Sorbonne Paris Cite, Paris Descartes University, Siric CARPEM, Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, Paris, France.
Department of Gastroenterology and Digestive Oncology, Hôpital Privé Jean Mermoz, Lyon, France.
Eur J Cancer. 2019 Sep;119:35-43. doi: 10.1016/j.ejca.2019.07.011. Epub 2019 Aug 12.
The Patient-Generated Subjective Global Assessment (PG-SGA) is currently the standard nutritional assessment tool for patients with cancer. In a retrospective assessment of a prospective cohort, we showed that the Nutritional Risk Index (NRI) seemed to be associated with treatment toxicity and survival in patients with metastatic colorectal cancer (mCRC).
The objective of this study was to compare these two nutritional tools (PG-SGA and NRI) on their correlation with chemotherapy-related toxicity and survival in non-pre-treated patients with mCRC.
This prospective multicentre observational study enrolled non-pre-treated patients with mCRC. PG-SGA and NRI were performed at the onset of first-line chemotherapy. Treatment-related toxicities were registered according to National Cancer Institute Common Toxicity Criteria Adverse Event version 4.0. Progression-free survival (PFS) and overall survival (OS) were calculated from the start of treatment.
A total of 168 patients were included from eight French centres. Patients were considered malnourished in 41% of cases according to PG-SGA and 56% of cases according to the NRI. In multivariate analysis, malnutrition according to PG-SGA was significantly associated with chemotherapy-related grade ≥2 clinical toxicities (odds ratio: 3.7; 95% confidence interval [CI]: 1.7-8.4; p = 0.001) and OS (hazard ratio [HR]: 2.6; 95% CI: 1.3-5.3; p = 0.006), but not with PFS (HR: 1.5; 95% CI: 0.8-2.6; p = 0.2). Conversely, malnutrition according to the NRI was not significantly associated with these tolerance and efficacy parameters.
Although more complex to perform in daily oncology practice, the PG-SGA score appears to be the best nutritional assessment tool because of its strong association with clinically relevant oncological outcomes such as OS and treatment-related toxicities in patients with mCRC.
目前，患者主观整体评估（PG-SGA）是癌症患者的标准营养评估工具。在对前瞻性队列的回顾性评估中，我们发现营养风险指数（NRI）似乎与转移性结直肠癌（mCRC）患者的治疗毒性和生存相关。
本研究旨在比较这两种营养工具（PG-SGA 和 NRI）在非初治 mCRC 患者中与化疗相关毒性和生存的相关性。
本前瞻性多中心观察性研究纳入了非初治 mCRC 患者。在一线化疗开始时进行 PG-SGA 和 NRI 评估。根据国家癌症研究所不良事件通用毒性标准 4.0 版登记治疗相关毒性。从治疗开始计算无进展生存期（PFS）和总生存期（OS）。
本研究共纳入了来自法国 8 个中心的 168 名患者。根据 PG-SGA，41%的患者被认为存在营养不良，根据 NRI，56%的患者被认为存在营养不良。多变量分析显示，PG-SGA 评估的营养不良与化疗相关的≥2 级临床毒性显著相关（优势比：3.7；95%置信区间[CI]：1.7-8.4；p=0.001）和 OS（风险比[HR]：2.6；95% CI：1.3-5.3；p=0.006），但与 PFS 无关（HR：1.5；95% CI：0.8-2.6；p=0.2）。相反，根据 NRI 评估的营养不良与这些耐受性和疗效参数没有显著相关性。
尽管在日常肿瘤学实践中更为复杂，但 PG-SGA 评分似乎是最好的营养评估工具，因为它与 OS 和治疗相关毒性等与临床相关的肿瘤学结果有很强的关联，在 mCRC 患者中。
