Does nutritional status affect treatment tolerability, chemotherapy response and survival in metastatic gastric cancer patients? Results of a prospective multicenter study in Turkey

Abstract

Background The possible impact of malnutrition on the efficacy and tolerability of modern chemotherapy for metastatic gastic adenocarcinoma (mGC) patients is unclear. With this study, we aimed to represent the possible impact of malnutrition on the efficacy and tolerability of chemotherapy, and also on the overall survival of mGC patients. Methods In this prospective multicenter study, we collected demographic, oncological and nutritional data of our mGC patients. The nutritional status of patients were assessed with the Nutritional Risk Index (NRI), Body Mass Index (BMI) and weight loss percentage within 21-day period, between the chemotherapy cycles. All of these parameters along with toxicity assessment were evaluated after each courses of chemotherapy in order to determine inter-treatment weight loss. NRIs were calculated with a formula as follows; [1.519 × serum albumin level(g/L) + 41.7 × current weight/basic weight]. Patients were classified as having ‘no malnutrition’ (NRI > 97.5), ‘moderate malnutrition’ (97.5 ≥ NRI ≥ 83.5) or ‘severe malnutrition’ (NRI < 83.5). Drug-induced toxicities and treatment responses were evaluated via National Cancer Institute CTCAE version 4.0 and RECIST Criteria 1.1, respectively. Results One hundred and sixteen mGC patients were enrolled into the study. Median age was 60 years with range 32–83. Primary location of the tumor was antrum in 40% of the patients and of which 24% had undergone primary tumor resection. Ninety-eight percent of the patients had WHO performance status 0 or 1. Malnutrition was diagnosed in 67% of the patients and was severe in 31% of them. All patients received chemotherapy as first-line setting. Severe malnutrition was not associated with chemotherapy responses (p = 0.57). Moderate/severe malnutrition was associated with more cytopenia, nausea/vomiting, diarrhea, neuropathy, (p < 0.05 for all parameters). Moderate/severe malnutrition is associated with worser non-hematological toxicities (p = 0.038). Forty-one percent of patients died during the follow up period (Median: 138 days, range: 21–378). Malnutritional level was associated with significantly reduced overall survival. Severe malnutrition was associated with shorter median overall survival (74 days (95% CI, 20.7–111.0) vs. 237 (95% CI, 148.4-325.6) in none/moderate groups, p = 0.007). Conclusions In mGC patients, moderate/severe malnutrition is associated with worse non-hematological toxicities. Severe malnutrition is also associated with reduced overall survival.

Nutritional risk index predicts the prognosis of gastric cancer patients with pyloric stenosis who received preoperative parenteral nutrition

“…Their results indicated that the NRI was related to a shorter survival time. Other studies on gastric cancer had also reached similar conclusions (21)(22)(23)(24)(25).…”

Chemotoxicity and Associated Risk Factors in Colorectal Cancer: A Systematic Review and Meta-Analysis

“…The study characteristics reveal that among the 30 studies examined (Table 1AB), the majority of studies had observational cohort study designs (n = 24 for prospective study design [7,[31][32][33][34][36][37][38][39][40][41][42][44][45][46][47][48][51][52][53][54][57][58][59], n = 5 for retrospective study design [35,43,49,55,56], while one study used a randomized control trial (RCT) [50].) Among 24 prospective studies, six studies [31,42,47,51,54,57] used longitudinal follow-up assessing chemotoxicity from baseline to after chemotherapy with multiple time points (at every cycle over 8 cycles [47,54]; at every 3 months over one year [51]; at every cycle over 12 cycles [31]; at weekly over a month [42]; at monthly over 3 months [57]) over the course of chemotherapy.…”

“…The sample sizes ranged from 2,691 [40] to 52 [33], and the sample sizes were between > 100 and < 500 in the majority of studies (n = 16). Among 30 studies, 24 studies [7,31,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]53,55,57] identified significant risk factors of chemotoxicity; 10 studies [31,33,37,39,40,43,46,[48][49][50] examined the differences of chemotoxicity by categorical groups (i.e., high, versus low values) of risk factors; 11 studies reported odds ratios [ORs] [34][35][36]38,41,44,45,47,51,53,55,57]; and 2 st...…”

“…Regarding risk factors of chemotoxicity (Table 2), four main categories were identified: nutritional status, geriatric assessment, biomarkers, and demographic/clinical factors. Fourteen studies [7,31,34,37,38,41,43,[45][46][47]49,51,55,57] focused on malnutrition. The most common risk factor was low albumin levels [34,41,46,47,49,51,55]), followed by weight loss [7,34,41,46,47], low BMI [37,38,46], and low hemoglobin levels [47,57] before chemotherapy.…”

Small and Large Intestine (II): Inflammatory Bowel Disease, Short Bowel Syndrome, and Malignant Tumors of the Digestive Tract

“…In patients with digestive cancer, several studies show that moderate-to-severe malnutrition increases the toxicity of chemotherapy as well as decreased overall survival [123][124][125][126].…”