Pribnow Allison K, Ortiz Roberta, Báez Luis Fulgencio, Mendieta Luvy, Luna-Fineman Sandra
Pediatric Hematology/Oncology Fellowship Program, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Hematology/Oncology, Children's Hospital Manuel de Jesus Rivera, Managua, Nicaragua.
Pediatr Blood Cancer. 2017 Nov;64(11). doi: 10.1002/pbc.26590. Epub 2017 Apr 27.
Most children with cancer live in resource-limited countries where malnutrition is often prevalent. We identified the relationship between malnutrition and treatment-related morbidity (TRM), abandonment of therapy, and survival of children with cancer in Nicaragua to better inform targeted nutritional interventions.
We conducted a retrospective review of patients aged 6 months to 18 years with newly diagnosed acute lymphoblastic leukemia, acute myeloid leukemia (AML), Wilms tumor, Hodgkin lymphoma, or Burkitt lymphoma (BL) who were treated between January 1, 2004, and December 31, 2007 at Children's Hospital Manuel de Jesus Rivera in Managua, Nicaragua. Statistical analysis examined the relations among nutritional status and cancer type, risk category, TRM, and event-free survival (EFS).
Sixty-seven percent of patients (189/282) were malnourished at diagnosis. Malnutrition was highest among patients with Wilms tumor (85.7%), BL (75%), and AML (74.3%). A total of 92.2% of patients (225/244) experienced morbidity during the first 90 days. Malnutrition was associated with severe infection (P = 0.033). Severely malnourished patients had ≥grade 3 TRM on more days (P = 0.023) and were more likely to experience severe TRM on >50% of days (P = 0.032; OR, 3.27 [95% CI, 1.05-10.16]). Malnourished patients had inferior median EFS (2.25 vs. 5.58 years; P = 0.049), and abandoned therapy more frequently (P = 0.015).
In Nicaragua, pediatric oncology patients with malnutrition at diagnosis experienced increased TRM, abandoned therapy more frequently, and had inferior EFS. Standardized nutritional evaluation of patients with newly diagnosed cancer and targeted provision of nutritional support are essential to decrease TRM and improve outcomes.
大多数癌症患儿生活在资源有限的国家，这些国家营养不良现象往往普遍存在。我们确定了尼加拉瓜癌症患儿营养不良与治疗相关发病率（TRM）、治疗中断及生存之间的关系，以便为有针对性的营养干预提供更充分的信息。
我们对2004年1月1日至2007年12月31日期间在尼加拉瓜马那瓜的曼努埃尔·德·赫苏斯·里维拉儿童医院接受治疗的6个月至18岁新诊断为急性淋巴细胞白血病、急性髓细胞白血病（AML）、肾母细胞瘤、霍奇金淋巴瘤或伯基特淋巴瘤（BL）的患者进行了回顾性研究。统计分析检验了营养状况与癌症类型、风险类别、TRM及无事件生存期（EFS）之间的关系。
67%的患者（189/282）在诊断时存在营养不良。肾母细胞瘤患者（85.7%）、BL患者（75%）和AML患者（74.3%）的营养不良情况最为严重。共有92.2%的患者（225/244）在最初90天内出现发病情况。营养不良与严重感染相关（P = 0.033）。严重营养不良的患者出现≥3级TRM的天数更多（P = 0.023），且在超过50%的天数里更有可能出现严重TRM（P = 0.032；比值比，3.27 [95%置信区间，1.05 - 10.16]）。营养不良的患者中位EFS较差（2.25年对5.58年；P = 0.049），且治疗中断更为频繁（P = 0.015）。
在尼加拉瓜，诊断时营养不良的儿科肿瘤患者TRM增加，治疗中断更为频繁，EFS较差。对新诊断癌症患者进行标准化营养评估并针对性地提供营养支持对于降低TRM和改善治疗结果至关重要。
