School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
School of Medicine, Tongji University, Shanghai, China.
Support Care Cancer. 2024 Oct 1;32(10):697. doi: 10.1007/s00520-024-08884-7.
The study aimed to determine the nutritional status and its prognostic effect on the survival of patients with advanced gastrointestinal cancer.
A prospective cohort study design was conducted in a tertiary hospital in Shanghai, China. The study consisted of 202 advanced gastrointestinal (GI) cancer patients from a palliative care unit. The following data were collected from the patients: biochemical indicators, i.e., anemia (hemoglobin levels), albumin, pre-albumin, C-reactive protein (CRP), and anthropometric parameters, i.e., body mass index (BMI), nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA), and performance status by Karnofsky Performance Status (KPS). Severe malnutrition was confirmed with the PG-SGA score of ≥ 9. Kaplan-Meier survival analysis and the log-rank test were used to calculate overall survival (OS). The effect of nutritional status on survival was performed by Cox regression analysis.
Severe malnutrition was found in 71.3% of patients according to the cutoff of the PG-SGA. PG-SGA score ≥ 9, albumin level < 35 g/L, and CRP level ≥ 10 mg/L predicted shortened life expectancy. Multivariate Cox regression analysis results showed that the PG-SGA score ≥ 9 and the albumin level < 35 g/L were predictive of OS.
Our data support that severe malnutrition is a predictor for OS in patients with advanced GI cancer. Information on nutritional status should be considered to individualize palliative care plan for these patients, and hence improve their quality of life.
本研究旨在确定晚期胃肠道癌症患者的营养状况及其对生存的预后影响。
在中国上海的一家三级医院进行了一项前瞻性队列研究设计。该研究纳入了来自姑息治疗病房的 202 名晚期胃肠道（GI）癌症患者。从患者中收集了以下数据：生化指标，如贫血（血红蛋白水平）、白蛋白、前白蛋白、C 反应蛋白（CRP）和人体测量参数，如体重指数（BMI）、患者主观整体评估（PG-SGA）的营养状况和卡诺夫斯基表现状态（KPS）。通过 PG-SGA 评分≥9 确认严重营养不良。采用 Kaplan-Meier 生存分析和对数秩检验计算总生存期（OS）。采用 Cox 回归分析评估营养状况对生存的影响。
根据 PG-SGA 的截断值，71.3%的患者存在严重营养不良。PG-SGA 评分≥9、白蛋白水平<35 g/L 和 CRP 水平≥10 mg/L 预测预期寿命缩短。多变量 Cox 回归分析结果表明，PG-SGA 评分≥9 和白蛋白水平<35 g/L 是 OS 的预测因素。
我们的数据支持严重营养不良是晚期胃肠道癌症患者 OS 的预测因素。应考虑营养状况信息，为这些患者制定个体化的姑息治疗计划，从而提高他们的生活质量。
