Aría Guerra Eva, Cortés-Salgado Alfonso, Mateo-Lobo Raquel, Nattero Lía, Riveiro Javier, Vega-Piñero Belén, Valbuena Beatriz, Carabaña Fátima, Carrero Carmen, Grande Enrique, Carrato Alfredo, Botella-Carretero José Ignacio
Department of Oncology..
Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal para la Investigación Sanitaria (IRyCIS)..
Nutr Hosp. 2015 Sep 1;32(3):1222-7. doi: 10.3305/nh.2015.32.3.9184.
the precise role of parenteral nutrition in the management of oncologic patients with intestinal occlusion is not well defined yet. We aimed to identify the effects of parenteral nutrition in these patients regarding prognosis.
55 patients with intestinal occlusion and peritoneal carcinomatosis were included. Parenteral nutrition aimed at 20-35 kcal/Kg/day, and 1.0 g/kg/day of amino-acids. Weight, body mass index, type of tumor, type of chemotherapy, and ECOG among others were recorded and analyzed.
69.1% of the patients had gastrointestinal tumors, 18.2% gynecologic and 12.7% others. Age was 60 ± 13y, baseline ECOG 1.5 ± 0.5 and body mass index 21.6 ± 4.3. Malnutrition was present in 85%. Survival from the start of parenteral nutrition was not significant when considering baseline ECOG (log rank = 0.593, p = 0.743), previous lines of chemotherapy (log rank = 2.117, p = 0.548), baseline BMI (log rank = 2.686, p = 0.261), or type of tumor (log rank = 2.066, p = 0.356). Survival in patients who received home parenteral nutrition after hospital discharge was higher than those who stayed in-hospital (log rank = 7.090, p = 0.008). Survival in patients who started chemotherapy during or after parenteral nutrition was higher than those who did not so (log rank = 17.316, p < 0.001). A total of 3.6% of patients presented catheter related infection without affecting survival (log rank = 0.061, p = 0.804).
Parenteral nutrition in patients with advanced cancer and intestinal occlusion is safe, and in tho se who respond to chemotherapy, further administration of home parenteral nutrition together with chemotherapy may enhance prolonged survival.
肠外营养在肠梗阻肿瘤患者管理中的精确作用尚未明确界定。我们旨在确定肠外营养对这些患者预后的影响。
纳入55例肠梗阻合并腹膜癌患者。肠外营养目标为20 - 35千卡/千克/天，以及1.0克/千克/天的氨基酸。记录并分析体重、体重指数、肿瘤类型、化疗类型、东部肿瘤协作组（ECOG）评分等。
69.1%的患者患有胃肠道肿瘤，18.2%为妇科肿瘤，12.7%为其他肿瘤。年龄为60±13岁，基线ECOG评分为1.5±0.5，体重指数为21.6±4.3。85%的患者存在营养不良。考虑基线ECOG评分（对数秩检验=0.593，p = 0.743）、既往化疗疗程（对数秩检验=2.117，p = 0.548）、基线体重指数（对数秩检验=2.686，p = 0.261）或肿瘤类型（对数秩检验=2.066，p = 0.356）时，肠外营养开始后的生存率无显著差异。出院后接受家庭肠外营养的患者生存率高于住院患者（对数秩检验=7.090 , p = 0.008）。在肠外营养期间或之后开始化疗的患者生存率高于未进行化疗的患者（对数秩检验=17.316 , p < 0.001）。共有3.6%的患者出现导管相关感染，但未影响生存率（对数秩检验=0.061 , p = 0.804）。
晚期癌症合并肠梗阻患者的肠外营养是安全的，对于那些对化疗有反应的患者，进一步给予家庭肠外营养联合化疗可能会延长生存期。
