Department of Critical Care, West China Hospital, Sichuan University, No. 363, Section 3, Furong Avenue, Wenjiang District, Chengdu, 611100, China.
Support Care Cancer. 2024 Aug 10;32(9):583. doi: 10.1007/s00520-024-08780-0.
Malnutrition commonly occurs in cancer patients, impacting their quality of life and survival duration. The objective of this meta-analysis and systematic review is to assess the effects of nutritional interventions on patients undergoing neoadjuvant chemoradiotherapy.
A comprehensive search was conducted in PubMed, Embase, and the Cochrane Library databases to obtain randomized controlled trials of nutritional interventions in patients with neoadjuvant chemoradiotherapy. Outcomes assessed included toxicity reactions to neoadjuvant therapy, levels of inflammation-related markers, nutritional status, and relevant clinical outcomes. The relative risk (RR) or weighted mean difference (WMD) and 95% confidence interval (CI) were used as effect sizes.
A total of 16 studies were included, involving 954 patients. Nutritional intervention significantly reduced the incidence of vomiting (RR = 0.37, 95%CI: 0.21-0.67, P = 0.001) and mucositis (RR = 0.82, 95%CI: 0.67-1.00, P = 0.046) in patients with neoadjuvant chemoradiotherapy. For the nutritional status of cancer patients, nutritional intervention significantly increased the proportion of well-nourished patients (RR = 12.74, 95%CI: 4.43-36.69, P < 0.001). In addition, nutritional intervention also reduced the length of hospital stay in neoadjuvant chemoradiotherapy patients after surgery (WMD = - 0.82, 95%CI: - 1.61- - 0.02, P = 0.043). However, there was no improvement in nausea (P = 0.534), diarrhea (P = 0.068), febrile neutropenia (P = 0.551), levels of albumin (P = 0.211), prealbumin (P = 0.063), C-reactive protein (P = 0.430), clinical remission (P = 0.148), or postoperative complications (P = 0.098).
Nutritional intervention can reduce the toxicity of neoadjuvant chemoradiotherapy (vomiting and mucositis), improve the nutritional status of patients, and shorten the length of postoperative hospital stay. Well-designed and high-quality studies are necessary to confirm the effect of nutritional interventions on cancer patients, with a specific focus on reaching nutritional goals and providing the right nutrients.
营养不良在癌症患者中很常见，会影响他们的生活质量和生存时间。本荟萃分析和系统评价的目的是评估营养干预对接受新辅助放化疗的患者的影响。
在 PubMed、Embase 和 Cochrane 图书馆数据库中全面检索新辅助放化疗患者营养干预的随机对照试验。评估的结局包括新辅助治疗的毒性反应、炎症相关标志物水平、营养状况和相关临床结局。使用相对风险（RR）或加权均数差（WMD）和 95%置信区间（CI）作为效应量。
共纳入 16 项研究，涉及 954 例患者。营养干预可显著降低新辅助放化疗患者呕吐（RR=0.37，95%CI：0.21-0.67，P=0.001）和黏膜炎（RR=0.82，95%CI：0.67-1.00，P=0.046）的发生率。对于癌症患者的营养状况，营养干预可显著增加营养良好患者的比例（RR=12.74，95%CI：4.43-36.69，P<0.001）。此外，营养干预还可缩短新辅助放化疗患者手术后的住院时间（WMD=-0.82，95%CI：-1.61--0.02，P=0.043）。然而，在恶心（P=0.534）、腹泻（P=0.068）、发热性中性粒细胞减少症（P=0.551）、白蛋白水平（P=0.211）、前白蛋白水平（P=0.063）、C 反应蛋白水平（P=0.430）、临床缓解率（P=0.148）或术后并发症发生率（P=0.098）方面无改善。
营养干预可降低新辅助放化疗的毒性（呕吐和黏膜炎），改善患者的营养状况，并缩短术后住院时间。需要设计良好且高质量的研究来证实营养干预对癌症患者的效果，特别关注达到营养目标和提供正确的营养素。
