主观整体评估在营养筛查中的应用及其对结直肠癌老年患者手术结局的影响：一项前瞻性研究。
Subjective global assessment for nutritional screening and its impact on surgical outcomes: A prospective study in older patients with colorectal cancer.
机构信息
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan.
Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan.
出版信息
Langenbecks Arch Surg. 2024 Nov 25;409(1):356. doi: 10.1007/s00423-024-03548-w.
PURPOSE
Our perioperative management center provides preoperative intervention and functional and nutritional assessments for colorectal cancer patients aged over 75 years. This study evaluated the associations of preoperative nutritional status with postoperative outcomes and prognosis in colorectal cancer patients aged 75 years or older.
METHODS
This was a prospective, observational study of 71 colorectal cancer patients aged 75 years or older who underwent surgery between July 2020 and September 2022. The Subjective Global Assessment (SGA) was evaluated as a nutritional index. The patients were classified into three groups: SGA-A (well nourished), B (moderately malnourished), and C (severely malnourished), and the correlations with postoperative outcomes and prognosis were examined.
RESULTS
The median age of the 71 patients (34 males, 37 females) was 78 (75-92) years, and their median body mass index (BMI) was 22.3 (13.4-31.9) kg/m. Forty-eight patients had colon cancer, and 23 had rectal cancer. On the SGA, 28 patients were SGA-A, 25 SGA-B, and 18 SGA-C. The SGA-B/C group had significantly higher BMI (p < 0.01) and more ICU admissions (p = 0.02). The G8 score was significantly lower (p = 0.03) in the SGA-B/C group, suggesting coexisting functional decline. In terms of postoperative outcomes, the SGA-B/C group had a significantly longer postoperative hospital stay (p = 0.04). The 3-year OS rates for all stages were 100% in the SGA-A group and 49.7% in the SGA-B/C group (p = 0.03), while the 3-year OS rates for patients excluding Stage IV were 100% in the SGA-A group and 68.5% in the SGA-B/C group, not significantly different (p = 0.14). The 3-year RFS rate was 95.5% in the SGA-A group and 65.3% in the SGA-B/C group (p = 0.15).
CONCLUSION
The SGA is a promising nutritional index associated with short-term outcomes in older patients undergoing colorectal cancer surgery. The SGA can be assessed in a few minutes during an outpatient visit, making it useful for routine clinical use.
目的
我们的围手术期管理中心为 75 岁以上的结直肠癌患者提供术前干预以及功能和营养评估。本研究评估了术前营养状况与 75 岁及以上结直肠癌患者术后结局和预后的相关性。
方法
这是一项前瞻性、观察性研究，纳入 2020 年 7 月至 2022 年 9 月期间接受手术的 71 例 75 岁及以上的结直肠癌患者。采用主观全面评估（SGA）作为营养指标。将患者分为 SGA-A（营养良好）、B（中度营养不良）和 C（重度营养不良）三组，观察与术后结局和预后的相关性。
结果
71 例患者（34 例男性，37 例女性）的中位年龄为 78（75-92）岁，中位 BMI 为 22.3（13.4-31.9）kg/m2。48 例为结肠癌，23 例为直肠癌。SGA 评估中，28 例患者为 SGA-A，25 例为 SGA-B，18 例为 SGA-C。SGA-B/C 组 BMI 明显较高（p<0.01），ICU 入住率较高（p=0.02）。SGA-B/C 组 G8 评分明显较低（p=0.03），提示存在功能下降。在术后结局方面，SGA-B/C 组的术后住院时间明显较长（p=0.04）。所有分期的 3 年 OS 率在 SGA-A 组为 100%，在 SGA-B/C 组为 49.7%（p=0.03），而排除 IV 期的患者中，SGA-A 组的 3 年 OS 率为 100%，SGA-B/C 组为 68.5%，差异无统计学意义（p=0.14）。SGA-A 组的 3 年 RFS 率为 95.5%，SGA-B/C 组为 65.3%（p=0.15）。
结论
SGA 是一种有前途的营养指标，与接受结直肠癌手术的老年患者的短期结局相关。SGA 可以在门诊就诊时几分钟内评估，因此对常规临床应用有用。
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