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Pettit MS, Crowder SL, Ackerman RS, Hafez O, Poch MA, Patel SY. Preoperative Nutritional Status and Enhanced Recovery after Surgery (ERAS) Prior to Radical Cystectomy: A Review of the Literature. Nutr Cancer 2023; 75:1743-1751. [PMID: 37553951 DOI: 10.1080/01635581.2023.2244172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
Preoperative nutritional status is an important and modifiable risk factor of a patient's recovery and outcome after radical cystectomy. There are multiple malnutrition screening tools and treatment options. In this review, we discuss the best indicators of this condition and how to optimize nutrition status prior to radical cystectomy.
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Affiliation(s)
- Matthew S Pettit
- University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
| | - Sylvia L Crowder
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Robert S Ackerman
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Osama Hafez
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Sephalie Y Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Decreased Preoperative Serum AGR as a Diagnostic Marker of Poor Prognosis after Radical Surgery of Upper Urinary Tract and Bladder Cancers from a Pooled Analysis of 9,002 Patients. DISEASE MARKERS 2022; 2022:6575605. [PMID: 36105255 PMCID: PMC9467785 DOI: 10.1155/2022/6575605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
A growing number of studies have regarded the preoperative serum albumin-to-globulin ratio (AGR) as a prognostic indicator of urothelial carcinoma (UC) following radical surgery. However, a pooled analysis of AGR's effect on UC prognosis was still insufficient. Up to January 2022, a systematic search was conducted using PubMed, Embase, Web of Science, and Cochrane Library. Stata SE software was applied in this study. The reviewers collected the hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), progression-free survival (PFS), and metastasis-free survival (MFS). A total of 9,002 patients from 12 retrospective studies were included in this analysis. The results showed that preoperative serum AGR was significantly associated with the OS (HR = 1.85, 95%CI = 1.43 to 2.39), CSS (HR = 2.38, 95%CI = 1.69 to 3.34), RFS (HR = 1.64, 95%CI = 1.29 to 2.08), PFS (HR = 2.16, 95%CI = 1.43 to 3.27), and MFS (HR = 3.00, 95%CI = 1.63 to 5.53) of patients with UC following radical surgery. Sensitivity analysis indicated the stability of the results. Subgroup analysis revealed that preoperative low AGR was seen as a risk factor for OS (HR = 1.90, 95%CI = 1.34 to 2.69), CSS (HR = 2.13, 95%CI = 1.40 to 3.26), and RFS (HR = 1.60, 95%CI = 1.24 to 2.07) in upper tract urothelial carcinoma (UTUC), but it was only a risk factor for CSS (HR = 2.95, 95%CI = 1.14 to 7.60) in bladder cancer (BC). Besides, preoperative AGR cut − value ≤ 1.4 could not be deemed as a stable prognostic indicator for RFS (HR = 2.07, 95%CI = 0.71 to 6.04) in UC. However, the predictive ability of AGR cut − value > 1.4 was stable. All in all, preoperative low AGR was considered as a risk factor for UC. AGR level can be regarded as a prognostic indicator for OS, CSS, and RFS in UTUC but only for CSS in BC. AGR greater than 1.4 can be a great cut-off value for predicting the prognosis of UC patients with radical operation.
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Xia Z, Fu X, Li J, Wu J, Niu C, Xu Y, Wang H, Yuan X, Tang L. Prognostic value of pretreatment serum albumin−globulin ratio in urothelial carcinoma: A systematic review and meta-analysis. Front Oncol 2022; 12:992118. [PMID: 36052239 PMCID: PMC9424645 DOI: 10.3389/fonc.2022.992118] [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: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate whether pretreatment albumin−globulin ratio (AGR) can be used as a biomarker for predicting the prognosis of patients with urothelial carcinoma (UC). Methods We systematically searched PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Google Scholar and Cochrane Library; the search time was up to May 2022. Stata 16.0 was used for data processing and statistical analysis. Results We identified 12 studies with 5,727 patients from 317 unique citations during the meta-analysis. Our results suggested that a low AGR before treatment was significantly associated with poor overall survival (OS) [hazard ratio (HR) = 1.99, 95% confidence interval (CI) = 1.45-2.75, P < 0.001], cancer-specific survival (CSS) [HR=2.01, 95% CI = 1.50-2.69, P < 0.001] and recurrence-free survival (RFS) [HR=1.39, 95% CI = 1.12-1.72, P = 0.002]. Furthermore, we defined different subgroups according to ethnicity, cancer type, cut-off value, sample size and stage. Similar prognostic outcomes for OS and CSS were observed in most subgroups. However, for subgroup of stage, the low pretreatment AGR only predicted the poor survival of patients with non-metastatic UC. Conclusion Our meta-analysis revealed that the AGR before treatment could be used as a predictive biomarker to indicate the prognosis of UC patients during clinical practice, especially in patients with non-metastatic UC.
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Affiliation(s)
- Zhongyou Xia
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Xueqin Fu
- Department of Breast Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Chao Niu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Yulai Xu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Hao Wang
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Xinzhu Yuan
- Blood Purification Center of Department of Nephrology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
- *Correspondence: Xinzhu Yuan, ; Lingtong Tang,
| | - Lingtong Tang
- Department of Clinical Laboratory, The People’s Hospital of Gao County, Yibin, China
- *Correspondence: Xinzhu Yuan, ; Lingtong Tang,
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Chen Q, Chen K, Wang S, Zhang L, Shi Y, Tao S, He Z, Wang C, Yu L. Prognostic value of the controlling nutritional status score in patients with myelodysplastic syndromes. Front Nutr 2022; 9:902704. [PMID: 35967813 PMCID: PMC9363897 DOI: 10.3389/fnut.2022.902704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/30/2022] [Indexed: 12/20/2022] Open
Abstract
Background Myelodysplastic syndromes (MDS) are a heterogeneous spectrum of clonal hematopoietic disorders with varying degrees of cytopenia and morphologic dysplasia. The controlling nutritional status (CONUT) score, an easy-to-use tool for assessing the nutritional status, was reported as an independent prognostic factor in cancer patients. However, its role in patients with MDS is unclear. Objective We aimed to explore the impact of CONUT score on the prognosis of patients with MDS, which is of great significance for clinical treatment. Methods A total of 121 patients with MDS were analyzed. The CONUT score was calculated prior to therapy. The bio-informatics tool X-tile was used to define the CONUT score and the threshold of 4 points was determined to predict the prognosis. Patients were divided into CONUTlow and CONUThigh groups, and the characteristics were compared between two groups. Results Results show that CONUTlow was associated with better overall survival (OS) than CONUThigh patients (Median OS, 30.20 vs. 19.63 months, p = 0.0003). However, there were no statistical differences in progression-free survival (PFS) between the two groups (p = 0.2683). Results of univariate and multivariate COX proportional hazard analysis adjusted for bone marrow blasts level, platelet count, International Prognostic Scoring System (IPSS) scores, gender, and hemoglobin (Hb) level showed that the CONUT score was useful in the evaluation standard of OS of MDS (hazard ratio (HR) 2.297, 95% CI 1.441–3.663, p < 0.001). Conclusions The CONUT, as a novel immuno-nutritional biomarker, may be useful in predicting the OS of MDS.
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Affiliation(s)
- Qiuni Chen
- Department of Hematology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
| | - Kankan Chen
- Department of Hematology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
| | - Sumei Wang
- Department of Hematology, The Huai'an Clinical College of Xuzhou Medical University, Huaian, China
| | - Lijuan Zhang
- Department of Hematology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
| | - Yuye Shi
- Department of Hematology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
| | - Shandong Tao
- Department of Hematology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
| | - Zhengmei He
- Department of Hematology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
| | - Chunling Wang
- Department of Hematology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
| | - Liang Yu
- Department of Hematology, The Huai'an Clinical College of Xuzhou Medical University, Huaian, China
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