Ozorio Gislaine Aparecida, Barão Katia, Forones Nora Manoukian
a Departamento de Medicina , Universidade Federal de São Paulo , Sao Paulo , Brazil.
b Escola Paulista de Medicina , Universidade Federal de São Paulo , Sao Paulo , Brazil.
Nutr Cancer. 2017 Jul;69(5):772-779. doi: 10.1080/01635581.2017.1321130. Epub 2017 May 19.
The aim of this study was to correlate patients with gastrointestinal cancer, classified according to different stages of cancer cachexia (SCC) as proposed by Fearon, with nutritional assessment tools such as PG-SGA, phase angle (PA), and handgrip strength. One hundred one patients with a mean age of 61.8 ± 12.8 yr, with 58.4% being men were included. 32.6% were malnourished according to the body mass index (BMI). A severe or moderate malnutrition had been diagnosed in 63.3% when assessed using the PG-SGA, 60.4% had decreased handgrip strength, and 57.4% had lower grades of PA. Among the patients in the study, 26% did not have cachexia, 11% had precachexia, 56% cachexia, and 8% refractory cachexia. The PG-SGA, PA, and handgrip strength were associated with cachexia (P ≤ 0.001). An increased risk of death was found in patients with cachexia [RR: 9.1; confidence interval (CI) 95%: 0.1-90.2, P = 0.039], refractory cachexia (RR: 69.4, CI 95%: 4.5-1073.8, P = 0.002), and increased serum C-reactive protein (CRP) levels (P < 0.001). In conclusion, most of the patients with digestive system cancer had cachexia or refractory cachexia in the first nutritional assessment. Nutritional risk, as determined by PG-SGA, was correlated with PA and handgrip strength. High CRP levels, cachexia, and refractory cachexia were prognostic factors for cancer patients.
本研究旨在将根据Fearon提出的癌症恶病质不同阶段(SCC)分类的胃肠道癌患者与诸如患者主观全面评定法(PG-SGA)、相位角(PA)和握力等营养评估工具相关联。纳入了101例平均年龄为61.8±12.8岁的患者,其中58.4%为男性。根据体重指数(BMI),32.6%的患者存在营养不良。使用PG-SGA进行评估时,63.3%的患者被诊断为重度或中度营养不良,60.4%的患者握力下降,57.4%的患者PA等级较低。在研究患者中,26%没有恶病质,11%有恶病质前期,56%有恶病质,8%有难治性恶病质。PG-SGA、PA和握力与恶病质相关(P≤0.001)。在恶病质患者[相对危险度(RR):9.1;95%置信区间(CI):0.1 - 90.2,P = 0.039]、难治性恶病质患者(RR:69.4,95%CI:4.5 - 1073.8,P = 0.002)以及血清C反应蛋白(CRP)水平升高的患者中发现死亡风险增加(P < 0.001)。总之,大多数消化系统癌症患者在首次营养评估时就存在恶病质或难治性恶病质。由PG-SGA确定的营养风险与PA和握力相关。高CRP水平、恶病质和难治性恶病质是癌症患者的预后因素。