Nutritional Status Affects Treatment Tolerability and Survival in Metastatic Colorectal Cancer Patients: Results of an AGEO Prospective Multicenter Study

Abstract

Background: The possible impact of malnutrition on the tolerability and efficacy of modern chemotherapy regimens for metastatic colorectal cancer (mCRC) is unclear. Methods: In this prospective, cross-sectional, multicenter study, we collected demographic, oncological and nutritional data for all consecutive mCRC patients during a 14-day period in eight hospitals. Nutritional status was assessed with the nutritional risk index (NRI), and patients were classified as severely malnourished when NRI was <83.5; drug-induced toxicities were evaluated using the National Cancer Institute Common Toxicity Criteria (version 3.0). Survival times were calculated from the date of the nutritional assessment. Results: We enrolled 114 mCRC patients (median age: 65 years, range: 22–92; WHO performance status 0/1/2/3: 21/54/21/4%) of whom 88% had at least 2 metastatic sites and 49% were receiving chemotherapy as first-line treatment. Malnutrition was diagnosed in 65% of the patients and was severe in 19%. Severe malnutrition was associated with more adverse effects following chemotherapy (p = 0.01) and with shorter median overall survival (14.0 vs. 36.2 months in non-/moderately malnourished patients, p = 0.02). Conclusions: In mCRC patients, severe malnutrition is associated with greater chemotherapy toxicity and reduced overall survival.

Distant Metastasis in Colorectal Cancer is a Risk Factor for Anastomotic Leakage

“…Second up to 65% of the patients with grade IV colorectal cancer have malnutrition 12 , and patients with malnutrition also have an altered immune response with an exaggerated Interleukin-6 and a suppressed Interleukin-1 response 13,14 . A low level of Interleukin-1-receptor-antagonist is a known risk factor for adverse outcome after colorectal surgery 15 .…”

Ten-year all-cause mortality in hospitalized non-surgical patients based on nutritional status screening

“…Nutritional status also influences treatment tolerability in oncology patients (28) . Our study was underpowered to show any differences in short-term (in-hospital) mortality, as only six patients died, but we did find an association of malnutrition with long-term mortality at up to 10 years of follow-up.…”

Актуальні Питання Розрахунку Вихідного Нутритивного Статусу Пацієнтів При Розширених Оперативних Втручаннях В Абдомінальній Хірургії

“…У сучасній клінічній практиці це не є мож-ливим через відсутність простих і однозначних діа-гностичних критеріїв. Уніфікування термінології для Міжнародної класифікації хвороб (МКХ) спри-ятиме формулюванню єдиного правильного діагно-зу, тим самим полегшить заповнення документації у щоденній практиці [26].…”

“…Те ж саме сто-сується і думки про інсуліноподібний фактор рос-ту. Тобто дослідження окремих факторів запалення може розглядатися як один з непрямих критеріїв метаболізму [26].…”