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McLay K, Stonewall N, Forbes L, Peters C. The association between malnutrition risk and revised Edmonton Symptom Assessment System (ESAS-r) scores in an adult outpatient oncology population: a cross-sectional study. J Patient Rep Outcomes 2024; 8:71. [PMID: 38995461 PMCID: PMC11245459 DOI: 10.1186/s41687-024-00750-8] [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] [Accepted: 06/23/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Cancer-associated malnutrition is associated with worse symptom severity, functional status, quality of life, and overall survival. Malnutrition in cancer patients is often under-recognized and undertreated, emphasizing the need for standardized pathways for nutritional management in this population. The objectives of this study were to (1) investigate the relationship between malnutrition risk and self-reported symptom severity scores in an adult oncology outpatient population and (2) to identify whether a secondary screening tool for malnutrition risk (abPG-SGA) should be recommended for patients with a specific ESAS-r cut-off score or group of ESAS-r cut-off scores. METHODS A single-institution retrospective cross-sectional study was conducted. Malnutrition risk was measured using the Abridged Patient-Generated Subjective Global Assessment (abPG-SGA). Cancer symptom severity was measured using the Revised Edmonton Symptom Assessment System (ESAS-r). In accordance with standard institutional practice, patients completed both tools at first consult at the cancer centre. Adult patients who completed the ESAS-r and abPG-SGA on the same day between February 2017 and January 2020 were included. Spearman's correlation, Mann Whitney U tests, receiver operating characteristic curves, and binary logistic regression models were used for statistical analyses. RESULTS 2071 oncology outpatients met inclusion criteria (mean age 65.7), of which 33.6% were identified to be at risk for malnutrition. For all ESAS-r parameters (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and wellbeing), patients at risk for malnutrition had significantly higher scores (P < 0.001). All ESAS-r parameters were positively correlated with abPG-SGA score (P < 0.01). The ESAS-r parameters that best predicted malnutrition risk status were total ESAS-r score, lack of appetite, tiredness, and wellbeing (area under the curve = 0.824, 0.812, 0.764, 0.761 respectively). Lack of appetite score ≥ 1 demonstrated a sensitivity of 77.4% and specificity of 77.0%. Combining lack of appetite score ≥ 1 with total ESAS score > 14 yielded a sensitivity of 87.9% and specificity of 62.8%. CONCLUSION Malnutrition risk as measured by the abPG-SGA and symptom severity scores as measured by the ESAS-r are positively and significantly correlated. Given the widespread use of the ESAS-r in cancer care, utilizing specific ESAS-r cut-offs to trigger malnutrition screening could be a viable way to identify cancer patients at risk for malnutrition.
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Affiliation(s)
- Katherine McLay
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.
| | - Nicole Stonewall
- Waterloo Wellington Regional Cancer Program, Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Laura Forbes
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Christine Peters
- Waterloo Wellington Regional Cancer Program, Grand River Regional Cancer Centre, Kitchener, ON, Canada
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LiYa L, XinSheng Z, Xiang H, Zhao L, Lu L, XiuMing L, Ye L, Jing C, KeMing Z, HongChi W, Jing X, Yang C, Xiu C, HongBo L, ShuQin Y, Fang L, YingHua L. A cross-sectional survey study on the correlation analysis of nutritional status and intestinal flora in patients with esophageal cancer. Front Nutr 2024; 11:1424039. [PMID: 39070256 PMCID: PMC11275563 DOI: 10.3389/fnut.2024.1424039] [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: 04/27/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Objective This study aims to examine the nutritional status of individuals diagnosed with esophageal cancer and compare the nutritional indicators and intestinal flora between malnourished and non-malnourished patients. The findings aim to contribute to the early prevention of malnutrition and the development of interventions targeting the intestinal flora to treat esophageal cancer. Methods An 80-patient sample of hospitalized individuals with esophageal cancer was selected from the radiotherapy department of our hospital between July 2021 and July 2022 to evaluate NRS2002 scores and PG-SGA scores. This cross-sectional analysis aimed to examine the disparities in dietary nutrient intake, blood indicators, body composition, and fecal intestinal flora between malnourished and non-malnourished patients with esophageal cancer. Additionally, we randomly selected 40 cases to predict and analyze the relationship between intestinal flora and malnutrition. Results The incidence of nutritional risk and malnutrition in patients with esophageal cancer was 62.5% and 60%, respectively. The low intake of carbohydrates and dietary fiber in the malnutrition group was statistically significant compared to those in the non-malnutrition group (P < 0.05). The albumin (ALB) level was lower in the malnutrition group than in the non-malnutrition group, while the C-reactive protein (CRP) level was higher; these differences were also statistically significant (P < 0.05). The basal metabolic rate, phase angle, body cell mass, muscle mass, skeletal muscle index, and fat-free mass index in the malnutrition group all decreased compared to the non-malnutrition group. The extracellular water/total body water was higher than that in the non-malnutrition group, which was also statistically significant (P < 0.05). As shown by 16S rDNA sequencing of fecal intestinal flora, there was no significant difference in α and β diversity between the malnutrition and non-malnutrition groups; at the genus level, significant differences were observed for Selimonas, Clostridioides, Dielma, Lactobacillus, and [Eubacterium]_siraeum_group. However, Dielma, Sellimonas, and Clostridioides were significantly lower in the malnutrition group than in the non-malnutrition group, while Anaerococcus, Atopobium, Eubacterium_siraeum_group, and Lactobacillus were significantly higher in the malnutrition group. Correlation analysis between different genera and clinical indicators showed that Lactobacillus was positively correlated with ALB, dietary energy, intracellular water/total body water (ICW/TBW), phase angle (PA), muscle mass (MM), skeletal muscle mass (SMM), body cell mass (BCM), basal metabolic rate (BMR), appendicular skeletal muscle mass (ASMM), total body water (TBW), fat-free mass index (FFMI), skeletal muscle index (SMI), fat-free mass (FFM), Weight, body mass index (BMI) (r > 0, P < 0.05), but negatively correlated with PG-SGA score, NRS2002 score, and extracellular water/total body water (ECW/TBW) (r < 0, P < 0.05). Based on PG-SGA, there was only a low accuracy for identifying nutrient deficiency (most areas under curve (AUC) values fell within 0.5 to 0.7, or even lower), with Lachnoclostridium's AUC being 0.688 (CI = 0.518-0.858) and Lactobacillus_salivarius_g_Lactobacillus's AUC being 0.257 (CI = 0.098-0.416). A KEGG functional analysis based on 16S data indicated potential differences affecting glucose metabolism pathways and the synthesis or division of DNA, influencing the onset, development, and prognosis of esophageal cancer patients. Conclusion Esophageal cancer patients are more likely to be malnourished. The nutritional status of these patients is closely linked to the intake of carbohydrates and fiber, albumin levels, inflammation levels, and lean body mass. Furthermore, the patient's intestinal flora composition plays a significant role in their nutritional well-being. Consequently, modulating the intestinal flora holds promise as a potential therapeutic approach for addressing malnutrition in esophageal cancer patients. Clinical trial registration ChiCTR2100048141.
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Affiliation(s)
- Li LiYa
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhang XinSheng
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Huang Xiang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu Zhao
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu Lu
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lv XiuMing
- Department of Clinical Nutrition, Hebei Yanda Hospital, Langfang, China
| | - Li Ye
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Chen Jing
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhang KeMing
- Department of Nutrition, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wang HongChi
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xia Jing
- Department of Endocrinology, Jiangyin Hospital of Traditional Chinese Medicine, Wuxi, China
| | - Cong Yang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Cui Xiu
- Department of Nutrition, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Long HongBo
- Department of Nutrition, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - You ShuQin
- Department of Endocrinology, Ili Kazakh Autonomous Prefecture, Huocheng County Hospital of Traditional Chinese Medicine, Yili, China
| | - Liu Fang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu YingHua
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Wei J, Chen Y, Su J, Zhao Q, Wang H, Zheng Z, Wu J, Jiang X. Effects of early nutritional intervention on oral mucositis and basic conditions in patients receiving radiotherapy for head and neck cancer: Randomized controlled trial (ChiCTR2000031418). Clin Nutr 2024; 43:1717-1723. [PMID: 38833872 DOI: 10.1016/j.clnu.2024.05.029] [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: 07/14/2023] [Revised: 05/05/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND & AIMS This study aims to observe the effects of early nutritional intervention on radiation-induced oral mucositis (OM) and the nutritional status of patients with head and neck cancer (HNC) receiving radiotherapy. METHODS Eligible patients receiving radiotherapy for HNC were randomly divided into an early nutritional intervention group (enteral nutritional intervention was administered at the beginning of radiotherapy) and a late nutritional intervention group (enteral nutritional intervention was administered at the beginning of eating restriction) in a 1:1 ratio. The primary endpoint was radiation-induced OM. Secondary endpoints included nutrition-related indicators, immune function, overall survival (OS), progression-free survival (PFS), quality of life, and other radiotherapy-induced adverse effects. RESULTS A total of 100 patients were enrolled between 2020 and 2021, including 50 each in the early nutritional intervention group and in the late group. The incidence of Grade-III/IV OM was lower in the early treatment group than in the late treatment group (2% vs 14%, P = 0.059). By week 7 weight loss was significantly lower in the early group than in the late group (1.08 kg, 95% CI: 0.08-2.09, P = 0.035). Regarding the PG-SGA scores after receiving radiotherapy, the early group comprised more well-nourished and fewer malnourished patients than those in the late group (P = 0.002). The scores of the immune function indices of T cell CD3+, CD4+/CD8+, and B cell CD19+ were slightly higher in the early group than in the late group; however, the difference was not statistically significant (all P > 0.05). PFS and OS were better in the early group than in the late group; however, the differences were not statistically significant (P > 0.05). CONCLUSIONS Early nutritional intervention can effectively improve the nutritional status and reduce the incidence of high-grade OM in patients with HNC receiving radiotherapy. TRIAL REGISTRATION Chinese Clinical Trials Registry (http://www.chictr.org.cn). CHICTR-ID ChiCTR2000031418.
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Affiliation(s)
- Jinlong Wei
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China; Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, 130021, China; NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun, 130021, China.
| | - Yulei Chen
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China; Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, 130021, China; NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun, 130021, China.
| | - Jing Su
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China; Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, 130021, China; NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun, 130021, China.
| | - Qin Zhao
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China; Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, 130021, China; NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun, 130021, China.
| | - Huanhuan Wang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China; Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, 130021, China; NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun, 130021, China.
| | - Zhuangzhuang Zheng
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China; Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, 130021, China; NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun, 130021, China.
| | - Jie Wu
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China; Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, 130021, China; NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun, 130021, China.
| | - Xin Jiang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China; Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, 130021, China; NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun, 130021, China.
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Lu YC, Tseng LW, Wu CE, Yang CW, Yang TH, Chen HY. Can Chinese herbal medicine offer feasible solutions for newly diagnosed esophageal cancer patients with malnutrition? a multi-institutional real-world study. Front Pharmacol 2024; 15:1364318. [PMID: 38855746 PMCID: PMC11157104 DOI: 10.3389/fphar.2024.1364318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Background Esophageal cancer (EC) is a major cause of cancer-related mortality in Taiwan and globally. Patients with EC are highly prone to malnutrition, which adversely affects their prognosis. While Chinese herbal medicine (CHM) is commonly used alongside conventional anti-cancer treatments, its long-term impact on EC patients with malnutrition remains unclear. Methods This study utilized a multi-center cohort from the Chang Gung Research Database, focusing on the long-term outcomes of CHM in EC patients with malnutrition between 1 January 2001, and 31 December 2018. Patients were monitored for up to 5 years or until death. Overall survival (OS) rates were calculated using the Kaplan-Meier method. Overlap weighting and landmark analysis were employed to address confounding and immortal time biases. Additionally, the study analyzed prescription data using a CHM network to identify key CHMs for EC with malnutrition, and potential molecular pathways were investigated using the Reactome database. Results EC patients with malnutrition who used CHM had a higher 5-year OS compared with nonusers (22.5% vs. 9% without overlap weighting; 24.3% vs. 13.3% with overlap weighting; log-rank test: p = 0.006 and 0.016, respectively). The median OS of CHM users was significantly longer than that of nonusers (19.8 vs. 12.9 months, respectively). Hazard ratio (HR) analysis showed a 31% reduction in all-cause mortality risk for CHM users compared with nonusers (HR: 0.69, 95% confidence interval: 0.50-0.94, p = 0.019). We also examined 665 prescriptions involving 306 CHM, with Hedyotis diffusa Willd. exhibiting the highest frequency of use. A CHM network was created to determine the primary CHMs and their combinations. The identified CHMs were associated with the regulation of immune and metabolic pathways, particularly in areas related to immune modulation, anti-cancer cachexia, promotion of digestion, and anti-tumor activity. Conclusion The results of this study suggest a correlation between CHM use and improved clinical outcomes in EC patients with malnutrition. The analysis identified core CHMs and combinations of formulations that play a crucial role in immunomodulation and metabolic regulation. These findings lay the groundwork for more extensive research on the use of CHM for the management of malnutrition in patients with EC.
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Affiliation(s)
- Yi-Chin Lu
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Liang-Wei Tseng
- Division of Chinese Acupuncture and Traumatology, Center of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao-En Wu
- Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Wei Yang
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Hsien Yang
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsing-Yu Chen
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Zeidler J, Kutschan S, Dörfler J, Büntzel J, Huebner J. Impact of nutrition counseling on nutrition status in patients with head and neck cancer undergoing radio- or radiochemotherapy: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:2195-2209. [PMID: 38175263 PMCID: PMC11023997 DOI: 10.1007/s00405-023-08375-1] [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: 07/27/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE In this systematic review, we included randomized controlled trials from 2004 to 2021 to determine the effect of individual dietary counseling for patients with head and neck cancer, specifically, nutritional outcome, morbidity, and quality of life (QOL), during and after chemo- and chemoradiotherapy. METHODS In October 2023, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL, and Medline) to find studies concerning the use and effectiveness of intensive nutritional care on head and neck cancer patients. RESULTS From all 2565 search results, 6 studies with 685 head and neck cancer patients were included in this systematic review. The patients were treated with radiotherapy or radiochemotherapy. The therapy concepts include intensive nutritional support from a dietician. Outcomes were nutritional status, body composition, quality of life, and adverse effect. All studies had low quality, high risk of bias, and reported heterogeneous results: some studies reported significant improved nutrition status, body composition and quality of life, while other studies did not find any changes concerning these endpoints. CONCLUSION Due to the very heterogeneous results and methodical limitations of the included studies, a clear statement regarding the effectiveness of intensive nutritional therapy of head and neck cancer patients is not possible. Further well-planned studies are needed.
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Affiliation(s)
- Jenny Zeidler
- Klinik Für Innere Medizin II, Hämatologie Und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Sabine Kutschan
- Klinik Für Innere Medizin II, Hämatologie Und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Jennifer Dörfler
- Klinik Für Innere Medizin II, Hämatologie Und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Jens Büntzel
- Klinik Für HNO-Erkrankungen, Südharz-Klinikum Nordhausen, Dr.-Robert-Koch-Str. 39, 99734, Nordhausen, Germany
| | - Jutta Huebner
- Klinik Für Innere Medizin II, Hämatologie Und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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Chen P, Yang L, Xiu M, Chen MG, Deng LH, Li Y. Effect of individualized nutritional intervention on head and neck cancer patients receiving radiotherapy. Support Care Cancer 2024; 32:94. [PMID: 38193938 DOI: 10.1007/s00520-023-08290-5] [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: 03/31/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To explore the effect of individualized nutritional interventions on head and neck cancer (HNC) patients receiving radiotherapy and provide a basis for improving the quality of life for those patients. METHODS A convenience sampling method was adopted to select HNC patients as the study objects. The Nutritional Risk Screening 2002 scale (NRS2002) was used to screen the nutritional risk in 108 HNC patients receiving radiotherapy, and the patients were randomly divided into control group and observation group. Routine dietary guidance was conducted in the control group, and individualized nutritional intervention was applied in the observation group. RESULTS Six months after the intervention, the albumin levels (37.40 ± 4.03 g/L), hemoglobin levels (128.70 ± 15.22 g/L), and body mass index scores (BMI) (23.96 ± 3.23 kg/m2) of the observation group were all better than to those of control group (t = 2.370, 2.216, and 3.135, respectively, and P < 0.05 in all). Six months after the intervention, the anxiety and depression scores in observation group (27.6 ± 7.2 points, 27.3 ± 2.2 points) were lower than those in control group (38.6 ± 9.6 points, 37.9 ± 3.3 points). The quality-of-life score in the observation group was higher than that in control group. The nursing satisfaction in the observation group (96.43%) was higher than that in the control group (75.00%). CONCLUSION The implementation of individualized nutritional intervention has promoted the improvement of laboratory indicators, weight, and BMI of head and neck cancer patients, reduced the risk of malnutrition of head and neck cancer patients, improved their quality of life, reduced the occurrence of adverse reactions during radiotherapy, and promoted long-term efficacy.
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Affiliation(s)
- Peng Chen
- Department of Oncology, Qingdao Municipal Hospital, No. 5 of Donghaizhong Road, Shinan District, Qingdao, 266003, Shandong, China
| | - Lei Yang
- Department 1 of Health Care, Qingdao Municipal Hospital, No. 5 of Donghaizhong Road, Shinan District, Qingdao, 266003, Shandong, China
| | - Min Xiu
- Department 1 of Health Care, Qingdao Municipal Hospital, No. 5 of Donghaizhong Road, Shinan District, Qingdao, 266003, Shandong, China
| | - Mei-Gui Chen
- Department of Oncology, Qingdao Municipal Hospital, No. 5 of Donghaizhong Road, Shinan District, Qingdao, 266003, Shandong, China
| | - Li-Hua Deng
- Department of Oncology, Qingdao Municipal Hospital, No. 5 of Donghaizhong Road, Shinan District, Qingdao, 266003, Shandong, China.
| | - Yi Li
- Department of Oncology, Qingdao Municipal Hospital, No. 5 of Donghaizhong Road, Shinan District, Qingdao, 266003, Shandong, China.
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He Y, Liao WJ, Hu AQ, Li XY, Wang JG, Qian D. A nomogram based on clinical characteristics and nutritional indicators for relative and absolute weight loss during radiotherapy in initially inoperable patients with locally advanced esophageal squamous cell carcinoma. Nutrition 2024; 117:112227. [PMID: 38486479 DOI: 10.1016/j.nut.2023.112227] [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: 05/01/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Radiation for locally advanced esophageal squamous cell carcinoma often is accompanied by radiation esophagitis, which interferes with oral intake. We aimed to develop a nomogram model to identify initially inoperable patients with relative and absolute weight loss who need prophylactic nutritional supplementation. METHODS A total of 365 initially inoperable patients with locally advanced esophageal squamous cell carcinoma receiving radiotherapy between January 2018 and December 2022 were included in the study, which was divided into discovery and validation cohorts. Receiver operating characteristic and Kaplan-Meier curve analyses were performed to compare the areas under the curve and survival benefits. RESULTS A total of 42.2% (154 of 365) of the patients had been diagnosed with cancer cachexia. The malnourished group had a higher interruption rate of radiotherapy and number of complication diseases (P < 0.05). Meanwhile, patients with malnutrition had lower lymphocytes and prognostic nutritional index (P < 0.05). The combined index showed a higher area under the curve value (0.67; P < 0.001) than number of complication diseases (area under the curve = 0.52) and prognostic nutritional index (area under the curve = 0.49) for relative weight loss (≥ 5%). Similarly, the combined index had a higher area under the curve value (0.79; P < 0.001) than number of complication diseases (area under the curve = 0.56), treatment regimens (area under the curve = 0.56), subcutaneous fat thickness (area under the curve = 0.60), pretreatment body weight (area under the curve = 0.61), neutrophils (area under the curve = 0.56), and prognostic nutritional index (area under the curve = 0.50) for absolute weight loss (≥ 5 kg). Absolute and relative weight loss remained independent prognostic factors, with short overall survival rates compared with the normal group (P < 0.05). Patients with high nomogram scores supported by nutritional intervention had less weight loss, better nutrition scores, and increased plasma CD8+ T cells, and interferon gamma. CONCLUSIONS We developed a nomogram model that was intended to estimate relative and absolute weight loss in initially inoperable patients with locally advanced esophageal squamous cell carcinoma during radiotherapy, which might help facilitate an objective decision on prophylactic nutritional supplementation.
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Affiliation(s)
- Yuan He
- Department of Radiation Oncology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wen-Jun Liao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - An-Qi Hu
- Department of Radiation Oncology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiao-Yang Li
- Department of Radiation Oncology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jian-Guo Wang
- Department of Radiation Oncology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dong Qian
- Department of Radiation Oncology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
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Dong J, Dai Z, Cao F, Zhang W, Zhang T, Chen X, Chen Y, Zhao F, Li J, Du Q, Zhang K, Zeng Y, Li C, Wang Y, Li Y, Wang K, Pang Q. Effects of PEG in patients with esophageal squamous cell carcinoma during concurrent chemoradiotherapy: a prospective study. Gastrointest Endosc 2023; 98:901-910.e3. [PMID: 37150411 DOI: 10.1016/j.gie.2023.04.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/30/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND AIMS This prospective study aimed to compare the changes in nutritional status and adverse events among patients with esophageal squamous cell carcinoma who received enteral nutrition through oral intake, PEG, and an enteral nasogastric tube (NGT) during concurrent chemoradiotherapy (CCRT). METHODS Of 141 included patients, 38, 74, and 29 patients were fed through oral intake, PEG, and NGTs, respectively. The clinical characteristics and baseline nutritional status of the 3 groups were recorded and analyzed. The Patient-Generated Subjective Global Assessment score, skeletal muscle index, and quality of life were evaluated before and after CCRT; the incidence of adverse events during feeding using PEG and NGTs was also recorded. The correlations among the different nutritional pathways and the CCRT-related adverse events (eg, radiation esophagitis and myelosuppression) were assessed. RESULTS At baseline, the oral intake group had a significantly better nutritional status and lower disease stage than those in the PEG and NGT groups. However, during CCRT, the oral intake group exhibited the most significant decreases in weight and skeletal muscle index. The synchronous chemotherapy completion rate was the highest in the PEG group. Multivariate analysis showed that the planning tumor volume and oral intake and NGT feeding pathways were associated with radiation esophagitis of at least grade 2. CONCLUSIONS We found that PEG effectively maintained the body weight and skeletal muscle index of patients with esophageal cancer during CCRT. PEG also improved the synchronous chemotherapy completion rate and reduced the occurrence of at least grade 2 radiation esophagitis. (Clinical trial registration number: NCT04199832.).
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Affiliation(s)
| | - Zhenbo Dai
- Department of Endoscopy Diagnosis and Therapy
| | - Fuliang Cao
- Department of Endoscopy Diagnosis and Therapy
| | - Wencheng Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Tian Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xi Chen
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | | | - Fangdong Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jiacheng Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qingwu Du
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Kunning Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | | | | | | | | | | | - Qingsong Pang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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9
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Antasouras G, Papadopoulou SK, Tolia M, Pandi AL, Spanoudaki M, Tsoukalas N, Tsourouflis G, Psara E, Mentzelou M, Giaginis C. May Nutritional Status Positively Affect Disease Progression and Prognosis in Patients with Esophageal and Pharyngeal Cancers? A Scoping Review of the Current Clinical Studies. Med Sci (Basel) 2023; 11:64. [PMID: 37873749 PMCID: PMC10594480 DOI: 10.3390/medsci11040064] [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: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Malnutrition in esophageal and pharyngeal cancer patients constitutes a common and serious concern, which significantly reduces patients' prognoses. Cancers of the esophagus and the pharynx can considerably impair feeding in patients, resulting in severe undernutrition. This is a scoping review that intends to critically analyze the most well-designed clinical studies investigating the potential beneficial impact of diverse nutritional assessment tools on the prognosis of patients with esophageal and pharyngeal cancers. METHODS The most accurate and remarkable scientific databases were comprehensively explored utilizing relative keywords to detect clinical studies that investigate whether nutritional status may affect disease prognosis. RESULTS Several assessment tools have evaluated and highlighted the potential beneficial impact of nutritional status on disease progression and patients' prognosis in both esophageal and pharyngeal cancers. Regarding esophageal cancer, CONUT, PNI, PG-SGA, and NRS-2002 are more commonly used, while albumin is also frequently evaluated. Regarding pharyngeal cancers, fewer studies are currently available. PNI has been evaluated, and its significance as a factor for shorter survival' times has been highlighted. The Comprehensive Nutritional Index has also been evaluated with positive results, as well as NRS 2002, GPS, and body-weight status. However, there is currently a lack of studies with an adequate number of women with cancer. An international literature gap was identified concerning follow-up studies with adequate methodology. CONCLUSIONS Nutritional status may significantly affect disease progression and patients' survival, highlighting the significance of a great nutritional status in individuals with esophageal and pharyngeal cancers. Further large-scale and well-designed prospective surveys should be performed to verify the potential beneficial effects of adequate nourishment in people suffering from cancer of the esophagus and pharynx.
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Affiliation(s)
- Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Maria Tolia
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Crete, 71110 Heraklion, Crete, Greece;
| | - Aimilia-Lynn Pandi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Nikolaos Tsoukalas
- Department of Oncology, 401 General Army Hospital of Athens (401 Geniko Stratiotiko Nosokomeio Athenon), 11525 Athens, Greece;
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece;
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
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10
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Shi Y, Shen G, Zeng Y, Ju M, Chen X, He C, Liang L, Ge X, Sun X, Di X. Predictive values of the hemoglobin, albumin, lymphocyte and platelet score (HALP) and the modified -Gustave Roussy immune score for esophageal squamous cell carcinoma patients undergoing concurrent chemoradiotherapy. Int Immunopharmacol 2023; 123:110773. [PMID: 37562292 DOI: 10.1016/j.intimp.2023.110773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/06/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
The hemoglobin, albumin, lymphocyte and platelet (HALP) score and the Gustave Roussy immune score (GRIm⁃Score) are prognostic markers in several types of malignant tumors. The prognostic values of HALP score and GRIm⁃Score in concurrent chemoradiotherapy for unresectable esophageal cancer remain unknown. METHODS We enrolled 150 esophageal squamous cell carcinoma (ESCC) patients who underwent concurrent chemoradiotherapy in our institution between 2013 and 2018. The cutoff values for HALP, and GRIm⁃Score were defined by using receiver's operating characteristic curves. Survival was analyzed with the Kaplan- Meier method, with differences analyzed with the log-rank test. Multivariate Cox proportional-hazards models were used to evaluate the prognostic significance of HALP and GRIm for ESCC. RESULTS HALP was significantly associated with the Zubrod ECOG WHO performance status, tumor location, and the clinical tumor, node, metastasis stage. Modified GRIm (mGRIm) was only significantly associated with metastasis / recurrence before radiotherapy (χ2 = 6.25). Univariate Cox regression analysis showed that higher mGRIm (HR 1.9 95%CI 1.3-2.9) and lower HALP (HR 2.4 95%CI 1.6-3.7) were all associated with worse OS. Multivariate COX analysis found that higher mGRIm score (HR 1.7 95%CI 1.1-2.6), and lower HALP score (HR 2 95%CI 1.3-3.2) were both independent risk factors of overall survival. The nomogram c-index in inside validation was 0.66. CONCLUSION Both HALP and mGRIm are independent prognostic factors for patients with unresectable ESCC.
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Affiliation(s)
- Yujing Shi
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Gefenqiang Shen
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuting Zeng
- Department of Radiation Oncology, Guizhou Province People Hospital, Guiyang, Guizhou, China
| | - Mengyang Ju
- Department of Radiation Oncology, Osaka University, Suita, Osaka, Japan
| | - Xiaojiao Chen
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Chenhong He
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Liang Liang
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xiaolin Ge
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinchen Sun
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Xiaoke Di
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Deng LH, Chi K, Zong Y, Li Y, Chen MG, Chen P. Malnutrition in patients with head and neck cancer undergoing radiotherapy: A cross-sectional study. Eur J Oncol Nurs 2023; 66:102387. [PMID: 37611500 DOI: 10.1016/j.ejon.2023.102387] [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: 03/21/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE In this study, we investigated the prevalence of malnutrition and analyzed the related factors among patients with head and neck cancer (HNC) undergoing radiotherapy. METHODS We included 108 patients with head and neck cancer undergoing radiotherapy from the oncology and thoracic surgery departments of a comprehensive medical center in Qingdao between January 2019 and June 2020. We used the Nutritional Risk Screening-2002 tool (NRS-2002) to evaluate their nutritional status during radiotherapy. We analyzed the basic sociodemographic information and laboratory indicators of the respondents to examine the impact of these factors on nutritional status. RESULTS In the 108 patients that we studied, those aged ≥65 years had a significantly higher nutritional risk when compared to patients <65 years of age (P < 0.05). Univariate analysis revealed that a late tumor stage (P = 0.039), the neck being the site of radiotherapy (P = 0.009), the presence of diabetes (P < 0.001), and the presence of anxiety and depression (P = 0.002) were associated with nutritional risks for patients with head and neck cancer undergoing radiotherapy. Multivariate logistic regression analysis identified a late tumor stage, the neck being the radiotherapy site, and combined anxiety and depression as nutritional risk factors in such patients. CONCLUSION We found a high incidence of malnutrition in patients undergoing radiotherapy for HNC; this highlights the importance of early identification of patients at risk and evaluation of related risk factors to enhance the efficacy of nutritional interventions.
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Affiliation(s)
- Li-Hua Deng
- Department of Oncology, Qingdao Hospital, University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital), Qingdao, Shandong, 266003, China
| | - Kun Chi
- Nursing Department, Qingdao Hospital, University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital), Qingdao, Shandong, 266003, China
| | - Yi Zong
- Department of Oncology, Qingdao Hospital, University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital), Qingdao, Shandong, 266003, China
| | - Yi Li
- Department of Oncology, Qingdao Hospital, University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital), Qingdao, Shandong, 266003, China
| | - Mei-Gui Chen
- Department of Oncology, Qingdao Hospital, University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital), Qingdao, Shandong, 266003, China
| | - Peng Chen
- Department of Oncology, Qingdao Hospital, University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital), Qingdao, Shandong, 266003, China.
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12
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Lee S, Kang DH, Ahn TS, Jo DH, Kim E, Baek MJ. Clinical influence of neoadjuvant chemoradiotherapy on immunonutritional status in locally advanced rectal cancer. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2023; 19:3-10. [PMID: 37449393 DOI: 10.14216/kjco.23002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Cancer patients receiving various anti-cancer treatments commonly experience malnutrition, and many studies have reported that nutritional status is associated with survival and prognosis. Although standard neoadjuvant chemoradiotherapy (CRT) is commonly used in patients with locally advanced rectal cancer owing to its tumor-downsizing and downstaging effects, there is a lack of research on the impact of patients' nutritional status on the efficacy of neoadjuvant CRT. METHODS We investigated the immunonutritional markers before and after long-course neoadjuvant CRT in 131 patients diagnosed with locally advanced rectal cancer from March 2013 to March 2022. RESULTS We divided the patients into two groups: a low prognostic nutritional index (PNI) with a cutoff value of 50.92, and a high PNI. In both groups, significant decreases in lymphocyte count and PNI and an increase in neutrophil-to-lymphocyte ratio (NLR) were observed before and after CRT (P<0.001). Furthermore, a higher proportion of patients experienced adverse effects in the low PNI group than in the high PNI group (76.6% in low PNI vs. 54.8% in high PNI, P=0.013). The most commonly reported CRT-induced adverse effect was lower gastrointestinal tract toxicity. CONCLUSION By measuring the PNI and NLR without additional tests prior to starting neoadjuvant CRT in patients with locally advanced rectal cancer, it is possible to predict the risk of acute adverse effects caused by CRT. Additionally, providing external nutritional support to reduce the immunonutritional changes that occur during CRT can decrease side effects and potentially increase treatment compliance.
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Affiliation(s)
- Soohyeon Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Dong Hyun Kang
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Tae Sung Ahn
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Dong Hee Jo
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eunhyeon Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Moo Jun Baek
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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13
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Brown D, Loeliger J, Stewart J, Graham KL, Goradia S, Gerges C, Lyons S, Connor M, Stewart S, Di Giovanni A, D'Angelo S, Kiss N. Relationship between global leadership initiative on malnutrition (GLIM) defined malnutrition and survival, length of stay and post-operative complications in people with cancer: A systematic review. Clin Nutr 2023; 42:255-268. [PMID: 36716618 DOI: 10.1016/j.clnu.2023.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/11/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS The predictive validity of the GLIM criteria for survival, length of hospital stay (LOHS) and post-operative complications among people with cancer have not been systematically reviewed. This systematic review aims to determine whether GLIM malnutrition is predictive of these outcomes, and whether the predictive validity is affected by how phenotypic and etiologic criteria are assessed. METHODS Cohort studies published after 2018 were systematically reviewed according to PRISMA guidelines from Embase, Medline Complete and CINAHL Complete. Risk of bias and methodologic quality were assessed using the Journal of the Academy of Nutrition and Dietetics' Quality Criteria Checklist tool for Primary research. RESULTS In total, 21 studies were included, including 28,726 participants. All studies investigated survival, where 18 reported GLIM malnutrition is associated with decreased survival. LOHS was investigated in six studies, with all finding an association between GLIM malnutrition and longer LOHS. Post-operative complications were assessed in seven studies, of which five reported GLIM malnutrition was predictive of increased post-operative complications. Methods to assess the GLIM phenotypic and etiologic criteria varied, with consistent predictive ability for survival regardless of method of assessing reduced muscle mass. However, predictive ability was more variable across different measures of inflammation and reduced intake. CONCLUSION GLIM malnutrition was consistently predictive of worse clinical outcomes. Different measures of reduced muscle mass did not affect the predictive ability of GLIM for survival. However, variation in assessment of the etiologic criteria resulted in varying predictive ability of the GLIM diagnosis for survival.
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Affiliation(s)
- Dylan Brown
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jenelle Loeliger
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jane Stewart
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate L Graham
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sunita Goradia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Chantal Gerges
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Shania Lyons
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Molly Connor
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sam Stewart
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Adrian Di Giovanni
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sarah D'Angelo
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia; Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Australia.
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A Multi-Site, International Audit of Malnutrition Risk and Energy and Protein Intakes in Patients Undergoing Treatment for Head Neck and Esophageal Cancer: Results from INFORM. Nutrients 2022; 14:nu14245272. [PMID: 36558428 PMCID: PMC9785112 DOI: 10.3390/nu14245272] [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: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with foregut tumors are at high risk of malnutrition. Nutrition care focuses on identifying individuals at risk of malnutrition and optimizing nutrient intake to promote the maintenance of body weight and lean body mass. This multi-center prospective, longitudinal study audited nutrition care practices related to screening for risk of malnutrition (Patient-Generated Subjective Global Assessment Short Form; PG-SGA SF), and nutrition interventions prescribed (route; adequacy of energy and protein intakes). Audits occurred at four time periods: baseline (before treatment) and at 2, 4, and 6 months after starting cancer treatment; 170 patients (esophageal (ESO; n = 51); head and neck (HN; n = 119)) were enrolled. Nutrition risk (PG-SGA SF score ≥ 4) was prevalent at every time period: HN (baseline: 60%; 6 months 66%) and ESO (77%; 72%). Both groups had significant (p < 0.001) weight losses over the 6 month audit period (HN = 13.2% ESO = 11.4%). Enteral nutrition (EN) was most likely to be prescribed at 2 months for HN and at 4 and 6 months for ESO. Target prescribed energy and protein intakes were not met with any nutrition intervention; although adequacy was highest for those receiving EN. Nutrition care practices differed for HN and ESO cancers and there may be time points when additional nutrition support is needed.
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Survival analysis of 80 elderly patients with esophageal squamous cell carcinoma receiving definitive concurrent chemoradiotherapy with S-1. Cancer Radiother 2022; 26:1064-1069. [PMID: 35864071 DOI: 10.1016/j.canrad.2022.04.007] [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: 11/10/2021] [Revised: 03/25/2022] [Accepted: 04/10/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE This single-center retrospective study aimed to observe survival and prognosis of elderly patients with esophageal cancer receiving radical radiotherapy combined with S1 chemotherapy, and to preliminarily explore whether hematologic indicators or inflammatory indicators before radiotherapy are prognostic factors. MATERIAL AND METHODS We retrospectively collected data of 80 elderly patients with esophageal cancer who had received radical concurrent chemoradiotherapy from January 2015 to July 2018. The patients were older than 70 years. Radiation therapy was delivered with intensity-modulated irradiation therapy (IMRT) or volumetric modulated arc therapy (VMAT), while the chemotherapy regimen was S1 alone. Toxicities were evaluated in accordance with the criteria of the Radiation Therapy Oncology Group. Baseline hematologic basic nutritional indicators, such as hemoglobin (HGB), albumin (ALB), and prealbumin (PAB), along with inflammatory indicators, such as the ratio of neutrophils to lymphocytes (NLR), the ratio of platelets to lymphocytes (PLR), were collected to preliminarily analyze their relationship with progression and survival. RESULTS The median follow-up time was 39 months (range 30-65 months). The median overall survival and progression-free survival times were 24 and 17 months, respectively. The 1-, 2-, and 3-year overall survival rates were 76.5%, 48.1%, and 31.3%, respectively. The 1-, 2-, and 3-year progression-free survival rates were 57.5%, 37.8%, and 29.4%, respectively. T stage, clinical staging, and lesion region were independent prognostic factors for OS. No significant associations with prognosis were observed either for baseline hematologic or for inflammatory indicators (all P>0.05). The rates of esophagitis (grade 2 and above) and hematologic toxicity were 60% and 45%, respectively. CONCLUSION Oral S-1 combined with definitive concurrent radiotherapy for elderly patients with esophageal cancer has a significant survival benefit. The toxicities are well tolerated. It seems that prognosis does not correlate with baseline hematologic nutritional indicators and inflammatory indicators.
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Chiang HC, Lin MY, Lin FC, Chiang NJ, Wang YC, Lai WW, Chang WL, Sheu BS. Transferrin and Prealbumin Identify Esophageal Cancer Patients with Malnutrition and Poor Prognosis in Patients with Normal Albuminemia: A Cohort Study. Nutr Cancer 2022; 74:3546-3555. [PMID: 35652575 DOI: 10.1080/01635581.2022.2079687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study, we aimed to analyze whether serum prealbumin and transferrin have a higher sensitivity than albumin for detecting malnutrition and predicting survival in esophageal cancer patients. A total of 212 patients were prospectively enrolled. Serum albumin, prealbumin, and transferrin were analyzed by enzyme-linked immunosorbent assays. The association of nutritional markers with survival was analyzed. We found that malnutrition was presented in 44.5% of the patients, while 56.6% were unaware of their body weight change. The area under the curve for diagnosing malnutrition was largest for prealbumin, followed by transferrin and albumin, with optimal breakpoints of 21 mg/dL, 206 mg/dL, and 4.3 g/dL, respectively, for diagnosing malnutrition. The diagnostic sensitivity for malnutrition was 34.1-63.4% with a single marker and this increased to 80.5% with all 3 markers. In patients with normal albuminemia (≥ 4.3 g/dL), a low level of prealbumin and/or transferrin predicted malnutrition and poor prognosis. Multivariate Cox regression analysis confirmed that a low level of the nutritional marker was an independent poor prognostic factor. In conclusion, serum prealbumin and transferrin outperformed albumin in identifying esophageal cancer patients with malnutrition and poor prognosis. Checking all three markers will help with the early diagnosis of malnutrition and enable timely intervention.
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Affiliation(s)
- Hsueh-Chien Chiang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Ying Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Forn-Chia Lin
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Jung Chiang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yi-Ching Wang
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bor-Shyang Sheu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Song H, Sun H, Yang L, Gao H, Cui Y, Yu C, Xu H, Li L. Nutritional Risk Index as a Prognostic Factor Predicts the Clinical Outcomes in Patients With Stage III Gastric Cancer. Front Oncol 2022; 12:880419. [PMID: 35646673 PMCID: PMC9136458 DOI: 10.3389/fonc.2022.880419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/13/2022] [Indexed: 12/13/2022] Open
Abstract
ObjectiveThis study is aimed to determine the potential prognostic significance of nutritional risk index (NRI) in patients with stage III gastric cancer.MethodsA total of 202 patients with stage III gastric cancer were enrolled in this study. NRI was an index based on ideal body weight, present body weight, and serum albumin levels. All patients were divided into two groups by receiver operating characteristic curve: low NRI group (NRI<99) and high NRI group (NRI≥99). The relationship between NRI and clinicopathologic characteristics was evaluated by Chi-square test. The clinical survival outcome was analyzed by Kaplan-Meier method and compared using log-rank test. The univariate and multivariate analyses were used to detect the potential prognostic factors. A nomogram for individualized assessment of disease-free survival (DFS) and overall survival (OS). The calibration curve was used to evaluate the performance of the nomogram for predicted and the actual probability of survival time. The decision curve analysis was performed to assess the clinical utility of the nomogram by quantifying the net benefits at different threshold probabilities.ResultsThe results indicated that NRI had prognostic significance by optimal cutoff value of 99. With regard to clinicopathologic characteristics, NRI showed significant relationship with age, weight, body mass index, total protein, albumin, albumin/globulin, prealbumin, glucose, white blood cell, neutrophils, lymphocyte, hemoglobin, red blood cell, hematocrit, total lymph nodes, and human epidermal growth factor receptor 2 (P<0.05). Through the univariate and multivariate analyses, NRI, total lymph nodes, and tumor size were identified as the independent factor to predict the DFS and OS. The nomogram was used to predict the 1-, 3-, and 5-year survival probabilities, and the calibration curve showed that the prediction line matched the reference line well for 1-, 3-, and 5-year DFS and OS. Furthermore, the decision curve analysis also showed that the nomogram model yielded the best net benefit across the range of threshold probability for 1-, 3-, 5-year DFS and OS.ConclusionsNRI is described as the potential prognostic factor for patients with stage III gastric cancer and is used to predict the survival and prognosis.
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Affiliation(s)
- Haibin Song
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Hongkai Sun
- Department of Anesthesiology, Hulunbeier People’s Hospital, Hulunbeier, China
| | - Laishou Yang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Hongyu Gao
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Yongkang Cui
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Chengping Yu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haozhi Xu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Linqiang Li
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin Medical University, Harbin, China
- *Correspondence: Linqiang Li,
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The Impact of Weight Loss during Chemoradiotherapy for Unresectable Esophageal Cancer: Real-World Results. Life (Basel) 2022; 12:life12050706. [PMID: 35629373 PMCID: PMC9146706 DOI: 10.3390/life12050706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
Weight loss is a common phenomenon presented in unresectable esophageal cancer (EC) patients during their definitive chemoradiotherapy (dCRT) treatment course. This study explored the prognostic value of weight changes during dCRT in unresectable EC patients. From 2009 to 2017, 69 cT4b thoracic EC patients undergoing complete curative dCRT without baseline malnutrition were included. Clinical factors were analyzed via the Cox proportional hazards model and survival was analyzed by the Kaplan−Meier method. During dCRT, the median weight loss percentage was 5.51% (IQR = 2.77−8.85%), and the lowest body weight was reached at 35 days (IQR = 23−43 days). Median OS of these patients was 13.5 months. Both univariate and multivariate analysis demonstrated that weight loss ≤ 4% during dCRT was significantly associated with superior OS with a hazard ratio of 2.61 (95% CI: 1.40−4.85, p = 0.002). The median OS for patients with weight loss ≤ 4% and >4% during dCRT was 59.6 months and 9.7 months, respectively (p = 0.001). Our study demonstrated that weight loss ≤ 4% during dCRT course is a favorable prognostic factor for cT4b EC patients. This index could serve as a nutrition support reference for unresectable EC patients receiving dCRT in the future.
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Qian J, Si Y, Zhou K, Tian Y, Guo Q, Zhao K, Yu J. Sarcopenia is associated with prognosis in patients with esophageal squamous cell cancer after radiotherapy or chemoradiotherapy. BMC Gastroenterol 2022; 22:211. [PMID: 35501704 PMCID: PMC9063365 DOI: 10.1186/s12876-022-02296-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
Abstract
Background This study aimed to determine the prognostic value of the sarcopenia on the progression free survival (PFS) and overall survival (OS) of esophageal squamous cell cancer (ESCC) patients who received radiotherapy (RT) or chemoradiotherapy (CRT). Methods Data on clinicopathological characteristics and nutritional parameters were analyzed and correlated with PFS and OS, retrospectively. Skeletal muscle, subcutaneous, visceral and total fat tissue cross-sectional areas were evaluated on CT images at the midpoint of the 3rd lumbar vertebrae. A total of 213 patients were enrolled in this study. Results Sarcopenia was significantly associated with subcutaneous fat content. The univariate analysis demonstrated that OS was superior in patients with non-sarcopenia, non-alcohol, NRI ≥ 100, albumin ≥ 40 g/L, TATI > 83.0, SATI > 27.8, VATI > 49, non-anemia, cervical and upper-thoracic ESCC, T stage 1–2, N stage 0–1 and TNM stage I–II. In the multivariate analysis, sarcopenia, albumin, N stage and TNM stage were identified as independent prognostic factors of survival. This study demonstrated that sarcopenia was related to worse PFS and OS in patients with ESCC who received RT or CRT. Conclusions Sarcopenia is considered to be a useful predictor in patients with ESCC who received RT or CRT. This study also provided a conceptual basis for further prospective research on the application of the sarcopenia for patients receiving RT or CRT for intermediate- and advanced-stage ESCC.
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Affiliation(s)
- Junchao Qian
- Department of Radiation Oncology, School of Medicine, Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China.,Hefei Cancer Hospital, Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China
| | - Youjiao Si
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China
| | - Ke Zhou
- Hefei Cancer Hospital, Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China
| | - Yu Tian
- Hefei Cancer Hospital, Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China
| | - Qisen Guo
- Department of Radiation Oncology, School of Medicine, Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China
| | - Kaikai Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China.
| | - Jinming Yu
- Department of Radiation Oncology, School of Medicine, Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, People's Republic of China.
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Huang Z, Zheng Q, Yu Y, Zheng H, Wu Y, Wang Z, Liu L, Zhang M, Liu T, Li H, Li J. Prognostic significance of platelet-to-albumin ratio in patients with esophageal squamous cell carcinoma receiving definitive radiotherapy. Sci Rep 2022; 12:3535. [PMID: 35241740 PMCID: PMC8894409 DOI: 10.1038/s41598-022-07546-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/28/2022] [Indexed: 02/06/2023] Open
Abstract
Accumulating evidence indicates that inflammation and nutrition status are associated with clinical outcomes in patients with various malignancies. This study aimed to evaluate the prognostic significance of the pretreatment platelet to albumin ratio (PAR) in esophageal squamous cell carcinoma (ESCC) patients undergoing definitive radiotherapy. A total of 470 patients who underwent definitive radiotherapy with or without chemotherapy were enrolled. The optimal cut-off values of PAR and other indicators were determined by the X-tile. The Kaplan-Meier method, multivariate analyses Cox regression were conducted to identify the association between those indicators and the survival outcomes. The median follow-up time was 23.5 months. The optimal cut-off value of PAR was 5.7 × 109 and patients were stratified as the low PAR group and the high PAR group. In the univariate analysis, a low overall survival rate was significantly associated with T stage (P = 0.005), TNM stage (P < 0.001), Adjuvant chemotherapy (P = 0.007), neutrophil to lymphocyte ratio (NLR) (P = 0.006), platelet to lymphocyte ratio (P < 0.001), systemic immune-inflammation index (P < 0.001), prognostic nutritional index (P < 0.001) and platelet to albumin ratio (PAR) (P < 0.001). Patients with high PAR were associated with poorer OS and PFS than patients with low PAR. On multivariate analysis, TNM stage (P = 0.001), adjuvant chemotherapy (P < 0.001), and PAR (P = 0.033) were independent prognostic factors in ESCC treated with definitive radiotherapy. PAR is a novel, convenient, and inexpensive prognostic indicator for patients with ESCC undergoing definitive radiotherapy. Future validation from prospective larger-scale studies is warranted.
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Affiliation(s)
- Zhiyu Huang
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Qunhao Zheng
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Yilin Yu
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Hongying Zheng
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Yahua Wu
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Zhiping Wang
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Lingyun Liu
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Mengyan Zhang
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Tianxiu Liu
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Hui Li
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Jiancheng Li
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China.
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Chen L, Qi Y, Kong X, Su Z, Wang Z, Wang X, Du Y, Fang Y, Li X, Wang J. Nutritional Risk Index Predicts Survival in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy. Front Nutr 2022; 8:786742. [PMID: 35096932 PMCID: PMC8793025 DOI: 10.3389/fnut.2021.786742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
Nutritional risk index (NRI) is an index based on ideal body weight that aims to present body weight and serum albumin levels. It has been utilized to discriminate patients at risk of postoperative complications and predict the postoperative outcome of major surgeries. However, this index remains limited for breast cancer patients treated with neoadjuvant chemotherapy (NACT). The research explores the clinical and prognostic significance of NRI in breast cancer patients. This study included 785 breast cancer patients (477 cases received NACT and 308 cases did not) were enrolled in this retrospective study. The optimal NRI cutoff value was evaluated by receiver operating characteristic (ROC) curve, then reclassified as low NRI group (<112) and high NRI group (≥112). The results demonstrated that NRI independently predicted survival on disease-free survival (DFS) and overall survival (OS) by univariate and multivariate Cox regression survival analyses [P = 0.019, hazard ratio (HR): 1.521, 95% CI: 1.071–2.161 and P = 0.004, HR: 1.415, 95% CI: 1.119–1.789; and P = 0.026, HR:1.500, 95% CI: 1.051–2.143 and P < 0.001, HR: 1.547, 95% CI: 1.221–1.959]. According to the optimal cutoff value of NRI, the high NRI value patients had longer mean DFS and OS time in contrast to those with low NRI value patients (63.47 vs. 40.50 months; 71.50 vs. 56.39 months). Furthermore, the results demonstrated that the high NRI score patients had significantly longer mean DFS and OS time than those with low NRI score patients in early-stage breast cancer (χ2 = 9.0510, P = 0.0026 and χ2 = 9.2140, P = 0.0024) and advanced breast cancer (χ2 = 6.2500, P = 0.0124 and χ2 = 5.8880, P = 0.0152). The mean DFS and OS values in patients with high NRI scores were significantly longer in contrast to those with low NRI scores in different molecular subtypes. The common toxicities after NACT were hematologic and gastrointestinal reactions, and the NRI had no statistically significant effects on toxicities, except in nausea (χ2 = 9.2413, P = 0.0024), mouth ulcers (χ2 = 4.8133, P = 0.0282), anemia (χ2 = 8.5441, P = 0.0140), and leukopenia (χ2 = 11.0951, P = 0.0039). NRI serves as a minimally invasive, easily accessible and convenient prognostic tool for evaluating breast cancer prognoses and treatment efficacy, and may help doctors in terms of selecting measures of greater efficiency or appropriateness to better treat breast cancer.
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Affiliation(s)
- Li Chen
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yihang Qi
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, University of Texas Health Science Center, San Antonio, TX, United States
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaying Du
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yi Fang
| | - Xingrui Li
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- Xingrui Li
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jing Wang
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22
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Wang B, Xu C, Ying K, Chu J, Geng W. Prognostic value of hemoglobin combined with Geriatric Nutritional Risk Index scores in patients undergoing postoperative radiotherapy for esophageal squamous cell carcinoma. Future Oncol 2021; 18:179-191. [PMID: 34870444 DOI: 10.2217/fon-2021-0439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To investigate the prognostic value of hemoglobin combined with geriatric nutritional risk index (GNRI) scores in patients undergoing postoperative radiotherapy for esophageal squamous cell carcinoma (ESCC). Patients & methods: Patients who underwent esophagectomy and postoperative radiotherapy were included in this retrospective study. Their preoperative hemoglobin and GNRI were collected to establish hemoglobin-GNRI (H-GNRI) scores, and their association with OS was evaluated. Results: Patients with high H-GNRI scores had better prognosis than those with low scores (p < 0.001). Differentiation (p = 0.001), T classification (p = 0.010), N classification (p = 0.001) and H-GNRI score (p = 0.018) were independent prognostic factors for all patients. Conclusion: H-GNRI score is an independent prognostic factor for the survival of patients with ESCC managed by surgery and postoperative radiotherapy.
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Affiliation(s)
- Bei Wang
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, 66 South People's Road, Yancheng 224000, Jiangsu Province, PR China
| | - Chuanhai Xu
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, 66 South People's Road, Yancheng 224000, Jiangsu Province, PR China
| | - Kaijun Ying
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, 66 South People's Road, Yancheng 224000, Jiangsu Province, PR China
| | - Jian Chu
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, 66 South People's Road, Yancheng 224000, Jiangsu Province, PR China
| | - Wei Geng
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, 66 South People's Road, Yancheng 224000, Jiangsu Province, PR China
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Mastoridis S, Bracalente G, Hanganu CB, Neccia M, Giuliani A, Gillies R, Marshall R, Maynard N, Sgromo B. Laparoscopic vs. open feeding jejunostomy insertion in oesophagogastric cancer. BMC Surg 2021; 21:367. [PMID: 34645433 PMCID: PMC8513201 DOI: 10.1186/s12893-021-01318-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 06/30/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. METHODS A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. RESULTS In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs. 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone or at the time of staging laparoscopy (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). CONCLUSIONS This report represents the largest to our knowledge single-centre comparison of open vs. laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.
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Affiliation(s)
- Sotiris Mastoridis
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK
| | | | | | | | | | - Richard Gillies
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK
| | - Robert Marshall
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK
| | - Nicholas Maynard
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK
| | - Bruno Sgromo
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK.
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Clinical importance of preoperative red-cell volume distribution width as a prognostic marker in patients undergoing radical surgery for pancreatic cancer. Surg Today 2021; 52:465-474. [PMID: 34524510 PMCID: PMC8873122 DOI: 10.1007/s00595-021-02374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022]
Abstract
Background and purpose A new noninvasive biomarker is being sought to predict the prognosis of patients with pancreatic cancer. Red-cell volume distribution width (RDW), a descriptive parameter for erythrocyte variation, has been shown to have prognostic value for some tumor types. Our purpose was to assess the RDW value to predict the prognosis of patients with pancreatic cancer. Methods The subjects of this retrospective study were 792 patients who underwent radical surgery for pancreatic cancer, divided into high-RDW and low-RDW groups based on receiver operating characteristic (ROC) curve analysis (15.6%). The controlling nutritional status (CONUT) score was used to assess preoperative nutritional status. Statistical analysis was conducted to investigate the differences between the high and low RDW groups, and to explore the possibility of the RDW being used as prognostic predictor for patients with pancreatic cancer. Results The immune-nutritional status was worse in the high-RDW group than in the low-RDW group. The high-RDW group patients also had a poorer prognosis. Risk factor analysis showed that the RDW could be an independent risk factor for pancreatic cancer. Conclusions The RDW is associated with immune-nutritional status in pancreatic cancer patients and can be used as an independent prognostic factor for their postoperative survival. Supplementary Information The online version contains supplementary material available at 10.1007/s00595-021-02374-7.
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Bozzetti F. Does nutrition support during chemotherapy increase long-term survival of cancer patients? Lessons from the past and future perspectives. Support Care Cancer 2021; 29:7269-7277. [PMID: 34309702 DOI: 10.1007/s00520-021-06213-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this review was to analyze the potential effect of the nutritional support (oral supplementation/counseling, tube feeding, parenteral nutrition) combined with chemotherapy on long-term survival of cancer patients. METHODS Using various electronic databases, we retrieved all English language papers on the combination nutritional support and chemotherapy and including data on long-term survival. RESULTS 29 trials (4 non-RCT) were retrieved. No significant benefit was observed except for a longer survival in a few selected subgroups of patients, depending on the tumor stage and compliance with the nutritional support. However, no study included survival as primary endpoint or was adequately powered for this purpose, and patients were seldom affected by malnutrition, a condition which would have made them extremely vulnerable and unsafe during an intensive chemotherapy with significant gastrointestinal toxicity. Finally, nutritional regimens were often inappropriate as regards quality and quantity of nutrients or too similar in the two arms of the trial to expect a result. CONCLUSION From the review of these trials, it appears clear that there is absence of evidence more than evidence of absence of effect of the supplemental nutritional support. This poor scenario should not discourage future large multicenter trials to assess the potential of an early versus a delayed support in mildly malnourished patients. From the practical point of view, a nutritional supplementation should be considered when severe malnutrition caused by the disease or following repeated oncologic treatments can make the patients poorly compliant with further chemotherapy cycles, as recommended by the international guidelines.
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Affiliation(s)
- Federico Bozzetti
- Faculty of Medicine, University of Milan, Via Festa del Perdono 11, 20100, Milan, Italy.
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Ho JK, Gui B, Yoon J, Zhang Q, Manne SL, Jabbour SK. Influence of Caregiver Presence During Physician Office Visits on Patients Undergoing Chemoradiation Therapy for Esophageal Cancer. Adv Radiat Oncol 2021; 6:100649. [PMID: 33912737 PMCID: PMC8071720 DOI: 10.1016/j.adro.2021.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/06/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Although the association of marital status with outcomes for patients with cancer has been widely studied, the mechanisms underpinning the protective effect of marriage are still not fully understood. The social support that marriage imparts is often discussed as an explanation for why patients with cancer who are married have better outcomes. Social support has been difficult to objectively quantify. Accompaniment of the patient at physician visits may be more meaningful than marital status itself. This study investigated the effect of caregiver presence at physician visits on treatment tolerance and outcome in patients undergoing chemoradiation therapy (CRT) for esophageal cancer. Methods and Materials Patients who received a diagnosis of esophageal cancer who underwent CRT from January 1, 2005, to January 1, 2016, as part of their curative-intent management were retrospectively reviewed. Data collected included the patients’ marital status, caregiver presence at each physician visit, baseline performance status, serum albumin values and leukocyte values throughout treatment, patient weight values throughout treatment, tumor response to therapy, and overall survival. Patients were divided into 2 groups based on frequency of caregiver presence at physician visits (<50% or ≥50% of visits). Using χ2 tests, Wilcoxon rank sum tests, and log-rank tests, the patients’ characteristics, treatment tolerance and treatment outcome, and overall survival, respectively, were compared. Results In total, 35 of 59 patients were defined as having frequent caregiver presence at physician visits (≥50% of all documented visits), whereas 24 patients were categorized as having infrequent caregiver accompaniment. No significant difference in performance status or weight loss before the diagnosis of esophageal cancer was found. Patients who had frequent caregiver presence at physician visits maintained body weight better than those who had infrequent caregiver presence (median weight loss of 2.7 kg compared with 4.9 kg; P = .04). There was no difference in overall survival between the 2 groups. Conclusions Although patients with esophageal cancer undergoing CRT who had frequent caregiver presence at physician visits were not found to have an overall survival benefit, they had less weight loss, which may confer favorable treatment tolerance and maintenance of nutritional status during cancer treatment.
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Affiliation(s)
- Joseph K. Ho
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Bin Gui
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, New Jersey
| | - Jennifer Yoon
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Quan Zhang
- First People’s Hospital of Huaian, Huaian, China
| | - Sharon L. Manne
- Rutgers Cancer Institute of New Jersey, Department of Population Science, New Brunswick, New Jersey
| | - Salma K. Jabbour
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, New Jersey
- Corresponding author: Salma Jabbour, MD
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Katada C, Fukazawa S, Sugawara M, Sakamoto Y, Takahashi K, Takahashi A, Watanabe A, Wada T, Ishido K, Furue Y, Harada H, Hosoda K, Yamashita K, Hiki N, Sato T, Ichikawa T, Shichiri M, Tanabe S, Koizumi W. Randomized study of prevention of gastrointestinal toxicities by nutritional support using an amino acid-rich elemental diet during chemotherapy in patients with esophageal cancer (KDOG 1101). Esophagus 2021; 18:296-305. [PMID: 33009977 DOI: 10.1007/s10388-020-00787-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This randomized study was designed to evaluate the clinical effect of an elemental diet during chemotherapy in patients with esophageal cancer. METHODS The inclusion criteria were as follows: (1) esophageal squamous cell carcinoma, (2) stage IB-IV, (3) schedule to receive docetaxel, cisplatin, and 5-fluorouracil (DCF chemotherapy), (4) 20-80 years old, (5) performance status of 0-2, (6) oral intake ability, and (7) written informed consent. Patients were divided into two groups: the elemental supplementary group and the non-supplementary group. Patients received ELENTAL® (160 g/day) orally 9 weeks after the start of chemotherapy. Primary endpoint was the incidence of grade 2 or higher gastrointestinal toxicity according to the Common Terminology Criteria for Adverse Events, version 4.0. Secondary endpoints were the incidence of all adverse events and the evaluation of nutritional status. RESULTS Thirty-six patients in the elemental supplementary group and 35 patients in the non-supplementary group were included in the analysis. The incidence of grade 2 or higher gastrointestinal toxicity and all grade 3 or 4 adverse events did not differ significantly between the groups. In the elemental supplementary group, the body weight (p = 0.057), muscle mass (p = 0.056), and blood levels of transferrin (p = 0.009), total amino acids (p = 0.019), and essential amino acids (p = 0.006) tended to be maintained after chemotherapy. CONCLUSION Nutritional support provided by an amino acid-rich elemental diet was ineffective for reducing the incidence of adverse events caused by DCF chemotherapy in patients with esophageal cancer.
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Affiliation(s)
- Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan.
| | - Saeko Fukazawa
- Department of Nutrition, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Mitsuhiro Sugawara
- Department of Pharmacy, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Yasutoshi Sakamoto
- Kitasato Clinical Research Center, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Kaoru Takahashi
- Department of Nursing, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Akiko Takahashi
- Department of Nursing, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Akinori Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Takuya Wada
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Kenji Ishido
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Yasuaki Furue
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Hiroki Harada
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Kei Hosoda
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Keishi Yamashita
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Teruko Sato
- Department of Nutrition, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Takafumi Ichikawa
- Department of Pathological Biochemistry, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Satoshi Tanabe
- Department of Advanced Medicine Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Wasaburo Koizumi
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
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Pham Van B, Nguyen Thi Thanh H, Le Thi H, Nguyen Le Tuan A, Dang Thi Thu H, Dang Viet D. Nutritional Status and Feeding Regimen of Patients with Esophagus Cancer-A Study from Vietnam. Healthcare (Basel) 2021; 9:healthcare9030289. [PMID: 33800823 PMCID: PMC8000479 DOI: 10.3390/healthcare9030289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/09/2022] Open
Abstract
Background: Esophagus cancer patients are at high risk of malnutrition. This study was performed to assess the nutritional status and dietary intake of newly diagnosed esophageal cancer patients in Vietnam National Cancer Hospital (NCH). Methods: A cross-sectional study was conducted on 206 early esophageal cancer inpatients after gastrostomy from September 2017 to June 2018. The chi-squared test, Fisher exact test, and Mann–Whitney test were performed. The software of the Vietnam National Institute of Nutrition was used to evaluate the dietary intake of patients. Results: All the participants were male with a mean age of 57.1 ± 8.5 years. Overall, 87.4% of patients had dysphagia. Furthermore, 82.5% and 90.8% of patients reported weight loss one and six months pre-diagnosis, respectively. Moreover, 52.9% of patients suffered from mild/moderate malnutrition and 29.6% of patients had severe malnutrition according to the Patient-Generated Subjective Global Assessment (PG-SGA). The body mass index (BMI) and mid upper arm circumference (MUAC) measurement revealed 47.6% and 50% of undernourished patients, respectively. The proportions of patients having malnutrition were 10.7%, 55.8%, and 27.2% according to albumin, prealbumin, and total lymphocyte counts, respectively. The means of energy, protein, lipid, and carbohydrate in the patients’ 24 h preoperative diets were 973.6 ± 443.0 kcal/day, 42.4 ± 21.6 g/day, 31.0 ± 15.5 g/day, and 130.0 ± 64.5 g/day. The total energy, total protein, animal protein, total lipid, and plant lipid in the dietary intake of patients were strongly correlated with age, economic classification, and PG-SGA (each p < 0.05). The total energy intake increased day by day, with the average energy intake of 1343.9 ± 521.3 kcal on the seventh day. Energy and protein response rates increased day by day and were highest at 7 days post-operation at 18.0% and 19.4%. Conclusion: Malnutrition and insufficient intake are noteworthy in esophageal cancer patients. The PG-SGA is strongly correlated with the dietary intake of patients. The results from this study will help medical staff to prevent malnutrition and improve the nutritional status of esophageal cancer inpatients. Furthermore, public awareness should be raised on recognizing weight loss as an early symptom of esophageal cancer and the utilization of preoperative assessment tools for nutritional assessment and malnutrition management.
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Affiliation(s)
- Binh Pham Van
- Abdominal Surgery Department 1 and Robotic Surgery Center, Vietnam National Cancer Hospital, Hanoi 12511, Vietnam
- Correspondence: or (B.P.V.); (H.L.T.)
| | - Hoa Nguyen Thi Thanh
- Clinical Nutrition Center, Vietnam National Cancer Hospital, Hanoi 12511, Vietnam; (H.N.T.T.); (H.D.T.T.)
| | - Huong Le Thi
- Clinical Nutrition Center, Vietnam National Cancer Hospital, Hanoi 12511, Vietnam; (H.N.T.T.); (H.D.T.T.)
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 11521, Vietnam;
- Correspondence: or (B.P.V.); (H.L.T.)
| | - Anh Nguyen Le Tuan
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 11521, Vietnam;
| | - Hang Dang Thi Thu
- Clinical Nutrition Center, Vietnam National Cancer Hospital, Hanoi 12511, Vietnam; (H.N.T.T.); (H.D.T.T.)
| | - Dung Dang Viet
- Gastrointestinal Surgery Center, 103 Military Hospital, Military Medical Academy, Hanoi 12109, Vietnam;
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Huang TT, Li SH, Chen YH, Lu HI, Lo CM, Fang FM, Chou SY, Chiu YC, Chou YP, Wang YM. Definitive chemoradiotherapy for clinical T4b esophageal cancer - Treatment outcomes, failure patterns, and prognostic factors. Radiother Oncol 2021; 157:56-62. [PMID: 33482233 DOI: 10.1016/j.radonc.2021.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The management of cT4b thoracic esophageal cancer (EC) is challenging. The optimal treatment remains unclear, and prospective or large-scale retrospective reports on treatment outcomes are lacking. The present study was conducted to investigate the treatment outcomes, failure patterns, treatment responses, and prognostic factors focusing on cT4b thoracic EC treated by definitive concurrent chemoradiotherapy (dCRT). METHODS A retrospective review of cT4b thoracic EC patients treated with curative intent dCRT at our institution between 2009 and 2017 was conducted. Survival analysis was calculated using the Kaplan-Meier method, and prognostic factors were examined by the Cox proportional hazards model. RESULTS A total of 95 cT4b EC patients were included, and the median survival was 11.4 months. The 1-year, 3-year, and 5-year survival rates were 49.4%, 22.2%, and 19.0%, respectively. Forty-six patients (48.4%) experienced locoregional failure, 3 patients (3.2%) developed distant metastasis, and 11 patients had synchronous locoregional and distant failure. The corresponding 1-year, 3-year, and 5-year locoregional failure rates were 62.6%, 74.5%, and 79.2%, respectively. The treatment response rate was 76.9%, and clinical complete response was achieved in 25.3% of patients. Multivariable analysis revealed that age ≤ 65 (p = 0.003), pre-dCRT body mass index (BMI) > 21 (p < 0.001), clinical N stage 0-1 (p = 0.014), and tumor length ≤ 6 cm (p = 0.026) were independent prognosticators for better survival. CONCLUSION Our study revealed that long-term survival is achievable for cT4b EC patients treated by dCRT, with a 3-year survival rate of more than 20%. Locoregional recurrence was the most common failure pattern. Age, BMI, N stage, and tumor length were significant prognosticators for survival in this group of patients.
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Affiliation(s)
- Tzu-Ting Huang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-I Lu
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ming Lo
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shang-Yu Chou
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yeh-Pin Chou
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
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30
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Ma LX, Taylor K, Espin-Garcia O, Anconina R, Suzuki C, Allen MJ, Honorio M, Bach Y, Allison F, Chen EX, Brar S, Swallow CJ, Yeung J, Darling GE, Wong R, Kalimuthu SN, Jang RW, Veit-Haibach P, Elimova E. Prognostic significance of nutritional markers in metastatic gastric and esophageal adenocarcinoma. Cancer Med 2020; 10:199-207. [PMID: 33295697 PMCID: PMC7826473 DOI: 10.1002/cam4.3604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background Malnutrition and sarcopenia are poor prognostic factors in many cancers. Studies in gastric and esophageal (GE) cancer have focused on curative intent patients. This study aims to evaluate the prognostic utility of malnutrition and sarcopenia in de novo metastatic GE adenocarcinoma. Methods Patients with de novo metastatic GE adenocarcinoma seen at the Princess Margaret Cancer Centre from 2010 to 2016 with an available pre‐treatment abdominal computed tomography (CT) were included. Malnutrition was defined as nutritional risk index (NRI) <97.5. Skeletal muscle index (SMI) was measured at the L3 level (sarcopenia defined as SMI <34.4 cm2/m2 in women and <45.4 cm2/m2 in men). Patients receiving chemotherapy had NRI and SMI recalculated at the time of first restaging CT. Results Of 175 consecutive patients, 33% were malnourished and 39% were sarcopenic at baseline. Patients with pretreatment malnourishment had significantly shorter overall survival (OS; 5.8 vs. 10.9 months, p = 0.000475). Patients who became malnourished during chemotherapy had worse OS compared to those who maintained their nutrition (12.2 vs. 17.5 months p = 0.0484). On univariable analysis, ECOG (p < 0.001), number of metastatic sites (p = 0.029) and NRI (p < 0.001) were significant prognostic factors while BMI (p = 0.57) and sarcopenia (p = 0.19) were not. On multivariable analysis, ECOG (p < 0.001), baseline NRI (p = 0.025), and change in NRI during treatment (p < 0.001) were significant poor prognostic factors for OS. Conclusions In de novo metastatic GE adenocarcinoma patients, ECOG, pretreatment NRI and change in NRI were significant prognostic factors for OS while sarcopenia was not. Use of NRI at baseline and during treatment can provide useful prognostic information.
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Affiliation(s)
- Lucy X Ma
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kirsty Taylor
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Reut Anconina
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Chihiro Suzuki
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael J Allen
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marta Honorio
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yvonne Bach
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Frances Allison
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eric X Chen
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Savtaj Brar
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Jonathan Yeung
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sangeetha N Kalimuthu
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Raymond W Jang
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Elena Elimova
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Álvaro Sanz E, Abilés J, Garrido Siles M, Rivas Ruíz F, Tortajada Goitia B, Domínguez AR. Evaluation of a protocol to detect malnutrition and provide nutritional care for cancer patients undergoing chemotherapy. Sci Rep 2020; 10:21186. [PMID: 33273641 PMCID: PMC7713220 DOI: 10.1038/s41598-020-78246-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
Patients with cancer frequently experience malnutrition, which is associated with higher rates of morbidity and mortality. Therefore, the implementation of strategies for its early detection and for intervention should improve the evolution of these patients. Our study aim is to design and implement a protocol for outpatients starting chemotherapy, by means of which any malnutrition can be identified and treated at an early stage. Before starting chemotherapy for patients with cancer, a complete assessment was made of their nutritional status, using the Nutriscore screening tool. When nutritional risk was detected, an interventional protocol was applied. Of 234 patients included in the study group, 84 (36%) required an individualised nutritional approach: 27 (32.1%) presented high nutritional risk, 12 had a Nutriscore result ≥ 5 and 45 experienced weight loss during chemotherapy. Among this population, the mean weight loss (with respect to normal weight) on inclusion in the study was - 3.6% ± 8.2. By the end of the chemotherapy, the mean weight gain was 0% ± 7.3 (p < 0.001) and 71.0% of the patients had experienced weight gain or maintenance, with respect to the initial weight. More than a third of cancer patients who start chemotherapy are candidates for early nutritional intervention. This finding highlights the importance of early identification of patients at risk in order to improve the efficacy of nutritional interventions, regardless of the stage of the disease.
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Affiliation(s)
- Elena Álvaro Sanz
- Pharmacy and Nutrition Service, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Jimena Abilés
- Pharmacy and Nutrition Service, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Marga Garrido Siles
- Pharmacy Service, Hospital Universitario Virgen de La Victoria, A7, km. 187, Área de Farmacia, Campus de Teatinos, S/N, 29010, Málaga, Spain.
- , Málaga, Spain.
| | | | | | - Antonio Rueda Domínguez
- UGCI Oncología Médica, Hospitales Universitarios Regional Y Virgen de La Victoria, IBIMA, Málaga, Spain
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Wang B, Jiang XW, Tian DL, Zhou N, Geng W. Combination of Haemoglobin and Prognostic Nutritional Index Predicts the Prognosis of Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma. Cancer Manag Res 2020; 12:8589-8597. [PMID: 32982451 PMCID: PMC7509334 DOI: 10.2147/cmar.s266821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate the predictive effect of the combined markers of haemoglobin and prognostic nutritional index (PNI) on the long-term survival of patients undergoing postoperative radiotherapy for esophageal squamous cell carcinoma (ESCC). Patients and Methods A total of 238 patients were included in this retrospective analysis. PNI was calculated as the serum albumin level (g/L) + 5 × absolute lymphocyte count, and the cut-off values of PNI and haemoglobin were calculated by receiver operating characteristic (ROC) curve analysis. Then, we combined haemoglobin and PNI, named the H-PNI score, as a predictor of tumour prognosis. The patients were divided into three groups: H-PNI score of 2 (having both hyper-haemoglobin and high PNI), H-PNI score of 1 (having one of these haematological abnormalities), and H-PNI score of 0 (having neither hyper-haemoglobin nor high PNI). The overall survival (OS) rate was calculated using the Kaplan–Meier method, and survival differences between groups were evaluated using the Log rank test. Cox proportional hazards models were used for univariate and multivariate analyses. P values <0.05 indicated statistical significance. Results The cut-off values of haemoglobin and PNI were 132.5 (g/L) and 46.55, respectively. Kaplan–Meier analysis showed that patients with high haemoglobin and PNI levels had a significantly better prognosis than those with low haemoglobin and PNI levels (P = 0.015 and P = 0.002, respectively). Similarly, the survival rate was significantly lower in patients with an H-PNI score of 0 than in those with an H-PNI score of 1–2 (P=0.000). Univariate analysis indicated that differentiation, T and N classification, and H-PNI score were significantly associated with OS. Finally, differentiation (P=0.002), T and N classification (P=0.000), and H-PNI score (P=0.01) were independent prognostic factors for ESCC patients undergoing postoperative radiotherapy. Conclusion The H-PNI score was an independent prognostic factor for ESCC patients undergoing postoperative radiotherapy.
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Affiliation(s)
- Bei Wang
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
| | - Xiao-Wen Jiang
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
| | - Da-Long Tian
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
| | - Ning Zhou
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
| | - Wei Geng
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
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Movahed S, Seilanian Toussi M, Pahlavani N, Motlagh AG, Eslami S, Nematy M, Ghayour-Mobarhan M, Khadem-Rezaiyan M, Emadzadeh M, Varshoee Tabrizi F, Bozzetti F, Norouzy A. Effects of medical nutrition therapy compared with general nutritional advice on nutritional status and nutrition-related complications in esophageal cancer patients receiving concurrent chemoradiation: A randomized controlled trial. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2020. [DOI: 10.3233/mnm-200424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: The purpose of this randomized controlled trial study was to assess the effects of medical nutrition therapy (MNT) compared with general nutritional advice (NA) on nutritional status in esophageal cancer (EC) patients during Chemoradiation (CRT). METHOD: The sample includes one hundred newly diagnosed patients with EC. The MNT group received individualized nutritional therapy. The NA group received general nutritional advice at the beginning of the participation. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutrition-related complications were assessed. RESULTS: Forty-nine cases were in the MNT group. The MNT group had significantly more favorable energy (26.4±14.1 vs. 18.2±11.2 kcal/kgw.day) and protein (1±0.6 vs. 0.7±0.4 g/kgw.day) intake than the NA group at the final evaluation. The PG-SGA score diminished but not significantly in both groups (11±6 vs. 12±6). As compared to the NA group, patients in the MNT group experienced more frequently no weight loss (21% vs. 11%) or mild weight loss (40% vs 35%) during the treatment. Meanwhile, moderate weight loss was more frequently observed in the NA group (26% vs. 44%). In the MNT group, those with severe weight loss had not proper adherence to the nutritional protocol. Mid-upper arm circumference, body composition, laboratory tests, physical performance, and nutrition-related complications were not significantly different between the two groups. CONCLUSION: As compared to general NA, MNT improved energy and macronutrients intake in patients with EC undergoing CRT which resulted in less severe weight loss and potentially better nutritional status.
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Affiliation(s)
- Sara Movahed
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Students Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Seilanian Toussi
- Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naseh Pahlavani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Students Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Ghanbari Motlagh
- Department of Radiotherapy Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Nematy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Abdolreza Norouzy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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The impact of sarcopenia and decrease in skeletal muscle mass in patients with advanced pancreatic cancer during FOLFIRINOX therapy. Br J Nutr 2020; 125:1140-1147. [DOI: 10.1017/s0007114520003463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractSarcopenia, defined as decrease in skeletal muscle mass (SMM) and strength, might be associated with reduced survival. We investigated the impact of sarcopenia and decrease in SMM in patients with advanced pancreatic cancer during FOLFIRINOX (FX) therapy. Consecutive sixty-nine patients who received FX were evaluated. Skeletal muscle index (SMI) (cm2/m2) was used to evaluate SMM. The cut-off value of sarcopenia was defined as SMI <42 for males and <38 for females, based on the Asian Working Group for sarcopenia criteria. Sarcopenia was diagnosed in thirty-three (48 %) subjects. Comparison of baseline characteristics of the two groups (sarcopenia group: non-sarcopenia group) showed a significant difference in sex, tumour size and BMI. There was no significant difference in the incidence of adverse events with grades 3–5 and progression-free survival (PFS) during FX between the two groups (PFS 8·1 and 8·8 months; P = 0·88). On the multivariate analysis, progressive disease at the first follow-up computed tomography (hazard ratio (HR) 3·87, 95 % CI 1·53, 9·67), decreased SMI ≥ 7·9 % in 2 months (HR 4·02, 95 % CI 1·87, 8·97) and carcinoembryonic antigen ≥ 4·6 (HR 2·52, 95 % CI 1·10, 6·11) were significant risk factors associated with poor overall survival (OS), but sarcopenia at diagnosis was not. OS in patients with decreased SMI of ≥7·9 % and <7·9 % were 10·9 and 21·0 months (P < 0·01), respectively. In conclusion, decrease in SMM within 2 months after the initiation of chemotherapy had significantly shorter OS, although sarcopenia at diagnosis did not affect OS. Therefore, it might be important to maintain SMM during chemotherapy for a better prognosis.
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Abstract
Prehabilitation aims at enhancing patient’s preoperative functional capacity to better withstand the stress of surgery and recovery.
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Wang B, Jiang X, Tian D, Geng W. Enteral nutritional support in patients undergoing chemoradiotherapy for esophageal carcinoma. Future Oncol 2020; 16:2949-2957. [PMID: 32857598 DOI: 10.2217/fon-2020-0181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Esophageal cancer patients are at a high risk of malnutrition. Both the disease itself and chemoradiotherapy will lead to the deterioration of nutritional status. The development of nutritional oncology promotes the application of enteral nutrition in tumor patients. Through nutritional support, prognosis is improved and the incidence of adverse chemoradiotherapy reactions is reduced, especially in those with head and neck or esophageal cancer. This review summarizes enteral nutritional support in esophageal cancer patients undergoing chemoradiotherapy in recent years, including a selection of nutritional assessment tools, the causes and consequences of malnutrition in esophageal cancer patients, types of access and effects of enteral nutrition. More patients with esophageal cancer will benefit from the development of enteral nutrition technology in the future.
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Affiliation(s)
- Bei Wang
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First people's Hospital of Yancheng, 66 South People's Road, Yancheng, 224000, Jiangsu Province, PR China
| | - Xiaowen Jiang
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First people's Hospital of Yancheng, 66 South People's Road, Yancheng, 224000, Jiangsu Province, PR China
| | - Dalong Tian
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First people's Hospital of Yancheng, 66 South People's Road, Yancheng, 224000, Jiangsu Province, PR China
| | - Wei Geng
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First people's Hospital of Yancheng, 66 South People's Road, Yancheng, 224000, Jiangsu Province, PR China
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Troesch B, Eggersdorfer M, Laviano A, Rolland Y, Smith AD, Warnke I, Weimann A, Calder PC. Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition. Nutrients 2020; 12:E2555. [PMID: 32846900 PMCID: PMC7551800 DOI: 10.3390/nu12092555] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Abstract
Life expectancy is increasing and so is the prevalence of age-related non-communicable diseases (NCDs). Consequently, older people and patients present with multi-morbidities and more complex needs, putting significant pressure on healthcare systems. Effective nutrition interventions could be an important tool to address patient needs, improve clinical outcomes and reduce healthcare costs. Inflammation plays a central role in NCDs, so targeting it is relevant to disease prevention and treatment. The long-chain omega-3 polyunsaturated fatty acids (omega-3 LCPUFAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are known to reduce inflammation and promote its resolution, suggesting a beneficial role in various therapeutic areas. An expert group reviewed the data on omega-3 LCPUFAs in specific patient populations and medical conditions. Evidence for benefits in cognitive health, age- and disease-related decline in muscle mass, cancer treatment, surgical patients and critical illness was identified. Use of DHA and EPA in some conditions is already included in some relevant guidelines. However, it is important to note that data on the effects of omega-3 LCPUFAs are still inconsistent in many areas (e.g., cognitive decline) due to a range of factors that vary amongst the trials performed to date; these factors include dose, timing and duration; baseline omega-3 LCPUFA status; and intake of other nutrients. Well-designed intervention studies are required to optimize the effects of DHA and EPA in specific patient populations and to develop more personalized strategies for their use.
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Affiliation(s)
- Barbara Troesch
- Nutrition Science and Advocacy, DSM Nutritional Products, 4303 Kaiseraugst, Switzerland; (B.T.); (I.W.)
| | - Manfred Eggersdorfer
- Department of Internal Medicine, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy;
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, INSERM 1027, Centre Hospitalo-Universitaire de Toulouse, 31300 Toulouse, France;
| | - A. David Smith
- Department of Pharmacology, University of Oxford, Oxford OX1 2JD, UK;
| | - Ines Warnke
- Nutrition Science and Advocacy, DSM Nutritional Products, 4303 Kaiseraugst, Switzerland; (B.T.); (I.W.)
| | - Arved Weimann
- Clinic for General, Visceral and Oncological Surgery, St. Georg gGmbH Clinic, 04129 Leipzig, Germany;
| | - Philip C. Calder
- Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
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Movahed S, Norouzy A, Ghanbari Motlagh A, Eslami S, Khadem-Rezaiyan M, Emadzadeh M, Nematy M, Ghayour-Mobarhan M, Varshoee Tabrizi F, Bozzetti F, Seilanian Toussi M. Nutritional Status in Patients with Esophageal Cancer Receiving Chemoradiation and Assessing the Efficacy of Usual Care for Nutritional Managements. Asian Pac J Cancer Prev 2020; 21:2315-2323. [PMID: 32856860 PMCID: PMC7771945 DOI: 10.31557/apjcp.2020.21.8.2315] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition is prevalent in esophageal cancer patients which affects cancer prognosis. The purpose of this study was a comprehensive assessment of nutritional status during Chemoradiation (CRT). METHODS Newly diagnosed adults with esophageal cancer were recruited for this study. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutritional-related complications were assessed before, after, and 4 to 6 weeks after CRT. RESULTS Seventy-one cases were enrolled. The mean age was 66.8±12 years. Patients' mean weight loss was 2.42±2.4 kilograms during treatment. A significant reduction observed in mean MUAC (26.68±4.9 vs. 25.42±5.1 cm), fat mass percentage (24.11±11.8 vs. 22.8±12.5), fat free mass index (16.87±2.4 vs. 16.47±2.6 kg/m2) and hand grip strength (43.2±19 vs. 36.1±20 kg) during CRT (all p-values <0.0001). We had also a non-significant change in mean energy intake (19.5±11 vs. 18.3±11 kcal/kgw. day) and protein intake (0.56±0.4 vs. 0.66±0.5 g/kgw.day) during CRT. In our assessment before, immediately after and 4-6 weeks following CRT, we recorded energy intake insufficiency in 55.7%, 58.7% and 27.3% and protein intake inadequacy in 89.8%, 89.1% and 72.7% of cases, respectively. The most common complications were dysphagia (56.7%), anorexia (25%), and constipation (47.9%) at admission. Dysphagia improved in some cases (42%), but anorexia (35%), early satiety (25%), Esophagitis (25%), dysosmia (21%) and dysgeusia (17%) were increased as CRT complication. yet, 25% of patients had dysphagia and 34.4% had constipation 4-6 weeks after CRT. The twelve-months mortality was significantly associated with lower BMI after CRT, primary PG-SGA score, weight loss, BMI<18.5, MUAC, physical performance, living in rural or urban areas, addiction. CONCLUSION Our study demonstrated a high prevalence of malnutrition among esophageal cancer patients which worsened during Chemoradiotherapy. Our findings warrant early screening and monitoring of nutritional status and effective nutritional interventions with symptoms management during treatment in these patients. .
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Affiliation(s)
- Sara Movahed
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Abdolreza Norouzy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Khadem-Rezaiyan
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Emadzadeh
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohsen Nematy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Federico Bozzetti
- Department of surgery, Faculty of Medicine, University of Milan, Lombardia, Italy.
| | - Mehdi Seilanian Toussi
- Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Mallet R, Modzelewski R, Lequesne J, Mihailescu S, Decazes P, Auvray H, Benyoucef A, Di Fiore F, Vera P, Dubray B, Thureau S. Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer. Radiat Oncol 2020; 15:116. [PMID: 32443967 PMCID: PMC7245030 DOI: 10.1186/s13014-020-01545-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/22/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radiotherapy is the standard treatment for locally-advanced tumour, not accessible to surgical resection. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy. METHODS The clinical, nutritional, anthropometric, and functional-imaging (18FDG-PET/CT) data were collected in 97 patients treated between 2006 and 2012 in our institution. The skeletal muscle area was automatically delineated on cross-sectional CT images acquired at the 3rd. lumbar vertebra level and divided by the patient's squared height (SML3/h2) to obtain the Skeletal Muscle Index (SMI). The primary endpoint was overall survival probability. RESULTS Seventy-six deaths were reported. The median survival time was 27 [95% Confidence Interval 23-40] months for the whole population. Univariate analyses (Cox Proportional Hazard Model) showed decreased survival probabilities in patients with reduced SMI, WHO > 0, Body Mass Index ≤21, and Nutritional Risk Index ≤97.5. Multivariate analyses showed that sarcopenia was the only significant prognostic factor (HR 2.32 [1.24-4.34], p = 0.008). Using Receiver Operating Characteristics curves, the Area Under the Curve (AUC) was 0.73 in males (p = 0.0002], the optimal threshold being 51.5 cm2/m2. In women, the AUC was 0.65 (p = 0.19). CONCLUSION Sarcopenia is a powerful independent prognostic factor, associated with a rise of the overall mortality in patients treated exclusively by radiochemotherapy for a locally advanced oesophageal cancer. L3 CT images are easily gathered from 18FDG-PET/CT acquisitions.
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Affiliation(s)
- Romain Mallet
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Justine Lequesne
- Clinical Research Department, Henri Becquerel Cancer Center, Rouen, France
| | - Sorina Mihailescu
- Clinical Research Department, Henri Becquerel Cancer Center, Rouen, France
| | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Hugues Auvray
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France
| | - Ahmed Benyoucef
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France
| | - Fréderic Di Fiore
- Department of Hepatogastroenterology, Rouen University Hospital & Department of Medical Oncology, Henri Becquerel Cancer Centre, University of Rouen, Rouen, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Bernard Dubray
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France. .,Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France.
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Zhao B, Lv W, Lin J. Delaying adjuvant chemotherapy in advanced gastric cancer patients: Risk factors and its impact on survival outcome. Curr Probl Cancer 2020; 44:100577. [PMID: 32418615 DOI: 10.1016/j.currproblcancer.2020.100577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/19/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
Abstract
Adjuvant chemotherapy following the curative resection could improve the survival outcome of advanced gastric cancer (GC) patients. However, it is unclear whether delayed initiation of adjuvant chemotherapy had a negative impact on survival outcome in GC patients. The purpose of this study was to review current published literature about the impact of delaying adjuvant chemotherapy on survival outcome and summarize risk factors for delaying adjuvant chemotherapy. Delayed initiation of adjuvant chemotherapy was quite frequent in GC patients who underwent gastrectomy due to postoperative complications, poor nutritional status, comorbid diseases and socioeconomic status. Therefore, it is important for these patients to have a sufficient and smooth transition from surgery to initiation of adjuvant chemotherapy. Based on current available evidence, there is no specific timing interval for the initiation of adjuvant chemotherapy in GC patients. Earlier initiation of adjuvant chemotherapy (<4 weeks) may not be mandatory for GC patients who underwent curative resection. However, the patients should be recommended to receive adjuvant chemotherapy within 6-8 weeks if their performance status and nutritional status were deemed to be appropriate. Minimizing postoperative complications and providing requisite nutritional advice may be helpful for timely initiation of adjuvant chemotherapy.
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Affiliation(s)
- Bochao Zhao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, PR China.
| | - Wu Lv
- Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, PR China
| | - Jie Lin
- Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, PR China.
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Furuta M, Yokota T, Tsushima T, Todaka A, Machida N, Hamauchi S, Yamazaki K, Fukutomi A, Kawai S, Kawabata T, Onozawa Y, Yasui H. Comparison of enteral nutrition with total parenteral nutrition for patients with locally advanced unresectable esophageal cancer harboring dysphagia in definitive chemoradiotherapy. Jpn J Clin Oncol 2020; 49:910-918. [PMID: 31219161 DOI: 10.1093/jjco/hyz089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/16/2019] [Accepted: 06/10/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The nutritional status of patients with esophageal squamous cell carcinoma (ESCC) harboring dysphagia is often poor. The efficacy and safety of enteral nutrition (EN) versus total parenteral nutrition (TPN) have not been addressed in patients with ESCC requiring nutritional support during definitive chemoradiotherapy (dCRT). METHODS We performed a retrospective analysis of 51 locally advanced unresectable ESCC patients with dysphagia receiving EN (n = 28) or TPN (n = 23) during dCRT between 2009 and 2016. RESULTS Patient characteristics in EN vs. TPN were as follows: median age (range), 67 (34 to 82) vs. 66 (57 to 83); ECOG performance status 0/1/2, 11/15/2 vs. 7/14/2; dysphagia score 2/3/4, 11/15/2 vs. 14/8/1; and primary tumor location Ce/Ut/Mt/Lt/Ae, 4/6/14/3/1 vs. 2/2/16/1/2. Median changes in serum albumin level one month after dCRT were +8.8% (-36 to 40) in EN and -12% (-64 to 29) in TPN (P = 0.00377). Weight, body mass index, and skeletal muscle area were not significantly different between the groups. Median durations of hospitalization were 50 days (18 to 72) in EN and 63 days (36 to 164) in TPN (P = 0.00302). Adverse events during dCRT in EN vs. TPN were as follows: catheter-related infection, 0 vs. 6 (27%); aspiration pneumonia, 3 (11%) vs. 2 (9%); mediastinitis, 3 (11%) vs. 1 (5%); grade ≥3 neutropenia, 6 (21%) vs. 14 (64%) (P = 0.00287); and febrile neutropenia, 0 vs. 6 (27%) (P = 0.00561). CONCLUSIONS EN may be advantageous for improving serum albumin level, and reducing hematological toxicity and duration of hospitalization compared with TPN during dCRT in ESCC patients.
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Affiliation(s)
- Mitsuhiro Furuta
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
| | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
| | - Nozomu Machida
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
| | - Satoshi Hamauchi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
| | - Akira Fukutomi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
| | - Sadayuki Kawai
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takanori Kawabata
- Division of Medical Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yusuke Onozawa
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center Shizuoka, Japan
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Pagano AP, Sicchieri JMF, Schiavoni IL, Barbeiro D, Manca CS, da Silva BR, Bezerra AE, Pinto LCM, Araújo RC, Teixeira AC, Chiarello PG. Phase angle as a severity indicator for liver diseases. Nutrition 2020; 70:110607. [DOI: 10.1016/j.nut.2019.110607] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/08/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022]
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Lu H, Zhao B, Zhang J, Huang R, Wang Z, Xu H, Huang B. Does delayed initiation of adjuvant chemotherapy following the curative resection affect the survival outcome of gastric cancer patients: A systematic review and meta-analysis. Eur J Surg Oncol 2020; 46:1103-1110. [PMID: 31948838 DOI: 10.1016/j.ejso.2020.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/23/2019] [Accepted: 01/07/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Adjuvant chemotherapy(AC) following the curative resection could improve the survival outcome of advanced gastric cancer(GC) patients. However, there is no specific timing interval from radical surgery to initiation of AC. Whether delayed initiation of AC could affect the survival outcome of these patients remains unclear. In this study, we performed a systematic review and meta-analysis to evaluate the relationship between delaying AC and the survival outcome of GC patients. METHODS PubMed, Embase and Cochrane Library databases were systematically searched for eligible studies that evaluated the relationship between time to AC and survival outcome. Survival data for HR and 95% CI were extracted and converted to a regression coefficient(β) corresponding to a continuous representation per 4-week delay of AC. Individual adjusted β were combined using a fixed-effects or random-effects model. Heterogeneity was assessed by I2 statistic and publication bias was detected using standard error-based funnel plots. RESULTS A total of 11 eligible studies involving 6,017 patients were included in this meta-analysis. Eight studies evaluated the impact of delaying AC on overall survival(OS) and five evaluated the impact of delaying AC on disease-free survival(DFS). The pooled results demonstrated that the initiation of AC per 4-week delay was associated with a significant decrease in OS(HR:1.05, 95% CI: 1.03-1.08, P < 0.001; I2 = 18.5%) and DFS (HR:1.06, 95% CI: 1.02-1.10, P = 0.001; I2 = 40.6%). CONCLUSION The initiation of AC per 4-week delay was associated with worse survival outcomes in GC patients. If physical status and postoperative recovery were appropriated, GC patients should be recommended to receive adjuvant chemotherapy timely.
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Affiliation(s)
- Huiwen Lu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Bochao Zhao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Jiale Zhang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Rui Huang
- Department of Clinical Medicine of year 2017, Dalian Medical University, PR China
| | - Zhenning Wang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Huimian Xu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Baojun Huang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
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Toyokawa G, Shoji F, Yamazaki K, Shimokawa M, Takeo S. Significance of the Red Blood Cell Distribution Width in Resected Pathologic Stage I Nonsmall Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2020; 32:1036-1045. [DOI: 10.1053/j.semtcvs.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022]
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Dai H, Shao YW, Tong X, Wu X, Pang J, Feng A, Yang Z. YAP1 amplification as a prognostic factor of definitive chemoradiotherapy in nonsurgical esophageal squamous cell carcinoma. Cancer Med 2019; 9:1628-1637. [PMID: 31851786 PMCID: PMC7050074 DOI: 10.1002/cam4.2761] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023] Open
Abstract
Background Definitive chemoradiation therapy (dCRT) is the standard treatment for patients with nonsurgical esophageal squamous cell carcinoma (ESCC), yet patients have demonstrated great variations in their responses to dCRT and inevitably progressed following treatment. Methods To identify prognostic biomarkers, we performed targeted next‐generation sequencing of 416 cancer‐related genes on primary tumors from 47 nonsurgical ESCC patients prior to dCRT treatment. The association between genetic alterations and patients' local recurrence‐free survival (LRFS), progression‐free survival (PFS), and overall survival (OS) was analyzed. Results TP53 (78% of patients), NOTCH1 (32%), ARID1A (13%), FAT1 (13%), and CDKN2A (13%) were commonly mutated in ESCC patients, while gene amplifications frequently occurred in MCL1 (36%), FGF19 (34%), MYC (32%), CCND1 (27%), ZNF217 (15%), CDKN2A (13%), and YAP1 (11%). Univariate and multivariate analyses of clinical factors and genetic alterations indicated that sex is an independent prognostic factor, with males tending to have better LRFS (hazard ratio [HR], 0.25; 95%CI, 0.08‐0.77, P = .015) and progression‐free survival (PFS) (HR, 0.35; 95%CI, 0.13‐0.93, P = .030) following dCRT. Meanwhile, YAP1 amplification (n = 7) was an adverse prognostic factor, and patients with this alteration demonstrated a tendency toward worse outcomes with shorter LRFS (HR, 4.06; 95%CI, 1.26‐13.14, P = .019) and OS (HR, 2.78; 95%CI, 0.95‐8.17, P = .062). In a subgroup analysis, while sex and M‐stage were controlled, a much stronger negative effect of YAP1 amplification vs wild‐type in LRFS was observed (log‐rank P = .0067). Conclusion The results suggested that YAP1 amplification is a potentially useful biomarker for predicting treatment outcomes and identifying patients with a high risk of relapse who should be closely monitored.
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Affiliation(s)
- Honghai Dai
- Tumor Research and Therapy Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yang W Shao
- Nanjing Geneseeq Technology Inc, Nanjing, China.,School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoling Tong
- Translational Medicine Research Institute, Geneseeq Technology Inc, Toronto, Ontario, Canada
| | - Xue Wu
- Translational Medicine Research Institute, Geneseeq Technology Inc, Toronto, Ontario, Canada
| | | | - Alei Feng
- Tumor Research and Therapy Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhe Yang
- Tumor Research and Therapy Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Sagou K, Ozeki K, Ukai S, Adachi Y, Fukushima N, Kohno A. Impact of a Nutritional Risk Index on Clinical Outcomes after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:2287-2296. [DOI: 10.1016/j.bbmt.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/10/2019] [Accepted: 07/02/2019] [Indexed: 02/03/2023]
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Lorton CM, Griffin O, Higgins K, Roulston F, Stewart G, Gough N, Barnes E, Aktas A, Walsh TD. Late referral of cancer patients with malnutrition to dietitians: a prospective study of clinical practice. Support Care Cancer 2019; 28:2351-2360. [PMID: 31485981 DOI: 10.1007/s00520-019-05042-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Malnutrition (MN) in cancer is common but underdiagnosed. Dietitian referrals may not occur until MN is established. We investigated cancer patient characteristics (demographics, nutritional status, and nutrition barriers) on referral to oncology dietitians. We also examined referral practices and prevalence of missed referral opportunities. METHODS This was a naturalistic multi-site study of clinical practice. Data from consecutive referrals were collected in inpatient and outpatient settings. Demographics, nutritional status (weight, body mass index (BMI), weight loss in the preceding 3-6 months, oral intake, nutrition barriers), referral reasons, and use of screening were recorded. Missed opportunities for earlier referral were also noted. RESULTS Two hundred patients were included (60% male, 51% inpatients). Half had gastrointestinal and hepatobiliary cancers. The majority were on antitumor treatment. Two-thirds had lost ≥ 5% body weight. Forty percent were overweight or obese. Seventy percent had ≥ 2 nutritional barriers. Most common nutrition barriers were anorexia, nausea, and early satiety. Greater weight loss and lower food intake were associated with ≥ 2 barriers. Weight loss was the most common referral reason. Screening was used in 35%. Referrals should have occurred sooner in nearly half (45%, n = 89). CONCLUSIONS Cancer patients were referred late to a dietitian, with multiple nutritional barriers. Most referrals were for established weight loss (WL). WL may be masked by pre-existing obesity. Almost half had missed earlier referral opportunities; screening was infrequent. Over one-quarter should have been re-referred sooner. There is a clear need for clinician education. Future research should investigate the optimal timing of dietitian referral and the best nutrition screening tools for use in cancer.
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Affiliation(s)
- Cliona M Lorton
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6W EV82, Ireland.
- Trinity College Dublin, Dublin, Ireland.
| | - O Griffin
- Trinity College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - K Higgins
- Tallaght University Hospital, Dublin, Ireland
| | - F Roulston
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - G Stewart
- St Vincent's Private Hospital, Dublin, Ireland
| | - N Gough
- Mater Private Mid-Western Radiation Oncology Centre, Limerick, Ireland
| | - E Barnes
- St Vincent's University Hospital, Dublin, Ireland
| | - A Aktas
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - T D Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6W EV82, Ireland
- Trinity College Dublin, Dublin, Ireland
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
- University College Dublin, Dublin, Ireland
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Wang Y, Wang L, Fang M, Li J, Song T, Zhan W, Xu H. Prognostic Value of the Geriatric Nutritional Risk Index in Patients Exceeding 70 Years Old with Esophageal Squamous Cell Carcinoma. Nutr Cancer 2019; 72:620-626. [PMID: 31390885 DOI: 10.1080/01635581.2019.1650189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
To investigate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in esophageal squamous cell carcinoma (ESCC) patients treated with radiotherapy (RT) or definitive concurrent chemoradiotherapy (dCRT). Fifty-two ESCC patients were included from July 2014 to December 2018. RT was delivered at a dose of 1.8-2.0 Gy per day to a total dose of 50-60 Gy. Tumor response was assessed using the RECIST 1.1 system. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan-Meier method. Multivariate analysis of predictive factors of response and survival was performed using a logistic regression and a Cox model, respectively. In multivariate analysis, GNRI score (HR 0.278, P = 0.036) was the only independent prognostic factor for tumor response. As for survival outcomes, GNRI score (OS: HR 0.505, P = 0.028; PFS: HR 0.583, P = 0.045) and treatment modality (OS: HR 0.356, P = 0.015; PFS: HR 0.392, P = 0.0014) were both independent prognostic factors for better OS and PFS. Additionally, there was no correlation between GNRI score and treatment modality (Spearman's ρ = 0.200; P = 0.154). In conclusion, routine use of the GNRI criteria may help in the risk stratification of elderly patients undergoing RT/dCRT. The dCRT treatment could provide survival benefits for elderly ESCC patients.
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Affiliation(s)
- Ying Wang
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Lei Wang
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Min Fang
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Jianbo Li
- Department of Radiation Oncology, Ningbo Mingzhou Hospital, Ningbo, P.R. China
| | - Tao Song
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Wenming Zhan
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Hong'en Xu
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
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Effect of whole-course nutrition management on patients with esophageal cancer undergoing concurrent chemoradiotherapy: A randomized control trial. Nutrition 2019; 69:110558. [PMID: 31526964 DOI: 10.1016/j.nut.2019.110558] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/30/2019] [Accepted: 07/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Malnutrition is the most common complication of patients with esophageal cancer and can lead to poor prognosis and death. Good nutritional status has been shown to help improve patient outcomes and reduce complications. In the absence of specific evidence on the effect of nutrition in patients with esophageal cancer, the purpose of this study was to investigate the effect of whole-course nutrition management on the prognosis and complications of chemoradiotherapy in patients with esophageal cancer through a randomized controlled trial. METHODS A total of 96 patients with esophageal cancer treated with concurrent chemoradiation were randomized to an intervention group (treated with whole-course nutrition management from the Nutrition Support Team) and a control group (treated with the general nutritional method) for approximately 6 wk. Dietary surveys and body measurements were conducted at baseline and every day thereafter. Patient-generated Subjective Global Assessment score, blood index, quality of life, and psychological condition were assessed at baseline and every week before discharge. Complications (e.g., radiation esophagitis, myelosuppression, and skin symptoms), completion rates of therapy, short-term efficacy evaluation, as well as clinical outcomes were measured. RESULTS A total of 85 patients completed the study (intervention group = 45; control group = 40). There were significant differences in the changes of serum albumin and total protein between the two groups throughout the trial (P < 0.05). Complications (e.g., radioactive esophagitis, skin symptom of complications) and quality of life were statistically different before and after the intervention (P < 0.05). The difference in the change of other indicators was not statistically significant. CONCLUSIONS Whole-course nutrition management can improve the nutritional status of patients with esophageal cancer treated with concurrent chemoradiotherapy, reduce the severity of radiation esophagitis and radiation skin reactions, improve the quality of life, and relieve depressive symptoms.
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Higuera-Pulgar I, Ribed A, Carrascal-Fabian ML, Romero-Jiménez RM, Velasco-Gimeno C, Bretón-Lesmes I, Camblor-Álvarez M, Cuerda-Compes C, García-Peris P. Evolution of nutritional status and survival in patients with cancer on tyrosine kinase inhibitors treatment. ACTA ACUST UNITED AC 2019; 66:472-479. [PMID: 31171456 DOI: 10.1016/j.endinu.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/17/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Treatment with oral antineoplastic agents known as tyrosine kinase inhibitors (TKIs) is new and, thus, little is known about their impact on nutritional status (NS), dietary intake, quality of life, and survival. The aim of this study was to provide information on these components in order to guide future nutritional recommendations. PATIENTS AND METHOD A prospective, observational study in adults who start treatment with TKIs, in whom NS was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), anthropometric measures, biochemical parameters, and dietary intake (24-hour dietary recall). The EORTC QLQ-C30 was used to assess quality of life. Nonparametric tests were used in statistical analysis, and survival was analyzed using Kaplan-Meier and log-rank curves. RESULTS Of the overall sample, 21.7% had moderate malnutrition according to PG-SGA, and 74.2% moderate weight loss at 6 months, but no patient had BMI<18.5kg/m2. Patients with moderate malnutrition had lower survival at four years of diagnosis (log-rank=0.015). Energy intake was lower than recommended by the ESPEN 2017 congress, and no patient covered the protein requirements (1.5g protein/kg weight) during follow-up. A worse score on the global health scale of the EORTC QLQ-C30 was related to worse NS. CONCLUSIONS Treatment with TKIs does not appear to have a significant impact on NS and quality of life after 6 months of follow-up. Malnutrition should be prevented through individualized nutritional advice because it is related to shorter survival.
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Affiliation(s)
- Isabel Higuera-Pulgar
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España.
| | - Almudena Ribed
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Luisa Carrascal-Fabian
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Rosa M Romero-Jiménez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Cristina Velasco-Gimeno
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Irene Bretón-Lesmes
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Miguel Camblor-Álvarez
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Cristina Cuerda-Compes
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Pilar García-Peris
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
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