Comparison of PG-SGA,SGA and body-composition measurement in detecting malnutrition among newly diagnosed lung cancer patients in stage IIIB/IV and benign conditions

Assessment tools and body-composition measurements are useful in diagnosing malnutrition. Which one is better for lung disease patients is unclear. The objectives of the present study are: to assess relationships between different methods of nutritional measurements in lung diseases patients; to determine which one is better in diagnosing malnutrition for lung disease patients; and to determine whether lung cancer patients can be differentiated from benign lung disease patients using different measurements. A total of 96 newly diagnosed primary lung cancer patients in stage IIIB/IV and 52 benign lung disease patients nutritional status were assessed according to the SGA, the scored PG-SGA, and serum albumin, prealbumin, transferrin, hemoglobin, total lymphocyte count, body mass index (BMI), and weight. A total of 40% of lung cancer patients were severely malnourished, with men or elder having a higher rate of malnutrition. Significantly lower values of weight, BMI, total lymphocyte count, transferrin, prealbumin and serum albumin were found for them. Age, sex, weight, weight half year ago and prealbumin are in the regression equation to predict them. For benign lung disease patients, 21.2% were severely malnourished with significantly lower values of weight and transferrin. Age and prealbumin are in the equation to predict severely malnourished benign lung disease patients. The highest receiver operation characteristic area under the curve was found for the PG-SGA score, BMI and weight. PG-SGA global rating, age and iron-transferring protein are in the equation for predicting disease status. The SGA and PG-SGA are appropriate for identifying malnutrition in lung disease patients. Lung cancer patients can be differentiated from benign conditions by PG-SGA.     

Evaluation of Nutritional Status of Cancer Patients during Treatment by Patient-Generated Subjective Global Assessment: a Hospital-Based Study

Cancer patients frequently experience malnutrition. Cancer and cancer therapy effects nutritional status through alterations in the metabolic system and reduction in food intake. In the present study, fifty seven cancer patients were selected as subjects from the oncology ward of Cachar Cancer Hospital and Research Centre, Silchar, India. Evaluation of nutritional status of cancer patients during treatment was carried out by scored Patient-Generated Subjective Global Assessment (PG-SGA). The findings of PG SGA showed that 15.8% (9) were well nourished, 31.6% (18) were moderately or suspected of being malnourished and 52.6% (30) were severely malnourished. The prevalence of malnutrition was highest in lip/oral (33.33%) cancer patients. The study showed that the prevalence of malnutrition (84.2%) was high in cancer patients during treatment.     

Nutritional Status in Patients with Esophageal Cancer Receiving Chemoradiation and Assessing the Efficacy of Usual Care for Nutritional Managements

Background: Malnutrition is prevalent in esophageal cancer patients which affects cancer prognosis. The purpose of this study was a comprehensive assessment of nutritional status during Chemoradiation (CRT). Methods: Newly diagnosed adults with esophageal cancer were recruited for this study. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutritional-related complications were assessed before, after, and 4 to 6 weeks after CRT. Results: Seventy-one cases were enrolled. The mean age was 66.8±12 years. Patients’ mean weight loss was 2.42±2.4 kilograms during treatment. A significant reduction observed in mean MUAC (26.68±4.9 vs. 25.42±5.1 cm), fat mass percentage (24.11±11.8 vs. 22.8±12.5), fat free mass index (16.87±2.4 vs. 16.47±2.6 kg/m2) and hand grip strength (43.2±19 vs. 36.1±20 kg) during CRT (all p-values <0.0001). We had also a non-significant change in mean energy intake (19.5±11 vs. 18.3±11 kcal/kgw. day) and protein intake (0.56±0.4 vs. 0.66±0.5 g/kgw.day) during CRT.  In our assessment before, immediately after and 4-6 weeks following CRT, we recorded energy intake insufficiency in 55.7%, 58.7% and 27.3% and protein intake inadequacy in 89.8%, 89.1% and 72.7% of cases, respectively. The most common complications were dysphagia (56.7%), anorexia (25%), and constipation (47.9%) at admission. Dysphagia improved in some cases (42%), but anorexia (35%), early satiety (25%), Esophagitis (25%), dysosmia (21%) and dysgeusia (17%) were increased as CRT complication. yet, 25% of patients had dysphagia and 34.4% had constipation 4-6 weeks after CRT. The twelve-months mortality was significantly associated with lower BMI after CRT, primary PG-SGA score, weight loss, BMI<18.5, MUAC, physical performance, living in rural or urban areas, addiction. Conclusion: Our study demonstrated a high prevalence of malnutrition among esophageal cancer patients which worsened during Chemoradiotherapy. Our findings warrant early screening and monitoring of nutritional status and effective nutritional interventions with symptoms management during treatment in these patients.     

Utilization of a Scored Patient-Generated Subjective Global Assessment in Detecting a Malnourished Status in Gynecologic Cancer Patients

Purpose: To assess the prevalence of malnutrition in gynecologic cancer patients using the Scored Patient- Generated Subjective Global Assessment (PG-SGA) questionnaire. Materials and Methods: A total of 97 gynecologic cancer patients who never had any treatment but were planned for surgery were enrolled. The patients were asked to complete the scored PG-SGA form before the treatment was started. Attending physicians were also asked to complete other information in the PG-SGA form. Total scores were calculated and the patients were classified into 3 nutritional status levels. Results: Mean age was 54 years. Postoperative diagnoses were endometrial cancer in 42 cases (43.2%), ovarian cancer in 29 cases (29.9%), and cervical cancer in 26 cases (26.8%). Mean PG-SGA score was 5.24.7. Malnutrition (PG-SGA B and C) was found in 52 patients (53.6%, 95% CI 43.7% - 63.2%). Preoperative BMI, hemoglobin, serum albumin, and cancer stage were not significantly associated with nutritional status. Malnutrition was significantly more common among patients diagnosed with ovarian cancer, compared to other types of cancer (79.3% vs. 42.6%, p 0.004). Conclusions: Prevalence of malnutrition among gynecologic cancer patients was 53.5%, according to the scored PG-SGA. Malnutrition was significantly more common among patients with ovarian cancer.     

Impact of Nutritional Status on the Quality of Life of Advanced Cancer Patients in Hospice Home Care

Background: Cancer patients frequently experience malnutrition and this is an important factor in impairedquality of life. Objective: This cross-sectional study examined the association between global quality of life andits various subscales with nutritional status among 61 (33 females and 28 males) advanced cancer patients caredfor by selected hospices in peninsular Malaysia. Methods: The Patient Generated-Subjective Global Assessment(PG-SGA) and the Hospice Quality of Life Index (HQLI) were used to assess nutritional status and quality oflife, respectively. Results: Nine (14.7%) patients were well-nourished, 32 (52.5%) were moderately or suspectedof being malnourished while 20 (32.8%) of them were severely malnourished. The total HQLI mean score forthese patients was 189.9±51.7, with possible scores ranging from 0 to 280. The most problem areas in thesepatients were in the domain of functional well-being and the least problems were found in the social/spiritualdomain. PG-SGA scores significantly correlated with total quality of life scores (r2= 0.38, p<0.05),psychophysiological well-being (r2= 0.37, p<0.05), functional well-being (r2= 0.42, p<0.05) and social/ spiritualwell-being (r2= 0.07, p<0.05). Thus, patients with a higher PG-SGA score or poorer nutritional status exhibiteda lower quality of life. Conclusion: Advanced cancer patients with poor nutritional status have a diminishedquality of life. These findings suggest that there is a need for a comprehensive nutritional intervention forimproving nutritional status and quality of life in terminally ill cancer patients under hospice care.     

An evaluation of the prevalence of malnutrition in cancer patients attending the outpatient oncology clinic

Background: The aim of the study was to assess the nutritional status of cancer patients attending the medical oncology outpatient setting for the first time. Methods: One‐hundred and forty‐one patients (87 males, 54 females) were assessed by a dietitian, using the nutrition assessment tool, the Patient‐Generated Subjective Global Assessment (PG‐SGA). Tumor types included colorectal, head and neck, lung, pancreatic, gastric or esophageal cancer. No patient had previously received chemotherapy. Results: Forty‐eight (34%) patients were well nourished (PG‐SGA rating A), 79 (56%) patients were at risk of malnutrition (B), and 14 (10%) patients were malnourished (C). The median PG‐SGA score was 7. There were no significant differences in nutritional status between those > 65 years and those ≤ 65 years. The highest PG‐SGA scores (indicating a greater nutritional risk) were found in patients with gastric, pancreatic and oesophageal cancers. There were significant differences found between certain cancer groups using the PG‐SGA, however, these were not detected using other more commonly used criteria, such as the body mass index (BMI). Conclusion: This study confirms that the majority of new patients with cancer presenting to a medical oncologist are at risk of malnutrition or malnourished. It calls for better screening, and adequate nutrition intervention in patients who are about to be considered for systemic treatment.     

Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

Introduction: Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors. Methods: A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status. Results: PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition. Conclusion: Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.     

恶性肿瘤住院患者营养状况与生活质量分析

目的:分析恶性肿瘤住院患者营养状况、生活质量现状及其相关性。方法:选取2018年2月至2018年11月我院入院的1 057例恶性肿瘤患者,采用NRS2002实施营养风险筛查、PG-SGA评估其营养状况、EORTC QLQ-C30调查其生活质量,在患者出院后收集住院期间营养支持情况。结果:1 057例患者中,34.3%存在营养风险,51.8%存在营养不良;营养良好组的白蛋白、血红蛋白、红细胞计数、体重、体质量指数、三头肌皮褶厚度、握力均高于营养不良组（P＜0.05）。营养良好组在总体健康状况及5个功能领域的分数高于营养不良组（P＜0.05）;在9个症状领域的得分低于营养不良组（P＜0.05）;营养状况与总体健康状况及5个功能领域呈负相关（P＜0.05）,与9个症状领域呈正相关（P＜0.05）。肿瘤患者营养支持率低,仅17.69%的患者得到营养支持。结论:恶性肿瘤住院患者营养状况普遍较差,营养不良影响患者生活质量。     

不同营养评定（诊断）方法在胃癌围术期患者中的相关性研究

目的　调查胃癌围术期患者的营养状况，探讨不同营养评定（诊断）方法之间的相关性，以期指导临床选择合适的营养评定工具。方法　选择2019年6月至12月南京医科大学第一附属医院普外科胃病区收治的123例胃癌围术期患者，分别使用营养不良评定标准全球领导人共识（GLIM）、欧洲临床营养和代谢学会制定的营养不良诊断标准（ESPEN）和患者主观整体评估（PG-SGA）对患者进行营养评定，采用生物电阻抗技术测量患者的人体组成，并收集患者近期的血红蛋白、清蛋白、总蛋白、视黄醇结合蛋白值及手握力值，采用Kappa一致性检验分析GLIM、ESPEN及PG-SGA评定结果的一致性，Spearman相关性分析探讨GLIM与人体组成评定指标及其他方法间的相关性。结果　GLIM与ESPEN评定结果的一致性较好（Kappa=0.267，P=0.010）；营养不良组的血红蛋白（111.9±15.8）、清蛋白（33.8±3.8）、脂肪组织（14.5±5.3）、脂肪组织百分比（23.9%±7.7%）、去脂肪组织指数（16.0±3.1）均显著低于营养良好组[数值分别为121.9±16.6、36.4±4.3、18.8±6.0、28.1%±8.7%、17.6±1.9]，差异有统计学意义；GLIM评定结果与FM（r=-0.392, P=0.001）、FM%（r=-0.283, P=0.015）、FFMI（r=-0.299, P=0.010）间呈负相关，与ESPEN评定结果（r=0.283, P=0.015）间呈正相关。结论　GLIM与ESPEN标准评定结果之间存在正相关关系，但一致性水平较低。因此，临床对患者进行营养评定时，应综合运用GLIM诊断标准、血液生化指标及人体组成评定指标FM、FM%、FFMI，以便更全面、准确地对胃癌围术期患者进行营养评定。     

427例恶性肿瘤患者营养状况调查

目的 调查恶性肿瘤患者营养状况,探讨其是否存在性别和年龄差异及PG-SGA在肿瘤患者营养评估中的价值。方法 采用PG-SGA对427名恶性肿瘤患者进行营养状况评估,同时测定传统营养指标。结果 营养不良发生率在非老年与老年患者中差异有统计学意义,而在不同性别患者中差异无统计学意义。不同PG-SGA分级（A、B、C）患者BMI、TSF、MAC等营养指标差异均存在统计学意义。PG-SGA评分与各个指标呈负相关,进一步就性别进行分层分析,表明除Hb、MAMC两个指标外,女性PG-SGA评分与其他营养指标显著负相关,而男性PG-SGA评分与各个营养指标均呈负相关。结论 肿瘤患者营养不良发生率存在年龄差异。PG-SGA与传统营养指标之间具有良好关联性,但存在性别差异。     

Validation of a malnutrition screening tool for patients receiving radiotherapy

Nutrition screening identifies individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutrition support. The aim of this study was to validate a new malnutrition screening tool (MST) in cancer patients undergoing radiotherapy. The MST was compared with the subjective global assessment (SGA) of nutritional status. One hundred and six patients attending two cancer care centres in Australia were independently rated as well nourished or malnourished using SGA and at risk or not at risk of malnutrition using the MST. Convergent validity of the MST was established by determining the ability of the MST to predict SGA. According to SGA, 89% of the patients were well nourished and 11% were moderately malnourished. According to the MST, 28% of patients were at risk of malnutrition. The MST had a sensitivity of 100% and a specificity of 81%. The positive predictive value was 0.4 and the negative predictive value was 1.0. The MST is easy to use and is a strong predictor of nutritional status. The malnutrition screening tool is a simple, quick, valid tool that can be used to identify radiation oncology outpatients who are at risk of malnutrition.     

直肠癌同步放化疗患者营养状态与放化疗不良反应相关性分析

目的 分析直肠癌同步放化疗患者营养状态与放化疗近期不良反应的相关性。方法 收集2018-2019年间浙江省肿瘤医院收治的115例行同步放化疗的直肠癌患者,同时采用欧洲营养风险筛查工具(NRS 2002)和患者主观整体评估量表(PG-SGA)评估患者放疗期间的营养风险状况,采用美国RTOG及不良反应常见术语标准评估急性放化疗不良反应。Spearman′s分析营养状态与放化疗急性不良反应相关性。结果 从放化疗开始前到放化疗第4周患者的营养风险呈逐步增加趋势,随后营养风险又逐步下降。NRS 2002评分和PG-SGA评分均与直肠癌放化疗患者血液学不良反应(r=0.26,P<0.05;r=0.31,P<0.01)、上消化道反应(r=0.51,P<0.01;r=0.63,P<0.01)、下消化道反应(r=0.23,P<0.05;r=0.45,P<0.01)、疲劳(r=0.47,P<0.01;r=0.64,P<0.01)均呈正相关,并且PG-SGA和不同不良反应之间的相关性系数大于NRS 2002。分层分析显示Ⅱ-ⅢB期、<65岁及术后辅助放化疗患者,营养状况和不良反应程度显著相关(均P<0.05)。结论 直肠癌患者同步放化疗期间存在较高的营养不良风险,营养不良风险越高患者放化疗急性不良反应通常越大,建议加强直肠癌放化疗期间的动态营养评估及支持。     

胃肠道肿瘤患者围化疗期营养状况的评价及对免疫功能的影响

目的:运用患者主观全面评价法(patient generated-subjective global assessment,PG-SGA)和营养风险筛查2002(nutrition risk screening 2002,NRS-2002)并结合实验室指标对围化疗期胃肠道肿瘤患者进行营养评价及免疫功能检测,观察营养不良及营养风险对相关临床指标的影响。方法:收集2012年2月至2014年2月期间于我院诊断为胃肠道恶性肿瘤术后待化疗患者80例,通过PG-SGA评分、NRS-2002评分、体格测量及实验室检测进行营养评价。检测T细胞亚群（CD4+、CD8+、CD4+/CD8+）。以PG-SGA评分作为营养评价指标,将80例化疗前患者分为A组（0-3分）、B组（4-8分）和C组（＞8分）,分别测定外周血T淋巴细胞亚群。其中资料完整的45例化疗患者于化疗6周期后重复上述内容,并观察化疗后并发症、平均住院时间。结果:PG-SGA评价结果为营养不良者占68.75%,NRS-2002评价结果营养不良者占42.50%。PG-SGA与NRS-2002分别与其他营养评价指标评价结果间均有显著相关性（P＜0.05）。随着营养不良评分的升高,CD4+和CD4+/CD8+均呈不同程度下降,差异有统计学意义（P＜0.05）。PG-SGA评分与CD4+之间的相关系数r=－0.399(P＜0.01);PG-SGA与CD4+/CD8+之间的相关系数r=－0.655(P＜0.01)。胃肠道肿瘤患者化疗后营养不良发生率高于化疗前。化疗后与化疗前,CD4+/CD8+明显下降,差异有显著性（P＜0.05）。化疗后营养不良组与营养良好组相比平均住院时间及并发症发生率显著增高（P＜0.05）。与无营养风险组相比,存在营养风险组的平均住院时间及并发症发生率显著增高（P＜0.05）。结论:联合运用PG-SGA、NRS-2002和实验室检测指标有助于提高肿瘤患者营养不良的诊断率。     

Correlation between nutritional status and toxicity of concurrent chemoradiotherapy in patients with rectal cancer

Objective To analyze the correlation between nutritional status and acute toxicity induced by concurrent chemoradiotherapy in patients with rectal cancer. Methods A total of 115 patients with rectal cancer who underwent concurrent chemoradiotherapy in Zhejiang Cancer Hospital from March 2018 to August 2019 were prospectively selected. Nutritional risk was assessed by NRS 2002 and PG-SGA nutritional screening tools before, during and after radiotherapy. The acute toxicity was assessed by RTOG and CTCAE 3.0 scoring criteria. The correlation between nutritional status and the acute toxicity of chemoradiotherapy was analyzed by Spearman′s correlation analysis. Results The nutritional risk of the cohort was gradually increased from the beginning of chemoradiotherapy to the fourth week of chemoradiotherapy, and then decreased gradually. Spearman′s correlation analysis showed that NRS 2002 and PG-SGA scores were positively correlated with acute hematological toxicity (r=0.26, P<0.05;r=0.31, P<0.01), upper gastrointestinal toxicity (r=0.51, P<0.01;r=0.63, P<0.01), proctitis (r=0.23, P<0.05;r=0.45, P<0.01) and fatigue (r=0.47, P<0.01;r=0.64, P<0.01) in patients with rectal cancer undergoing chemoradiotherapy. The correlation coefficients between PG-SGA and various toxicities were higher than those of NRS 2002. Stratified analysis showed that patients with stage Ⅱ-Ⅲ B, age<65 years and postoperative adjuvant chemoradiotherapy, nutritional status was significantly associated with the severity of toxicity (all P<0.05). Conclusions Patients with rectal cancer has a high risk of malnutrition during concurrent chemoradiotherapy. The higher the risk of malnutrition, the greater the acute toxicity of chemoradiotherapy. Therefore, dynamic nutrition assessment and nutritional support should be strengthened for rectal cancer patients during chemoradiotherapy.     

Validation of nutritional risk index method against patient-generated subjective global assessment in screening malnutrition in colorectal cancer patients

Objective：To validate malnutrition screening tool of nutrition risk index （NRI） against patent-generated subjective global assessment （PG-SGA） as a gold standard tool in colorectal cancer patients before radiotherapy.Methods：Nutritional status of 52 volunteer colorectal cancer patients with a mean age of 54.1±16.8 years who referred to radiotherapy center were assessed by PG-SGA （gold standard method） and NRI.Serum albumin levels of patients were determined by colorimetric method.A contingency table was used to determine the sensitivity,specificity,and predictive value of the NRI in screening patients at risk of malnutrition,in comparison with the PG-SGA in patients before radiotherapy.Results：The findings of PG-SGA and NRI showed that 52％ and 45％ of patients in our study were moderately or severely malnourished respectively.The NRI had a sensitivity of 66％ and a specificity of 60％ against PG-SGA.The positive predictive value was 64％ and the negative predicative value was 62％.The agreement between NRI and PG-SGA was statistically insignificant （kappa =0.267; P＞0.05）.Conclusions：The findings of present study showed that the prevalence of malnutrition was high in patients with colorectal cancer.Moreover,NRI method had low sensitivity and specificity in assessing nutritional status of patients with cancer.It seems that the combination of anthropometric,laboratory parameters and a subjective scoring system may be helpful tools in screening of malnutrition in cancer patients.     

肿瘤患者营养不良筛查评估及意义

肿瘤患者营养不良发病率高，尤其多见于消化道肿瘤、头颈部肿瘤和肺癌。门诊患者需要营养治疗建议的比例最低，住院患者较高，家庭护理患者需要营养治疗建议的比例最高。肿瘤相关蛋白质-能量营养不良可以产生多种负面影响，如治疗风险增加和死亡率提高，早发现、早诊断有利于肿瘤患者的康复和预后。营养不良筛查和评估工具的临床应用有利于肿瘤相关蛋白质-能量营养不良的早发现、早诊断。与人体测量相比，营养不良筛查和评估工具及临盘床预后一致性更好。SGA、MNA和PG-SGA都可以作为肿瘤患者营养不良的筛查和评估工具，有临床应用前景，其中PG-SGA是最适合肿瘤患者，敏感性和特异性均较高的方法，值得推广。     

The Effect of Omega-3 Enriched Oral Nutrition Supplement on Nutritional Indices and Quality of Life in Gastrointestinal Cancer Patients: A Randomized Clinical Trial

Objective: Gastrointestinal (GI) cancer patients often experience severe malnutrition during cancer therapies due to gastrointestinal dysfunctions including poor digestion and absorption as well as tumor-associated anorexia. In this study, we performed a randomized clinical trial to determine the efficacy of oral nutrition supplement (ONS) enriched with omega-3 fatty acids on nutritional status, quality of life (QOL), and pro-inflammatory indices. Methods: Patients diagnosed with GI cancers were recruited and screened for eligibility. A total of 58 patients were randomly allocated to either the control group (n=27) or the experimental group (n=31). The intervention group received 200 ml ONS twice a day while the control group received routine care. Anthropometrics, Patient-Generated Subjective Global Assessment (PG-SGA) score, QOL score and nutrient intake data were collected at baseline, week 4 and week 8. Blood was drawn for biochemical assessments. Nine patients from each group dropped out of the study Forty patients (18 control patients and 22 intervention patients) completed the study. Results: This study showed that ONS intervention improved PG-SGA scores in the intervention group (p<0.01). Scores of physical functioning score and role functioning were declined only in the control group and the difference between week 8 and baseline for role functioning was significant (p<0.001). Fatigue score was steadily decreased in the experiment group, and the differences between week 8 and baseline was significant between two groups (p<0.02). However, no statistically significant improvement in biochemical markers of nutritional status and pro-inflammatory cytokine concentrations were found. These results suggests that ONS intervention for 8 weeks improves PG-SGA scores and QOL scores in patients undergoing cancer therapy.     

血清Orexin A、ALB、Leptin水平用于胃肠道肿瘤营养不良预测的临床价值

目的:探析血清中细胞因子Orexin A、ALB、Leptin水平与胃肠道肿瘤营养不良的相关性,为临床营养状况评估提供依据。方法:回顾性分析2016年3月至2017年12月间在本院住院治疗的124例胃肠道肿瘤患者的诊疗数据,采用PG-SGA评分系统对患者营养状况进行评估,并对其血清中Orexin A、ALB、Leptin、TNF-α等细胞因子水平进行生化检测,采用Logistic回归方法分析胃肠道肿瘤营养中相关因素。结果:根据PG-SGA评分,A级（营养状况良好）患者43例,B级（中度或可疑营养不良）患者59例,C级（重度营养不良）患者22例。营养不良患者所占比例65.32%。单因素分析中,患者年龄、血清中Orexin A、ALB、TNF-α和Leptin水平与营养状态有关（P＜0.05）。Logistic回归分析得出患者血清中Orexin A（OR=1.075,95%CI:1.025~1.126）、ALB（OR=0.932,95%CI:0.681~1.276）、Leptin（OR=2.077,95%CI:2.009~2.148）的含量与营养状况有相关性。ROC曲线分析显示Orexin A（AUG=0.708）、ALB（AUG=0.791）、Leptin（AUG=0.592）水平均可用于胃肠道肿瘤患者营养不良的预测,且可用作联合诊断。结论:血清中Orexin A、ALB、Leptin水平与胃肠道肿瘤营养不良相关,可用于临床营养不良的预测。     

口服营养补充剂对胃癌患者辅助化疗期间营养状况及化疗相关毒副反应耐受性的影响

目的:探讨服用口服营养补充剂对胃癌术后患者辅助化疗期间营养状况及化疗相关毒副反应耐受性的影响。方法:回顾性分析中国人民解放军北部战区总医院肿瘤科2017年1月-2017年12月收治的胃癌术后首次接受辅助化疗的59名患者,其中28名患者自入院起即接受常规营养教育和口服肠内营养补充(ONS)且持续至化疗4周期以上作为ONS组, 31名患者仅接受常规营养饮食教育作为对照组。比较两组患者化疗前及4周期化疗后的营养状况及化疗相关不良反应严重程度。结果:两组患者化疗前一般情况、PG-SGA评分、体重指数（BMI）、血清白蛋白(ALB）水平无明显统计学差异（P＞0.05）。经过4周期化疗后,ONS组患者PG-SGA评分（12.61±1.93）低于对照组（14.84±2.21）（P＜0.05）;ONS组患者体重指数BMI（22.32±3.06）kg/m2高于对照组患者（20.49±2.91）kg/m2（P＜0.05);ONS组患者血清白蛋白（35.36±3.89）g/L高于对照组（31.32±3.03）g/L（P＜0.05）;ONS组化疗相关骨髓抑制及消化道不良反应严重程度低于对照组（P＜0.05）。结论:口服营养补充剂可以有效改善胃癌术后患者辅助化疗期间的营养不良状态,降低化疗毒副反应严重程度,增加化疗毒副反应的耐受性。     

The relationship of nutritional status with anticancer immunity and its prognostic value for head and neck cancer

Malnutrition has been reported to be associated with reduced survival and deficient anticancer immunity, and undernourishment is a frequent comorbidity in head and neck cancer (HNC) patients. In this study, we evaluated the relationship between nutritional status and immunologic factors, and its prognostic value for HNC. We retrospectively reviewed 212 HNC patients who had undergone a nutrition evaluation based on the Patient-Generated Subjective Global Assessment (PG-SGA) and curative radiotherapy (RT). The role of nutritional status in the prognosis of HNC and its correlation with anticancer immune response was assessed in HNC patients, and in the 4-nitroquinoline 1-oxide (4NQO)-induced tongue tumor animal model. Our data revealed that malnutrition (high PG-SGA scores) was significantly associated with more advanced disease, lower body mass index, lower RT completion rates, and reduced survival. Patients in the group with high PG-SGA scores had a higher neutrophil-to-lymphocyte ratio, higher proportion of myeloid-derived suppressor cells (MDSCs), and elevated IL-6 levels in the peripheral circulation. Patients with increased PG-SGA scores following treatment were more likely to developing locoregional failure. In the 4NQO-induced tumor model, nutritional supplementation decreased the rate of invasive tumor formation and attenuated the immune-suppressive microenvironment. Following ectopic tumor implantation in an immunocompetent host, nutrition supplements decreased tumor growth in association with attenuated MDSC recruitment and lower IL-6 expression. In conclusion, malnutrition by PG-SGA was associated with poor prognosis in HNC patients. Based on the data of HNC patients and the 4NQO-tumor model, adequate nutritional supplementation might improve the prognosis associated with augmented anticancer immunity.