Stauder Reinhard, Augschoell Julia, Hamaker Marije E, Koinig Karin A
Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria.
Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands.
Hemasphere. 2020 Jan 15;4(1):e332. doi: 10.1097/HS9.0000000000000332. eCollection 2020 Feb.
Poor nutritional status is a common problem in cancer patients at advanced age, but the prevalence and impact of malnutrition in hematological malignancies remains underinvestigated. To evaluate nutritional status in older adults over age 70 with newly diagnosed hematological malignancies, we enrolled 147 patients and assessed weight loss, food intake, Mini Nutritional Assessment (MNA), and BMI. We compared nutritional status with demographic data, inflammation markers, and restrictions in multidimensional geriatric assessment. MNA classified 43% of patients being at risk of, and 15% having manifest malnutrition. A moderate/severe decrease in food intake was reported by 24% or 16%, a recent weight loss of 1 to 3 kg or >3 kg by 19% or 31%, and a BMI <23 kg/m by 29%. Lowered serum albumin (<3.5 g/dL) was prevalent in 14% of patients, and in 38% Glasgow Prognostic Score indicated hyperinflammation. Principal component analysis clustered malnutrition with inflammation markers and pronounced impairments, that is, fatigue, depression, comorbidities, reduced functional capacities. Severe decrease in food intake (HR: 3.3 (1.9-5.8), p < 0.001), >3 kg weight loss (HR: 2.3 (1.4-3.9), p = 0.001), impaired MNA (HR: 2.8 (1.3-6.2), p = 0.010), and low serum albumin (HR: 2.1 (1.1-4.0), p = 0.030) were significantly associated with shortened overall survival. Recent weight loss >3 kg (HR: 2.2 (1.1-4.3), p = 0.022), and low BMI (HR: 3.3 (1.8-6.0), p < 0.001) remained independent adverse parameters in multivariate Cox proportional hazard regression analyses. Malnourishment at initial diagnosis is frequent in older patients with hematological malignancies and represents an adverse prognosticator. Clustering of malnutrition with impairments and systemic inflammation suggests an underlying common pathway.
营养状况不佳是老年癌症患者的常见问题，但血液系统恶性肿瘤中营养不良的患病率和影响仍未得到充分研究。为了评估70岁以上新诊断血液系统恶性肿瘤的老年人的营养状况，我们招募了147名患者，并评估了体重减轻、食物摄入量、微型营养评定法（MNA）和体重指数（BMI）。我们将营养状况与人口统计学数据、炎症标志物以及多维老年评估中的限制因素进行了比较。MNA将43%的患者归类为有营养不良风险，15%的患者存在明显营养不良。据报告，24%或16%的患者食物摄入量有中度/重度下降，19%或31%的患者近期体重减轻1至3千克或超过3千克，29%的患者BMI<23千克/米²。14%的患者血清白蛋白降低（<3.5克/分升），38%的患者格拉斯哥预后评分显示有高炎症反应。主成分分析将营养不良与炎症标志物以及明显的功能损害，即疲劳、抑郁、合并症、功能能力下降归为一类。食物摄入量严重下降（风险比：3.3（1.9 - 5.8），p<0.001）、体重减轻超过3千克（风险比：2.3（1.4 - 3.9），p = （此处原文有误，应为0.001））、MNA受损（风险比：2.8（1.3 - 6.2），p = 0.010）以及血清白蛋白水平低（风险比：2.1（1.1 - 4.0），p = 0.030）与总生存期缩短显著相关。近期体重减轻超过3千克（风险比：2.2（1.1 - 4.3），p = 0.022）以及低BMI（风险比：3.3（1.8 - 6.0），p<0.001）在多变量Cox比例风险回归分析中仍然是独立的不良参数。血液系统恶性肿瘤老年患者初诊时营养不良很常见，是一个不良预后因素。营养不良与功能损害和全身炎症反应归为一类表明存在潜在的共同途径。
