Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

Cao, Jingjing; Xu, Hongxia; Li, Wei; Guo, Zengqing; Lin, Yuan; Shi, Yingying; Wen, Hairuo; Ba, Yi; Li, Suyi; Li, Zengning; Wang, Kunhua; Wu, Jing; He, Ying; Yang, Jiajun; Xie, Conghua; Zhou, Fen; Song, Xinxia; Chen, Gongyan; Ma, Wenjun; Luo, Suxia; Chen, Zihua; Ma, Cong; Ma, Hu; Zhou, Chunshan; Wang, Wei; Luo, Qi; Shi, Yongmei; Qi, Yue; Jiang, Haiping; Guan, Wenxian; Chen, Junqiang; Chen, Jiaxin; Fang, Yu; Zhou, Lan; Feng, Yongzeng; Tan, Rongshao; Ou, Junwen; Zhao, Qingchuan; Wu, Jianxiong; Lin, Xin; Yang, Liuqing; Fu, Zhenming; Wang, Chang; Deng, Li; Li, Tao; Song, Chunhua; Shi, Hanping; Status, Investigation on Nutrition

doi:10.1016/j.currproblcancer.2020.100638

Cited by 52 publications

(29 citation statements)

References 29 publications

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“…Within the first 48 h after hospital admission, demographic and clinicopathological data were collected by trained investigators, including gender, age at diagnosis, body mass index (BMI), smoking status, comorbidities, alcohol consumption, tea consumption, family history of cancer, tumor stage, NLR, and PG-SGA score. The nutritional status of all patients was evaluated using the PG-SGA: a patient with over 3 points would be regarded as relatively malnourished ( 15 ); in contrast, less than or equal to 3 points was classified into the well-nourished group. BMI was calculated by body weight in kilograms divided by the height in squared meters (kg/m 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…Finally, the grades for nutritional assessment are divided into the following categories: good nutritional status, suspicious malnutrition, moderate malnutrition, and severe malnutrition. A patient with over 3 points would be regarded as relatively malnourished ( 15 ). Thus, PG-SGA has been used for guiding nutritional treatment, making clinical decisions, and predicting outcomes in various cancers, including NPC ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Association of Systemic Inflammation and Malnutrition With Survival in Nasopharyngeal Carcinoma Undergoing Chemoradiotherapy: Results From a Multicenter Cohort Study

Wang

Yang

et al. 2021

Front. Oncol.

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BackgroundMalnutrition and systemic inflammation are common in patients with nasopharyngeal carcinoma (NPC). The Patient-Generated Subjective Global Assessment (PG-SGA) score and neutrophil-to-lymphocyte ratio (NLR) reflect the integrated nutritional status and inflammatory level of patients with NPC, respectively. We performed this study to identify whether NLR and PG-SGA score are associated with outcome and survival time for patients with NPC undergoing chemoradiotherapy.MethodsThe multicenter cohort study included 1,102 patients with NPC between June 2012 and December 2019. The associations of all-cause mortality with NLR and PG-SGA score were calculated using the Kaplan–Meier method and the log-rank test. We also did a multivariate-adjusted Cox regression analysis to identify the independent significance of different parameters. Restricted cubic spline regression was carried out to evaluate the association between NLR and overall survival (OS). A nomogram was established using the independent prognostic variables. Interaction terms were used to investigate whether there was an interactive association between NLR and PG-SGA.ResultsA total of 923 patients with NPC undergoing chemoradiotherapy were included in this study: 672 (72.8%) were males and 251 (27.2%) were females, with a mean age of 49.3 ± 11.5 years. The Kaplan–Meier curves revealed that patients with malnutrition (PG-SGA score >3) had worse survival than patients who were in the well-nourished group (PG-SGA score ≤3) (p < 0.0001). In addition, patients in the high NLR group (NLR ≥ 3) had worse survival than those in the low NLR group (NLR < 3) (p < 0.0001). Patients with high PG-SGA and high NLR had the worst survival (p < 0.0001). An increase in NLR had an inverted L-shaped dose–response association with all-cause mortality. A nomogram was developed by incorporating domains of NLR and PG-SGA score to accurately predict OS 12–60 months for patients [the C-index for OS prediction of nomogram was 0.75 (95% CI, 0.70–0.80)]. The interaction of PG-SGA with NLR was significant (p = 0.009). Patients with high PG-SGA and high NLR had a nearly 4.5-fold increased risk of death (HR = 4.43, 95% CI = 2.60–7.56) as compared with patients with low PG-SGA and low NLR.ConclusionsOur study provided clear evidence that high PG-SGA score and high NLR adversely and interactively affects the OS of patients with NPC undergoing chemoradiotherapy.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Systemic Inflammation and Malnutrition With Survival in Nasopharyngeal Carcinoma Undergoing Chemoradiotherapy: Results From a Multicenter Cohort Study

Wang

Yang

et al. 2021

Front. Oncol.

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“…NOURISH is the largest study to assess nutritional status in UGI cancer patients at the time of curative intent surgery using a validated assessment method. The majority of other studies of nutritional status in UGI cancer have been undertaken in ambulatory populations or have been included as part of mixed cancer or gastrointestinal surgical populations [ 14 , 22 , 23 , 24 , 25 , 26 , 27 ]. This study is unique as patients were recruited from 27 tertiary health services at the time of curative intent surgery, only major UGI surgical oncology procedures were included, and the validated SGA tool was used to diagnose malnutrition.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

et al. 2021

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Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2–4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.

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“…EC is a digestive tract malignant tumor that currently ranks sixth in incidence and fourth in mortality in China ( 18 ). Currently, there are no effective targeted drugs for the treatment of EC and prevention.…”

Section: Discussionmentioning

confidence: 99%

Tegaserod Maleate Inhibits Esophageal Squamous Cell Carcinoma Proliferation by Suppressing the Peroxisome Pathway

Wang

Jiang

et al. 2021

Front. Oncol.

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Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) are the two major types of esophageal cancer (EC). ESCC accounts for 90% of EC. Recurrence after primary treatment is the main reason for poor survival. Therefore, recurrence prevention is a promising strategy for extending the 5-year survival rate. Here, we found tegaserod maleate could inhibit ESCC proliferation both in vivo and in vitro. Proteomics analysis revealed that tegaserod maleate suppressed the peroxisome signaling pathway, in which the key molecules peroxisome membrane protein 11B (PEX11B) and peroxisome membrane protein 13 (PEX13) were downregulated. The immunofluorescence, catalase activity assay, and reactive oxygen species (ROS) confirmed that downregulation of these proteins was related to impaired peroxisome function. Furthermore, we found that PEX11B and PEX13 were highly expressed in ESCC, and knockout of PEX11B and PEX13 further demonstrated the antitumor effect of tegaserod maleate. Importantly, tegaserod maleate repressed ESCC tumor growth in a patient-derived xenograft (PDX) model in vivo. Our findings conclusively demonstrated that tegaserod maleate inhibits the proliferation of ESCC by suppressing the peroxisome pathway.

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Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

Cited by 52 publications

References 29 publications

Association of Systemic Inflammation and Malnutrition With Survival in Nasopharyngeal Carcinoma Undergoing Chemoradiotherapy: Results From a Multicenter Cohort Study

Association of Systemic Inflammation and Malnutrition With Survival in Nasopharyngeal Carcinoma Undergoing Chemoradiotherapy: Results From a Multicenter Cohort Study

Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

Tegaserod Maleate Inhibits Esophageal Squamous Cell Carcinoma Proliferation by Suppressing the Peroxisome Pathway

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