握力与 CONUT 联合预测胃肠道癌症患者的总生存期：一项多中心队列研究。

The combination of handgrip strength and CONUT predicts overall survival in patients with gastrointestinal cancer: A multicenter cohort study.

机构信息

Department of Clinical Nutrition, Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China; State Market Regulation, Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China.

出版信息

Clin Nutr. 2024 Sep;43(9):2057-2068. doi: 10.1016/j.clnu.2024.07.026. Epub 2024 Jul 25.

DOI:10.1016/j.clnu.2024.07.026

PMID:39088962

Abstract

BACKGROUND

The controlled nutritional status score (CONUT) and handgrip strength (HGS) were both predictive indexes for the prognosis of cancers. However, the combination of CONUT and HGS for predicting the prognosis of gastrointestinal cancer had not been developed. This study aimed to explore the combination of CONUT and HGS as the potential predictive prognosis in patients with gastric and colorectal cancer.

METHODS

A cohort study was conducted with gastric and colorectal cancer patients in multicenter in China. Based on the optimal HGS cutoff value for different sex, the HGS cutoff value was determined. The patients were divided into high and low HGS groups based on their HGS scores. A CONUT score of 4 or less was defined as a low CONUT, whereas scores higher than 4 were defined as high CONUT. The Kaplan-Meier method was used to create survival curves, and the log-rank test was used to compare time-event relationships between groups. A Cox proportional hazard regression model was used to determine independent risk factors for overall survival (OS).

RESULTS

A total 2177 gastric and colorectal patients were enrolled in this study, in which 1391 (63.9%) were men (mean [SD] age, 66.11 [11.60] years). Multivariate analysis revealed that patients with high HGS had a lower risk of death than those with low HGS (hazard ratio [HR],0.87; 95% confidence interval [CI], 0.753-1.006, P = 0.06), while high CONUT had a higher risk of death than those with low CONUT (HR, 1.476; 95% CI, 1.227-1.777, P < 0.001). Patients with both low HGS and high CONUT had 1.712 fold increased risk of death (HR, 1.712; 95% CI, 1.364-2.15, P < 0.001). Moreover, cancer type and sex were stratified and found that patients with high CONUT and low HGS had lower survival rate than those with low CONUT and high HGS in both gastric or colorectal cancer, and both male and female.

CONCLUSION

A combination of low HGS and high CONUT was associated with poor prognosis in patients with gastrointestinal cancer, which could probably predict the prognosis of gastrointestinal cancer more accurate than HGS or CONUT alone.

摘要

背景

控制营养状态评分（CONUT）和握力（HGS）均是癌症预后的预测指标。然而，尚未建立 CONUT 和 HGS 联合预测胃肠道癌症预后的方法。本研究旨在探讨 CONUT 和 HGS 联合作为预测胃癌和结直肠癌患者预后的潜在预测指标。

方法

本研究为在中国多中心进行的胃癌和结直肠癌患者队列研究。根据不同性别最佳 HGS 截断值，确定 HGS 截断值。根据 HGS 评分将患者分为高 HGS 组和低 HGS 组。CONUT 评分 4 分或以下定义为低 CONUT，评分高于 4 分为高 CONUT。采用 Kaplan-Meier 法绘制生存曲线，对数秩检验比较组间时间事件关系。采用 Cox 比例风险回归模型确定总生存期（OS）的独立危险因素。

结果

本研究共纳入 2177 例胃癌和结直肠癌患者，其中 1391 例（63.9%）为男性（平均[标准差]年龄，66.11[11.60]岁）。多因素分析显示，高 HGS 患者的死亡风险低于低 HGS 患者（风险比[HR]，0.87；95%置信区间[CI]，0.753-1.006，P=0.06），而高 CONUT 患者的死亡风险高于低 CONUT 患者（HR，1.476；95%CI，1.227-1.777，P<0.001）。同时存在低 HGS 和高 CONUT 的患者死亡风险增加 1.712 倍（HR，1.712；95%CI，1.364-2.15，P<0.001）。此外，按癌症类型和性别分层发现，在胃癌和结直肠癌以及男性和女性中，高 CONUT 和低 HGS 的患者生存率均低于低 CONUT 和高 HGS 的患者。