Akita Hirofumi, Takahashi Hidenori, Asukai Kei, Tomokuni Akira, Wada Hiroshi, Marukawa Satoko, Yamasaki Tomoyuki, Yanagimoto Yoshitomo, Takahashi Yusuke, Sugimura Keijiro, Yamamoto Kazuyoshi, Nishimura Junichi, Yasui Masayoshi, Omori Takeshi, Miyata Hiroshi, Ochi Ayami, Kagawa Ayano, Soh Yuko, Taniguchi Yuko, Ohue Masayuki, Yano Masahiko, Sakon Masato
Department of Surgery, Osaka International Cancer Institute, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan.
Department of Surgery, Osaka International Cancer Institute, Japan.
Clin Nutr ESPEN. 2019 Oct;33:148-153. doi: 10.1016/j.clnesp.2019.06.003. Epub 2019 Jun 21.
BACKGROUND & AIMS: Neoadjuvant chemoradiotherapy (NACRT) for pancreatic cancer (PC) is potentially associated with various toxicities, which can lead to impaired nutritional status. Eicosapentaenoic acid (EPA) can reduce proinflammatory cytokines and positively influence cancer cachexia syndrome. The aim of this study is to clarify the utility of EPA enriched nutrition support during NACRT for PC.
We randomly assigned 62 patients with PC that received NACRT to either a nutrition intervention (NI) or a normal diet (ND). Patients in the NI group received 2 bottles/day (550 kcal/day) of an EPA-enriched nutrition supplement during NACRT. The primary endpoints were the before-to-after NACRT ratios (post/pre ratios) of skeletal muscle mass and psoas major muscle area (PMA). The secondary endpoints were the post/pre ratios of other nutritional parameters and treatment-related toxicities.
Only 14 patients (45.2%) in the NI group consumed more than 50% of the EPA-enriched supplement provided. The post/pre ratio of skeletal muscle mass in the NI group (0.99 ± 0.060) was not significantly different from that of the ND group (0.96 ± 0.079, p = 0.102). However, patients that consumed ≥50% of the EPA-enriched supplement (the good intake group) had significantly higher skeletal muscle mass ratios than patients in the ND group (p = 0.042). The PMA ratio was significantly higher in the NI group (0.96 ± 0.081) than in the ND group (0.89 ± 0.072, p = 0.001). The NI and ND groups were not significantly different in other nutritional parameters or in NACRT-related toxicity.
We found that EPA-enriched intake could potentially improve the nutritional status of patients with PC that received NACRT, but it was difficult for many patients to drink, due to its disagreeable taste. University Hospital Medical Information Network (http://www.umin.ac.jp), registration number UMIN000033589, https://upload.umin.ac.jp/cgi-bin/ctr_e/ctr_view.cgi?recptno=R000038300.
胰腺癌（PC）的新辅助放化疗（NACRT）可能会引发多种毒性反应，进而导致营养状况受损。二十碳五烯酸（EPA）能够降低促炎细胞因子水平，并对癌症恶病质综合征产生积极影响。本研究旨在阐明在PC患者接受NACRT期间，富含EPA的营养支持的效用。
我们将62例接受NACRT的PC患者随机分为营养干预（NI）组或正常饮食（ND）组。NI组患者在NACRT期间每天服用2瓶（550千卡/天）富含EPA的营养补充剂。主要终点为NACRT前后骨骼肌质量和腰大肌面积（PMA）的比值（治疗后/治疗前比值）。次要终点为其他营养参数的治疗后/治疗前比值以及与治疗相关的毒性反应。
NI组中只有14例患者（45.2%）摄入了超过所提供的富含EPA补充剂的50%。NI组骨骼肌质量的治疗后/治疗前比值（0.99±0.060）与ND组（0.96±0.079，p=0.102）无显著差异。然而，摄入≥50%富含EPA补充剂的患者（良好摄入组）的骨骼肌质量比值显著高于ND组患者（p=0.042）。NI组的PMA比值（0.96±0.081）显著高于ND组（0.89±0.072，p=0.001）。NI组和ND组在其他营养参数或与NACRT相关的毒性方面无显著差异。
我们发现富含EPA的摄入可能会改善接受NACRT的PC患者的营养状况，但由于其味道不佳，许多患者难以饮用。大学医院医学信息网络（http://www.umin.ac.jp），注册号UMIN000033589，https://upload.umin.ac.jp/cgi-bin/ctr_e/ctr_view.cgi?recptno=R000038300。
