a higher risk of adverse clinical outcomes in patients with acute/subacute CVST.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02436-w.