Chen Wei-Zhe, Zhang Xian-Zhong, Zhang Feng-Min, Yu Ding-Ye, Chen Wen-Hao, Lin Feng, Dong Qian-Tong, Zhuang Cheng-Le, Yu Zhen
Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of General Surgery, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Nutr. 2022 Aug 19;9:960670. doi: 10.3389/fnut.2022.960670. eCollection 2022.
Malnutrition and sarcopenia are common in elderly gastric cancer patients, which are also interrelated and affect each other. We aimed to determine the characteristics of coexistence of malnutrition and sarcopenia in the elderly gastric cancer patients and investigate the predictive roles of malnutrition and sarcopenia on clinical outcomes.
Between 2014 and 2019, a total of 742 elderly gastric cancer patients were enrolled. Malnutrition and sarcopenia were diagnosed according to the most recent diagnostic criteria. Patients were divided into four groups according to presence of these two symptoms. Clinical characteristics, short- and long-term outcomes were compared among four groups. The independent risk factors for complications and survival were evaluated using univariate and multivariate analyses.
Of all patients, 34.8% were diagnosed with malnutrition and 34.0% were diagnosed with sarcopenia. Patients with both malnutrition and sarcopenia had the highest rate of total ( < 0.001), surgical ( = 0.003), and medical complications ( = 0.025), and the highest postoperative hospital stays ( < 0.001) and hospitalization costs ( < 0.001). They also had the worst overall survival ( < 0.0001) and disease-free survival ( < 0.0001). Sarcopenia and Charlson Comorbidity Index (≥2) were independent risk factors for total complications. Hypoalbuminemia and malnutrition were non-tumor-related independent risk factors for overall survival and disease-free survival.
Malnutrition and sarcopenia had superimposed negative effects on elderly gastric cancer patients. Preoperative geriatric evaluation including screening for malnutrition and sarcopenia are recommended for all elderly gastric cancer patients for accurate treatment strategy.
营养不良和肌肉减少症在老年胃癌患者中很常见，二者相互关联且相互影响。我们旨在确定老年胃癌患者中营养不良与肌肉减少症共存的特征，并研究营养不良和肌肉减少症对临床结局的预测作用。
2014年至2019年期间，共纳入742例老年胃癌患者。根据最新诊断标准诊断营养不良和肌肉减少症。根据这两种症状的存在情况将患者分为四组。比较四组患者的临床特征、短期和长期结局。采用单因素和多因素分析评估并发症和生存的独立危险因素。
所有患者中，34.8%被诊断为营养不良，34.0%被诊断为肌肉减少症。同时患有营养不良和肌肉减少症的患者总体（<0.001）、手术（=0.003）和医疗并发症发生率最高（=0.025），术后住院时间最长（<0.001），住院费用最高（<0.001）。他们的总生存期（<0.0001）和无病生存期也最差（<0.0001）。肌肉减少症和Charlson合并症指数（≥2）是总并发症的独立危险因素。低蛋白血症和营养不良是总生存期和无病生存期的非肿瘤相关独立危险因素。
营养不良和肌肉减少症对老年胃癌患者有叠加的负面影响。建议对所有老年胃癌患者进行术前老年评估，包括筛查营养不良和肌肉减少症，以制定准确的治疗策略。
