癌症患者的肠内营养支持：短期预后及医疗费用与炎症的关联

Enteral nutrition support in patients with cancer: association of short-term prognosis and medical costs with inflammation.

作者信息

Liu Chenan, Deng Li, Lin Shiqi, Liu Tong, Ren Jiangshan, Shi Jinyu, Zhang Heyang, Xie Hailun, Chen Yue, Zheng Xin, Bu ZhaoTing, Shi Hanping

机构信息

Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.

Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.

出版信息

Support Care Cancer. 2024 Dec 22;33(1):50. doi: 10.1007/s00520-024-09085-y.

DOI:10.1007/s00520-024-09085-y

PMID:39710757

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11663818/

Abstract

BACKGROUND

Enteral nutrition (EN) is commonly used for nutritional support in patients with cancer. Whether inflammation, one of the driving factors of malnutrition and cancer, affects the association between EN and short-term prognosis and medical costs in patients with cancer remains unclear. We aimed to investigate the association between EN and short-term prognosis of patients with cancer and the effect of inflammation on EN-associated medical costs.

METHODS

This multicentre prospective cohort study evaluated patients with pathologically confirmed solid tumours. After admission, all patients who received EN, including oral or tube feeding, were assigned to the EN group. The log-rank test was used to identify the optimal cutoff values for inflammatory markers. Cox regression analysis was used to analyse the associations among EN, inflammation, and prognosis. Propensity score matching was used to balance biases between the EN and non-EN groups and validate the stability of the results.

RESULTS

A total of 5121 patients were included, with 2965 (57.90%) men and an average age of 59.06 (11.30) years. A total of 462 patients received EN, with 390 (84.4%) receiving oral nutritional supplementation. During the 90-day follow-up, 304 patients died. In the low inflammation group, there was no association between EN and short-term prognosis (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.39-2.18). In the high inflammation group, EN significantly improved the short-term prognosis (HR = 0.48, 95% CI = 0.30-0.76). In patients with low inflammation (p < 0.001), EN increased hospitalisation costs (p < 0.001) without reducing length of stay (LOS) (p = 0.15). In patients with high inflammation, EN did not increase hospitalisation expenses (p = 0.47) but reduced the LOS (p = 0.004).

CONCLUSION

EN can improve the short-term prognosis of patients with high inflammation and reduce LOS without increasing the hospitalisation expenses. Baseline inflammation levels may serve as effective indicators for personalised and precise EN treatment.

CLINICAL TRIAL REGISTRATION

ChiCTR1800020329 (chictr.org.cn).

摘要

背景

肠内营养（EN）常用于癌症患者的营养支持。炎症作为营养不良和癌症的驱动因素之一，是否会影响EN与癌症患者短期预后及医疗费用之间的关联尚不清楚。我们旨在研究EN与癌症患者短期预后之间的关联以及炎症对EN相关医疗费用的影响。

方法

这项多中心前瞻性队列研究评估了经病理确诊为实体瘤的患者。入院后，所有接受EN（包括口服或管饲）的患者被分配到EN组。采用对数秩检验确定炎症标志物的最佳临界值。采用Cox回归分析来分析EN、炎症和预后之间的关联。使用倾向评分匹配来平衡EN组和非EN组之间的偏差，并验证结果的稳定性。

结果

共纳入5121例患者，其中男性2965例（57.90%），平均年龄59.06（11.30）岁。共有462例患者接受EN，其中390例（84.4%）接受口服营养补充。在90天的随访期间，304例患者死亡。在低炎症组中，EN与短期预后之间无关联（风险比[HR]=0.92，95%置信区间[CI]=0.39-2.18）。在高炎症组中，EN显著改善了短期预后（HR=0.48，95%CI=0.30-0.76）。在低炎症患者中（p<0.001），EN增加了住院费用（p<0.001），但未缩短住院时间（LOS）（p=0.15）。在高炎症患者中，EN未增加住院费用（p=0.47），但缩短了LOS（p=0.004）。