Department of Woman and Child Health, Fondazione Policlinico Agostino Gemelli, Rome, Italy.
Clinical Nutrition Unit, Gastroenterology Area, Fondazione Policlinico Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy.
Gynecol Oncol. 2018 May;149(2):263-269. doi: 10.1016/j.ygyno.2018.03.044. Epub 2018 Mar 14.
To investigate whether patients' altered body composition (measured with bioimpedentiometry), due to a poor nutritional status, predicts the incidence of no residual disease at primary debulking and the risk of complications in patients with newly-diagnosed advanced epithelial ovarian cancer (EOC).
Data regarding patients with newly-diagnosed stage IIIC-IV EOC undergoing elective nutritional assessment between December 2016 and March 2017, were prospectively collected. Bioelectrical impedance analysis (BIA) with measurement of BIA-derived phase angle [PhA] at 50KHz, was accomplished. Only patients with disease which was considered resectable at staging laparoscopy were submitted to open primary cytoreduction. The rate of residual tumor (RT)=0 and the incidence of complications were assessed.
Seventy patients were included. Fifty-two of them were submitted to primary cytoreduction (74.3%) and 48 (68.6% of the entire cohort, 92.3% of those who underwent primary debulking) had RT=0 at the end of surgery. Median values of PhA were significantly lower in patients with RT>vs. =0 (4.7, range: 3.6-5.8 vs. 5.3, range: 4.2-6.8; p=0.001). Twenty-four (out of the 52 operated) patients (46.2%) developed at least one complication. PhA was significantly lower in patients with vs. without complications (5, range: 3.6-6.4, vs. 5.4, range 4.5-6.8; p=0.03). After multivariable analysis, Fagotti score and PhA were the only independent predictors of residual disease (OR:13.56; 95%CI:1.33-137.6; p=0.027 and 9.24; 1.16-73.43; p=0.036, respectively) and of any complication (OR:4.9;95%CI:1.17-20.6; p=0.03 and 7.27; 1.45-36.4; p=0.01, respectively).
Derangement of body composition (likely due to disease-related malnutrition) expressed as a low phase angle, is an independent predictor of residual disease and peri-operative complications at the time of upfront cytoreduction for advanced EOC.
探讨因营养不良导致的患者身体成分改变（通过生物电阻抗分析测量）是否可预测初次肿瘤细胞减灭术时无残留疾病的发生率和新诊断晚期上皮性卵巢癌（EOC）患者发生并发症的风险。
前瞻性收集 2016 年 12 月至 2017 年 3 月期间接受选择性营养评估的新诊断为 IIIC-IV 期 EOC 的患者数据。进行生物电阻抗分析（BIA），测量 50KHz 时的 BIA 衍生相位角[PhA]。仅对在腹腔镜分期检查时认为可切除的疾病进行开腹初次细胞减灭术。评估残余肿瘤（RT）=0 的发生率和并发症的发生情况。
共纳入 70 例患者。其中 52 例患者接受了初次肿瘤细胞减灭术（74.3%），48 例患者（整个队列的 68.6%，初次肿瘤细胞减灭术患者的 92.3%）在手术结束时 RT=0。RT＞0 与 RT=0 的患者的 PhA 中位数显著较低（4.7，范围：3.6-5.8 与 5.3，范围：4.2-6.8；p=0.001）。24 例（52 例手术患者中的 24 例）（46.2%）至少发生了 1 种并发症。有并发症的患者的 PhA 显著低于无并发症的患者（5，范围：3.6-6.4 与 5.4，范围：4.5-6.8；p=0.03）。多变量分析后，Fagotti 评分和 PhA 是唯一可预测残余疾病（比值比：13.56；95%置信区间：1.33-137.6；p=0.027 和 9.24；1.16-73.43；p=0.036）和任何并发症（比值比：4.9；95%置信区间：1.17-20.6；p=0.03 和 7.27；1.45-36.4；p=0.01）的独立预测因素。
以低相位角表示的身体成分紊乱（可能由于疾病相关的营养不良所致）是新诊断晚期上皮性卵巢癌初次肿瘤细胞减灭术时残余疾病和围手术期并发症的独立预测因素。
