Buscemi Paolo, Randazzo Cristiana, Buscemi Carola, Barile Anna Maria, Finamore Elena, Caruso Roberta, Colombrita Piero, Lombardo Martina, Cangemi Serena, Zucchi Giulia, Cordova Adriana, Lo Casto Antonio, Buscemi Silvio
Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BIND), University of Palermo, Palermo, Italy.
Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy.
Front Nutr. 2025 Mar 11;12:1530460. doi: 10.3389/fnut.2025.1530460. eCollection 2025.
Malnutrition commonly affects patients with oral squamous cell carcinoma (OSCC), which contributes to worsening prognosis. Moreover, specific strategies for diagnosing and managing malnutrition in OSCC are lacking. We aimed to investigate if the modality of nutritional treatment as standard oral (ON) or artificial enteral nutrition (AN), assigned by a dedicated nutritional team or not, influences survival in patients with OSCC. Moreover, given the difficulties in obtaining adequate nutritional evaluation in patients with OSCC we preliminary evaluated the magnetic resonance imaging volumetric reconstruction of posterior paraspinal muscles at the level of the third cervical vertebra (MRI-C3) as a tentative new approach to investigate sarcopenia.
This retrospective study included 52 consecutive patients with OSCC who underwent surgery at the University Hospital of Palermo (I) from Jan 2020 to May 2023. In-hospital nutritional support was provided by a dedicated team. The patients were retrospectively compared with a control group of 11 patients who were surgically treated for OSCC between January and December 2019 in the same unit of surgery, in the absence of a dedicated nutritional team. Upon discharge, the nutritional treatment consisted of ON or AN. In 2020-2023, industrially produced special medical food formulations were used rather than natural foods as it was in use in 2019; also, adequate protein supplements were assigned in order to reach the recommended protein intake of 1-0-1.2 g/kg ideal body weight. The MRI-C3 volumetric reconstruction was obtained in 16 patients.
As per-protocol, the patients were categorized according to pre-surgery TNM stage: groups A (TNM stages I-III) and B (IVa-IVc). The prevalence of group A patients was 59.6% in the case group and 85.7% in the control group ( < 0.001), with higher survival rates at follow-up in the control group (80.5% vs. 27.3%), therefore, the two historical groups were not comparable. Given the limited number of cases, all patients were included in a unique group. Advanced stages of OSCC (log-rank test, < 0.001) and AN ( < 0.001) were independently associated with a lower survival rates. The 3-12 month post-surgery MRI_C3 volume increased in patients who received ON treatment and decreased in those who received AN treatment ( < 0.001).
AN is associated with lower survival probability than ON in patients with OSCC. The MRI-C3 measurement of paravertebral muscles is a promising technique for detecting sarcopenia that needs to be confirmed by further studies including larger groups of patients.
营养不良常影响口腔鳞状细胞癌（OSCC）患者，这会导致预后恶化。此外，缺乏诊断和管理OSCC患者营养不良的具体策略。我们旨在研究由专门的营养团队分配的标准口服营养（ON）或人工肠内营养（AN）的营养治疗方式是否会影响OSCC患者的生存率。此外，鉴于在OSCC患者中进行充分营养评估存在困难，我们初步评估了第三颈椎水平（MRI-C3）的椎旁肌磁共振成像体积重建作为一种研究肌肉减少症的新方法。
这项回顾性研究纳入了2020年1月至2023年5月在巴勒莫大学医院（I）接受手术的52例连续OSCC患者。住院期间的营养支持由一个专门的团队提供。将这些患者与2019年1月至12月在同一手术科室接受OSCC手术治疗的11例患者组成的对照组进行回顾性比较，该对照组没有专门的营养团队。出院时，营养治疗包括ON或AN。在2020 - 2023年，使用了工业生产的特殊医学食品配方，而不是2019年使用的天然食品；此外，还分配了足够的蛋白质补充剂，以达到推荐的每千克理想体重1.0 - 1.2克蛋白质的摄入量。对16例患者进行了MRI-C3体积重建。
按照方案，患者根据术前TNM分期进行分类：A组（TNM分期I - III）和B组（IVa - IVc）。A组患者在病例组中的患病率为59.6%，在对照组中为85.7%（P < 0.001），对照组随访时的生存率更高（80.5%对27.3%），因此，这两个历史组不具有可比性。鉴于病例数量有限，所有患者被纳入一个单独的组。OSCC的晚期阶段（对数秩检验，P < 0.001）和AN（P < 0.001）与较低的生存率独立相关。接受ON治疗的患者术后3 - 12个月MRI_C3体积增加，而接受AN治疗的患者则减少（P < 0.001）。
在OSCC患者中，AN与比ON更低的生存概率相关。椎旁肌的MRI-C3测量是一种有前景的检测肌肉减少症的技术，需要通过包括更大患者群体的进一步研究来证实。
