Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy.
Clinical Nutrition, Department of Internal Medicine, Molinette Hospital, Turin, Italy.
Cancer Med. 2020 Jul;9(13):4686-4698. doi: 10.1002/cam4.3064. Epub 2020 May 15.
Robust data reporting the survival of cancer patients on home parenteral nutrition (HPN) are lacking. The aim of this prospective, cohort study was to investigate clinical characteristics, predictive factors, and overall survival (OS) of adult-malnourished cancer patients eligible for HPN according to the European guideline recommendations.
During the study period, 1658 cancer patients were consecutively evaluated in a tertiary university hospital. Of these, 761 who received HPN were grouped into four cohorts according to the provision of supplemental PN (SPN) or total (TPN) and whether they received chemotherapy (CT or CT ): SPN/CT (n = 376), TPN/CT (n = 99), SPN/CT (n = 191), and TPN/CT (n = 95). Patient demographics, nutritional status, cancer-related characteristics, and prognostic scores assessed at HPN start. The primary outcome was OS.
Median OS was 8.9, 4.3, 5.7, and 2.2 months for the SPN/CT , TPN/CT , SPN/CT , and TPN/CT cohorts, respectively. In multivariable analysis, predictors showing significant association with decreased survival were patient cohorts, modified Glasgow Prognostic Score (1 and 2 scores), weight loss (>15%) in the 3 months before HPN start, and TNM IV stage while protective factors of survival were Karnofsky Performance Status (>50), albumin level (>3.5 g/dL), oral protein intake, BMI (>20.5), and weight at HPN start.
For the first time, in four different cohorts of cancer patients on HPN, clinical characteristics and survival were compared. This large study showed that survival is significantly correlated with patient characteristics at HPN start and that the presence of favorable factors may determine even a fourfold increase in survival. These data are expected to assist physicians in the appropriate prescription of HPN.
缺乏关于癌症患者家庭肠外营养（HPN）生存情况的可靠数据报告。本前瞻性队列研究的目的是根据欧洲指南建议，调查符合 HPN 条件的成人营养不良癌症患者的临床特征、预测因素和总体生存率（OS）。
在研究期间，对一家三级大学医院的 1658 名癌症患者进行了连续评估。其中，761 名接受 HPN 的患者根据补充肠外营养（SPN）或全肠外营养（TPN）的提供情况以及是否接受化疗（CT 或 CT）分为四组：SPN/CT（n=376）、TPN/CT（n=99）、SPN/CT（n=191）和 TPN/CT（n=95）。在开始 HPN 时评估患者的人口统计学、营养状况、癌症相关特征和预后评分。主要结局是 OS。
SPN/CT、TPN/CT、SPN/CT 和 TPN/CT 组的中位 OS 分别为 8.9、4.3、5.7 和 2.2 个月。多变量分析显示，与生存时间缩短相关的预测因素包括患者组、改良格拉斯哥预后评分（1 分和 2 分）、HPN 开始前 3 个月体重减轻（>15%）和 TNM IV 期，而生存的保护因素包括 Karnofsky 表现状态（>50）、白蛋白水平（>3.5g/dL）、口服蛋白质摄入、BMI（>20.5）和 HPN 开始时的体重。
这是首次在接受 HPN 的四组不同癌症患者中比较了临床特征和生存情况。这项大型研究表明，生存与 HPN 开始时患者的特征显著相关，并且存在有利因素可能使生存时间延长四倍。这些数据有望帮助医生适当开具 HPN 处方。
