Wei Juan, Xiang WeiFeng, Wei HangPing, Hu XiaoYan, Lu YiFang, Dong XiaoFang
Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China.
BMC Gastroenterol. 2024 Dec 18;24(1):452. doi: 10.1186/s12876-024-03548-6.
In gastric cancer (GC) patients, malnutrition is common and has a negative impact on treatment tolerance, survival, and prognosis. The purpose of this study was to explore the relationship between prechemotherapy nutritional state and early myelosuppression in stage IV GC patients treated with first-line chemotherapy.
This retrospective study included patients with stage IV GC who received first-line chemotherapy between July 2012 and December 2021. Clinical and laboratory data were collected within 1 week before chemotherapy to calculate nutrition risk index, prognostic nutritional index. Pretreatment abdominal computed tomography scans were used to quantify skeletal muscle index (SMI). The main measurable outcome was the incidence of grade ≥ 2 early myelosuppression after chemotherapy.
Among 102 patients eligible for analysis, 50% were malnourished, 50% were poor prognoses and 49% were sarcopenic at baseline.The side effects were generally well managed, with a 26.5% occurrence of grade 3/4 side effects. Pre-chemotherapy patients with low Nutrition Risk Index (NRI) (p = 0.002), low prognostic nutritional index (PNI) (p = 0.001), and low SMI (p = 0.001) had significantly higher incidences of grade ≥ 2 myelosuppression occurred after the first cycle of chemotherapy. Moreover, the high level of PNI was associated with higher completion rate of chemotherapy (p = 0.01). Multivariate logistic regression analysis revealed that SMI at baseline (p = 0.006) and hemoglobin level (p = < 0.001) were prognostic factors for grade ≥ 2 early myelosuppression.
Stage IV GC patients with low NRI, low PNI and low SMI experienced significantly more grade ≥ 2 early myelosuppression during the first line of chemotherapy.
在胃癌（GC）患者中，营养不良很常见，并且对治疗耐受性、生存率和预后有负面影响。本研究的目的是探讨接受一线化疗的IV期GC患者化疗前营养状态与早期骨髓抑制之间的关系。
这项回顾性研究纳入了2012年7月至2021年12月期间接受一线化疗的IV期GC患者。在化疗前1周内收集临床和实验室数据，以计算营养风险指数、预后营养指数。化疗前的腹部计算机断层扫描用于量化骨骼肌指数（SMI）。主要可测量结局是化疗后≥2级早期骨髓抑制的发生率。
在102例符合分析条件的患者中，50%存在营养不良，50%预后较差，49%在基线时存在肌肉减少症。副作用总体管理良好，3/4级副作用发生率为26.5%。化疗前营养风险指数（NRI）低（p = 0.002）、预后营养指数（PNI）低（p = 0.001）和SMI低（p = 0.001）的患者在化疗第一个周期后发生≥2级骨髓抑制的发生率显著更高。此外，PNI水平高与化疗完成率高相关（p = 0.01）。多因素逻辑回归分析显示，基线时的SMI（p = 0.006）和血红蛋白水平（p = < 0.001）是≥2级早期骨髓抑制的预后因素。
NRI低、PNI低和SMI低的IV期GC患者在一线化疗期间经历的≥2级早期骨髓抑制明显更多。
