Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands.
Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands; Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
J Geriatr Oncol. 2022 Nov;13(8):1092-1102. doi: 10.1016/j.jgo.2022.06.010. Epub 2022 Jul 6.
Multiple screening methods for malnutrition are available, but a systematic review of evidence in patients with colorectal cancer (CRC) is lacking. The aim of this study is to systematically investigate which outcome variables of nutritional screening methods are associated with treatment tolerance in patients with CRC.
A systematic review was performed with respect to outcome variables of nutritional screening methods and their association with systemic treatment tolerance in patients with CRC. The Cochrane guidelines for systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Two authors independently assessed the risk of bias and quality of each included study.
A total of sixteen studies were included. The following screening methods for malnutrition were assessed in the included studies: serum albumin, body mass index, C-reactive protein/albumin ratio, modified version of the Glasgow prognostic score, mini nutritional assessment, nutritional risk index, patient-generated subjective global assessment, sarcopenia and weight loss.
Sarcopenia tended to be associated with treatment tolerance more often than other screening methods but the current review suggests that there are ample screening methods rendering meaningful outcomes regarding a patient's nutritional status and associated risk for treatment intolerance. This grants practitioners the flexibility to choose from a variety of different nutritional screening methods. Nutritional screening can thus be tailored to the individual patient. Importantly, nutritional screening may help identify those patients at risk for chemotoxicity thus allowing for the implementation of targeted prehabilitation programs in order to prevent (severe) chemotoxicity.
有多种营养不良筛查方法，但缺乏针对结直肠癌（CRC）患者的证据系统评价。本研究旨在系统调查营养筛查方法的哪些结局变量与 CRC 患者的治疗耐受性相关。
系统评价了营养筛查方法的结局变量及其与 CRC 患者全身治疗耐受性的相关性。遵循了 Cochrane 系统评价指南和系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南。两位作者独立评估了每项纳入研究的偏倚风险和质量。
共纳入 16 项研究。纳入研究评估了以下营养不良筛查方法：血清白蛋白、体重指数、C 反应蛋白/白蛋白比值、格拉斯哥预后评分改良版、微型营养评估、营养风险指数、患者生成的主观整体评估、肌肉减少症和体重减轻。
肌肉减少症与治疗耐受性的相关性似乎比其他筛查方法更为常见，但本综述表明，有许多筛查方法可以提供有意义的结局，反映患者的营养状况和相关治疗不耐受风险。这为从业者提供了从各种不同的营养筛查方法中进行选择的灵活性。因此，可以根据个体患者量身定制营养筛查。重要的是，营养筛查可能有助于识别那些有化学毒性风险的患者，从而可以实施有针对性的预康复计划，以预防（严重）化学毒性。
