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Liu X, Li M, Zhao Y, Jiao X, Yu Y, Li R, Zeng S, Chi J, Ma G, Huo Y, Peng Z, Liu J, Zhou Q, Zou D, Wang L, Li Q, Wang J, Yao S, Chen Y, Ma D, Hu T, Gao Q. The impact of preoperative immunonutritional status on postoperative complications in ovarian cancer. J Ovarian Res 2025; 18:88. [PMID: 40301987 PMCID: PMC12038932 DOI: 10.1186/s13048-025-01624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 02/13/2025] [Indexed: 05/01/2025] Open
Abstract
BACKGROUND Preoperative immunonutritional status can influence postoperative complications. Malnutrition in ovarian cancer patients diminishes the body's resilience to abdominal surgery, resulting in inferior surgical outcomes and increased postoperative complications. We aim to investigate the effect of preoperative immunonutritional status, including NLR, PLR, LMR, TCLR, FAR, FLR, SII, PNI and CONUT on postoperative complications in epithelial ovarian cancer (EOC) in a large population. METHODS A multicenter real-world study included 922 patients with histologically confirmed EOC who received comprehensive staged surgery or debulking surgery at seven tertiary hospitals in China between 2012 and 2023. Logistic regression and Lasso regression analyses were employed to identify variables associated with postoperative complications. A predictive nomogram model was developed based on multivariate modeling. RESULTS The study included a total of 922 patients diagnosed with epithelial ovarian cancer across seven medical centers with 565 (61.3%) patients experiencing postoperative complications. Significant differences were found in the distribution of inflammatory and nutritional risk indicators, including NLR, PLR, LMR, TCLR, FAR, FLR, SII, PNI and CONUT between the two groups (all P < 0.01). A multivariable model identified several predictive factors for postoperative complications: PNI > 46.73 (odds ratio [OR] = 0.49, P < 0.001), FAR > 10.77 (OR = 1.60, P = 0.019), LMR > 3.70 (OR = 0.68, P = 0.044), hydrothorax (OR = 2.60, P = 0.005), laparoscopy (OR = 0.59, P = 0.010 vs. laparotomy), enterectomy (OR = 2.50, P = 0.001). CONCLUSION Poor immunonutritional status can increase the risk of postoperative complications. These findings suggest that prompt nutritional interventions may reduce the incidence of postoperative complications and improve surgical outcomes. The risk prediction model, including PNI, FAR, LMR, hydrothorax, laparoscopy vs. laparotomy, and enterectomy, might facilitate patient-centered decision-making and risk stratification. CLINICAL TRIAL REGISTRATION The study was registered in the Clinical trial registry: NCT06483399. ( https://clinicaltrials.gov/study/NCT06483399 ).
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Grants
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 2022YFC2704200 National Key Research and Development Program of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 81772787, 82072889 National Natural Science Foundation of China
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- 20A0769 Major Project of Chinese Society of Medical Education
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
- Y-2019AZZD-0359, Y-2019AZQN-0385 Beijing Xisike Clinical Oncology Research Foundation
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Affiliation(s)
- Xingyu Liu
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Ming Li
- Department of Gynaecology and Obstetrics, Henan Provincial People's Hospital, Henan, China
| | - Yingjun Zhao
- Department of Gynaecology and Obstetrics, Henan Provincial People's Hospital, Henan, China
| | - Xiaofei Jiao
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Yang Yu
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Ruyuan Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoqing Zeng
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Jianhua Chi
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Guanchen Ma
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Yabing Huo
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Zikun Peng
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Jiahao Liu
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Qi Zhou
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
| | - Dongling Zou
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Li Wang
- Department of Cancer Biology Immunotherapy, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Qingshui Li
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Jing Wang
- Hunan Clinical Research Center in Gynecologic Cancer, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- Department of Gynecologic Cancer, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Youguo Chen
- Department of Gynecology & Obstetrics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Ding Ma
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China
| | - Ting Hu
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China.
| | - Qinglei Gao
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430000, China.
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Kim J, Lee CH, Yim GW. Multimodal Prehabilitation for Gynecologic Cancer Surgery. Curr Oncol 2025; 32:109. [PMID: 39996909 PMCID: PMC11853901 DOI: 10.3390/curroncol32020109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Revised: 02/11/2025] [Accepted: 02/12/2025] [Indexed: 02/26/2025] Open
Abstract
Surgical treatment is commonly employed to treat patients with gynecologic cancer, although surgery itself may function as a stressor, reducing the patients' functional capacity and recovery. Prehabilitation programs attempt to improve patients' overall health and baseline function prior to surgery, thereby enhancing recovery and lowering morbidity. In recent years, prehabilitation has come to primarily refer to multimodal programs that combine physical activity, nutritional support, psychological well-being, and other medical interventions. However, the specific methods of implementing prehabilitation and measuring its effectiveness are heterogeneous. Moreover, high-level evidence regarding prehabilitation in gynecologic cancer surgery is limited. This review provides a summary of multimodal prehabilitation studies in gynecologic oncologic surgery. Enhanced postoperative recovery, lower postoperative complications, lower rate of blood transfusions, and faster gastrointestinal functional recovery have been reported after multimodal prehabilitation interventions. Patients and healthcare professionals should recognize the importance of prehabilitation in the field of gynecologic oncologic treatment, based on the emerging evidence. In addition, there is a need to establish an appropriate target group and construct a well-designed and tailored prehabilitation program.
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Affiliation(s)
| | | | - Ga Won Yim
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang 10326, Republic of Korea; (J.K.); (C.H.L.)
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Legault EP, Ribeiro PAB, Moreau-Amaru D, Robert E, Forte S, Comtois AS, Samouëlian V, Tournoux F. The PREPARE Study: Acceptability and Feasibility of a Telehealth Trimodal Prehabilitation Program for Women with Endometrial Neoplasia. Curr Oncol 2025; 32:55. [PMID: 39851971 PMCID: PMC11763516 DOI: 10.3390/curroncol32010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 01/11/2025] [Accepted: 01/13/2025] [Indexed: 01/26/2025] Open
Abstract
Patients with endometrial neoplasia (EN) often have multiple comorbidities and a higher surgical risk. Prehabilitation programs (PPs) combine various interventions to improve preoperative conditions and reduce impairment due to surgical stress. We conducted a pragmatic pilot study to evaluate the acceptability and feasibility of a trimodal telehealth PP (exercise, nutrition, and psychological support) for EN patients. The participants could select their exercise group: (1) a supervised PP (SPP), group sessions 3×/week; (2) a semi-supervised PP (SSPP), group session 1×/week, training alone 2×/week; or (3) a physical activity counseling session (PACS). Out of the 150 EN patients awaiting surgery screened during the 18 months of the study recruitment, 66% (99/150) were eligible, and 40% consented to participate (SPP, n = 13; SSPP, n = 17; PACS, n = 9). The overall dropout was low (13%; 5/39), with no significant differences across groups. No serious adverse events occurred. We observed a positive impact on different outcomes across the different groups, such as in the Functional Assessment of Cancer Therapy quality of life score (SPP; delta = 6.1 [CI: 0.9; 12.6]) and functional capacity measured using the 30″ sit-to-stand test (PACS delta = 2.4 [CI: 1.2; 3.6]). The same-day hospital leave was high in the SSPP group (54.5%). Our pilot telehealth PP seems to be safe, feasible, and well accepted and may procure clinical and patient-centered gains that need to be confirmed in a larger trial.
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Affiliation(s)
- Elise P. Legault
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC H2L 1Y4, Canada;
| | - Paula A. B. Ribeiro
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
| | - Danielle Moreau-Amaru
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Emmanuelle Robert
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Sara Forte
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Alain S. Comtois
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC H2L 1Y4, Canada;
| | - Vanessa Samouëlian
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X 0A9, Canada
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - François Tournoux
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
- Service de Cardiologie du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada
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Aru N, Yang C, Chen Y, Liu J. Low L3 skeletal muscle index and endometrial cancer: a statistic pooling analysis. BMC Cancer 2025; 25:43. [PMID: 39780132 PMCID: PMC11716173 DOI: 10.1186/s12885-025-13430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 01/02/2025] [Indexed: 01/11/2025] Open
Abstract
OBJECTIVE Sarcopenia, a condition characterized by the gradual decline of muscle mass, strength, and function, is a key indicator of malnutrition in cancer patients and has been linked to poor prognoses in oncology. Sarcopenia is commonly assessed by measuring the skeletal muscle index (SMI) of the third lumbar spine (L3) using computed tomography (CT). This meta-analysis aimed to explore the relationship between low SMI and clinicopathological features, as well as prognosis, in individuals with endometrial cancer (EC). METHODS Data from various databases including PubMed, Embase, Cochrane, Medline, and Web of Science were searched up until October 20th, 2024. Studies that investigated the association of low SMI and EC survival or clinicopathological characteristics were included. Pooled effect sizes were reported as hazards ratio (HR), odds ratios (ORs) or weighted mean difference (WMD). The quality and risk of bias in the studies were evaluated using the Newcastle-Ottawa Scale (NOS) and the Quality In Prognosis Studies (QUIPS), and the study was registered on PROSPERO (CRD42024509949) before commencing the search. RESULTS A total of 218 studies were identified across all five databases, with 11 studies meeting the criteria for qualitative and quantitative analysis, involving 1588 patients. The findings of our meta-analysis demonstrated a significant link between low SMI and progression-free survival [P = 0.002; HR: 1.62, 95% CI: 1.20-2.17]. Low SMI was also associated with a BMI < 25 (P < 0.00001; OR: 4.55, 95% CI: 3.01-6.87), FIGO stage (P = 0.04; OR: 1.33, 95% CI: 1.01-1.75), pathology grades (P = 0.001; OR: 1.77, 95% CI: 1.26-2.49), and the endometrioid pathological type (P = 0.01; OR: 0.68, 95% CI: 0.51-0.92). However, no significant correlation was found between low SMI and 5-year overall survival, serous pathological type, recurrence, length of hospital stay, intraoperative complications, and postoperative complications. All the included studies scored ≥ 7 on the NOS, indicating relatively high-quality evidence. CONCLUSIONS The meta-analysis highlighted the association between low SMI and unfavorable clinical features and outcomes in EC patients, emphasizing the importance of early diagnosis and appropriate management of sarcopenia assessed by low SMI to enhance prognoses in EC patients.
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Affiliation(s)
- Na Aru
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Congyu Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuntian Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaming Liu
- Department of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China.
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Ma N, He X, Nei Q, Liu Z, Chen X, Chang H, Yao K, Guo S. Serum hemoglobin and albumin levels serve as prognostic predictors after adrenal metastasectomy. Discov Oncol 2024; 15:759. [PMID: 39692934 DOI: 10.1007/s12672-024-01647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 11/27/2024] [Indexed: 12/19/2024] Open
Abstract
PURPOSE Adrenal metastasectomy is a common local treatment for adrenal metastases, with a lack of serum prognostic factors. Here, we identified the prognostic significance of preoperative hemoglobin and albumin levels in patients undergoing adrenal metastasectomy. MATERIALS AND METHODS Data from 93 patients who underwent adrenal metastasectomy were assessed retrospectively. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff values of hemoglobin and albumin for survival. Overall survival (OS) and disease-free survival (DFS) were evaluated using the Kaplan-Meier method, thereafter Cox regression models and subgroup analyses were applied to adjust confounding factors. A risk stratification developed by joint use of serum hemoglobin and albumin levels was also tested. RESULTS Optimal cut-off points were 130.5 g/L and 44.8 g/L for hemoglobin and albumin, respectively. Multivariate Cox regression analysis identified decreased hemoglobin (HR [95% CI]: 0.41 [0.18-0.91], P = 0.029) and albumin (HR [95% CI]: 0.12 [0.02-0.88], P = 0.038) levels as independent factors for poorer OS. Patient with both decreased hemoglobin and albumin levels had the worst OS (P = 0.001) and DFS (P = 0.001) than other risk groups. Subgroup analyses proved decreased hemoglobin and albumin levels predicted poorer OS independent of cancer types. CONCLUSIONS Preoperative hemoglobin and albumin levels may serve as prognostic predictors after adrenal metastasectomy. A prognostic model that combines hemoglobin and albumin can improve accuracy in predicting patient outcomes and be easily implemented in clinical practice.
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Affiliation(s)
- Nan Ma
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xiaobo He
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Qiwei Nei
- Department of Urology, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, 519000, China
| | - Zhenhua Liu
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xianda Chen
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Hui Chang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Kai Yao
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
| | - Shengjie Guo
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
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Yüksel B, Dumlu Bilgin G, Kavsara HK. Exploring the Relationship Between Dietary Phytochemical Index and Chemotherapy-Related Symptoms: Insights From a Cross-Sectional Study. Food Sci Nutr 2024; 12:10306-10314. [PMID: 39723091 PMCID: PMC11666823 DOI: 10.1002/fsn3.4568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 10/04/2024] [Accepted: 10/11/2024] [Indexed: 12/28/2024] Open
Abstract
Phytochemicals may confer substantial benefits in alleviating chemotherapy-related symptoms. This cross-sectional study aimed to determine the role of dietary phytochemicals on treatment-related symptoms in patients receiving chemotherapy. Data including demographic variables, anthropometric measures such as weight and height, 3-day food record, and Nightingale Symptom Assessment Scale (N-SAS), a composite measure of patients' chemotherapy-related symptoms, were gathered via face-to-face interviews. The dietary phytochemical index (DPI) was computed based on the patient's food records and presented by dividing into quartiles. The study included 152 participants with a mean age of 59.59 ± 13.19 years. The mean N-SAS score was 2.16 ± 0.80. The average DPI score for the entire group was 24.66 ± 6.55, significantly higher in women (26.61 ± 6.06) than men (23.05 ± 6.54) (p = 0.001). As the DPI quartile values increased, there was a statistically significant decrease in N-SAS scores (p = 0.002). A significantly negative correlation was found between the N-SAS score and DPI, as well as all cancers (r = -0.364; p < 0.001). Additionally, a negative correlation was observed between the N-SAS score and specific cancer types, comprising lung cancer (r = -0.513; p = 0.005), breast cancer (r = -0.612; p < 0.001), and gastrointestinal system (GIS) cancer (r = -0.329; p = 0.033). Increasing dietary phytochemicals in chemotherapy patients may help manage treatment-related symptoms. Phytochemicals may confer substantial benefits in alleviating chemotherapy-related symptoms. This cross-sectional study aimed to determine the role of dietary phytochemicals on cancer-related symptoms in patients receiving chemotherapy. A significantly negative correlation was found between N-SAS score and DPI and all cancers (r = -0.364; p < 0.001) and different cancer types such as lung (r = -0.513; p = 0.005), breast (r = -0.612; p < 0.001), and GIS (r = -0.329; p = 0.033). As a result, increasing dietary phytochemicals in chemotherapy patients may help manage treatment-related symptoms.
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Affiliation(s)
- Barış Yüksel
- Department of Nutrition and DieteticsYeditepe University, Institute of Health SciencesIstanbulTürkiye
| | - Gözde Dumlu Bilgin
- Faculty of Health Sciences, Department of Nutrition and DieteticsYeditepe UniversityIstanbulTürkiye
| | - Hasan Kaan Kavsara
- Faculty of Health Sciences, Department of Nutrition and DieteticsYeditepe UniversityIstanbulTürkiye
- Graduate School of Health Sciences, Nutrition and DieteticsIstanbul Medipol UniversityIstanbulTürkiye
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Mayer A, Cibula D. Optimizing prehabilitation in gynecologic malignancies: Improving acceptance, overcoming barriers, and managing program complexity. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108739. [PMID: 39418833 DOI: 10.1016/j.ejso.2024.108739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/23/2024] [Accepted: 10/01/2024] [Indexed: 10/19/2024]
Abstract
Prehabilitation aims to improve patients' physical condition before a stressful event, such as surgery, and enhance recovery. Despite its potential benefits, many emerging prehabilitation programs face challenges in enrolling or retaining patients. In our prehabilitation study PHOCUS, which aims to prepare ovarian cancer patients for surgery, we have also encountered lower acceptance and retention rates. Particularly the most vulnerable patients, who are old and frail, and may benefit the most from the prehabilitation, decline participation due to the complexity of the proposed program. In our review we discussed obstacles and barriers that prevent patients' participation based on both literature and our experience. Among the main reasons are patient's low motivation, high intensity of the program and a lack of social support. To overcome these challenges, we suggest increasing the program's flexibility, adapting the program according to individual patient's needs and enhancing patients' education about the benefits of prehabilitation.
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Affiliation(s)
- Alexandra Mayer
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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8
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Ho C, Mohd Yusof BN, Abdul Majid H, Daud ZAM. Effect of perioperative immunonutrition intervention among gynecological cancer patients: A systematic review. Clin Nutr ESPEN 2024; 64:168-176. [PMID: 39362334 DOI: 10.1016/j.clnesp.2024.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 08/15/2024] [Accepted: 09/25/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Gynecologic cancer (GC) patients often experience systemic inflammation, malnutrition, and compromised postoperative outcomes. This systematic review aims to comprehensively synthesize existing data regarding the impact of perioperative immunonutrition (IMN) intervention on GC patients. METHODS The databases of CENTRAL, EMBASE, Web of Science, and the Cochrane Library were used to conduct a literature search, supplemented by internet search engines and manual searches. Publications released between January 2009 and October 2023 was identified, reviewed, and data extracted. RESULTS The review encompasses six studies involving 712 patients, comprising two randomized controlled trials (RCTs), two prospective studies, and two retrospective cohort studies. Three studies prescribed IMN perioperatively; two pre-operatively and one post-operatively. Four out of six studies reported less post-operative infection and complications. Two studies reported shorter hospitalization using the IMN formula. One study reported a longer hospitalization with IMN supplementation. Overall survival showed no significant difference in the two studies. Four studies reported positive modulation of inflammatory markers and lymphocytes as outcomes, with IMN formulas. DISCUSSION AND CONCLUSION Perioperative IMN emerge as a promising intervention, demonstrating notable benefits included shortened hospitalization as well and positive modulation of inflammatory markers.
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Affiliation(s)
- ChiouYi Ho
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Seri Kembangan, Selangor, Malaysia; Department of Dietetics and Food Service, Institut Kanser Negara, Ministry of Health Malaysia, 4, Jalan P7, Presint 7, 62250 Wilayah Persekutuan Putrajaya, Malaysia.
| | - Barakatun Nisak Mohd Yusof
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Seri Kembangan, Selangor, Malaysia.
| | - Hazreen Abdul Majid
- School of Health and Rehabilitation Sciences, AECC University College, Parkwood Campus, Parkwood Road, Bournemouth Dorset, BH5 2DF, United Kingdom; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Seri Kembangan, Selangor, Malaysia.
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9
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Vaz J, Piver R, Brzezinska B, Suhner J, Sareddy S, Vuppala P, Vernon M, Xu H, Rungruang B, Johnson M, Higgins RV, Ghamande S, Richardson KP, McIndoe R, Purohit S, Mysona D. Nutrition's checkpoint inhibition: The impact of nutrition on immunotherapy outcomes. Gynecol Oncol 2024; 189:129-136. [PMID: 39116830 DOI: 10.1016/j.ygyno.2024.07.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To determine if nutritional status effects response to immunotherapy in women with gynecologic malignancies. METHODS A retrospective chart review was conducted on gynecologic cancer patients who received immunotherapy at a single institution between 2015 and 2022. Immunotherapy included checkpoint inhibitors and tumor vaccines. The prognostic nutritional index (PNI) was calculated from serum albumin levels and total lymphocyte count. PNI values were determined at the beginning of treatment for each patient and assessed for their association with immunotherapy response. Disease control response (DCR) as an outcome of immunotherapy was defined as complete response, partial response, or stable disease. RESULTS One hundred and ninety-eight patients received immunotherapy (IT) between 2015 and 2022. The gynecological cancers treated were uterine (38%), cervix (32%), ovarian (25%), and vulvar or vaginal (4%) cancers. The mean PNI for responders was higher than the non-responder group (p < 0.05). The AUC value for PNI as a predictor of response was 49. A PNI value of 49 was 43% sensitive and 85% specific for predicting a DCR. In Cox proportional hazards analysis, after adjusting for ECOG score and the number of prior chemotherapy lines, severe malnutrition was associated with progression-free survival (PFS) (HR = 1.85, p = 0.08) and overall survival (OS) (HR = 3.82, p < 0.001). Patients with PNI < 49 were at a higher risk of IT failure (HR = 2.24, p = 0.0001) and subsequent death (HR = 2.84, p = 9 × 10-5). CONCLUSIONS PNI can be a prognostic marker to predict response rates of patients with gynecologic cancers treated with immunotherapy. Additional studies needed to understand the mechanistic role of malnutrition in immunotherapy response.
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Affiliation(s)
- Jennifer Vaz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Rachael Piver
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Bogna Brzezinska
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Jessa Suhner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Sneha Sareddy
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Priyanka Vuppala
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Marlo Vernon
- Department of Biostatistics, Data Science and Epidemiology, School of Public Health, Augusta University, Augusta, GA, USA
| | - Hongyan Xu
- Department of Biostatistics, Data Science and Epidemiology, School of Public Health, Augusta University, Augusta, GA, USA
| | - Bunja Rungruang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Marian Johnson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Robert V Higgins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Sharad Ghamande
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Katherine P Richardson
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Richard McIndoe
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Sharad Purohit
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - David Mysona
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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10
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Oppermann A, James S, Minotti MM, Schotz KM, Francis ME, Kleckner IR, Vyfhuis MAL, Ferris MJ, Baguley BJ, Kleckner AS. Dietary Counseling Interventions During Radiation Therapy: A Systematic Review of Feasibility, Safety, and Efficacy. Nutr Cancer 2024; 77:26-50. [PMID: 39340400 DOI: 10.1080/01635581.2024.2406999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 09/14/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024]
Abstract
Radiotherapy is a common cancer treatment, and concurrent nutritional interventions can maintain nutritional status and improve clinical and supportive care outcomes. However, optimal nutritional interventions during radiotherapy are not firmly established. Herein, we assessed the feasibility, safety, and efficacy of dietary counseling interventions without oral nutrition supplements on health outcomes in adults receiving radiotherapy for cancer in a systematic review. Prospective clinical trials that implemented nutritional counseling interventions during radiotherapy were identified from four databases from inception through December 2023. Feasibility, safety, and efficacy were extracted from 32 articles that described 23 randomized and 4 non-randomized clinical trials. The interventions included individualized nutritional counseling (n = 14 articles), nutritional counseling plus exercise (n = 4), and nutritional counseling focused on increasing or reducing intake of specific nutrients (n = 9). Trials targeted head and neck (n = 12), pelvic cancers (n = 14), and/or breast (n = 5) cancers. Control groups had variable designs and included general nutrition education and intervention as needed. Studies recruited 120 ± 104 participants (range 26-468). Interventions tended to be feasible regarding retention and attendance at sessions, though feasibility metrics varied among different interventions. Most interventions were safe with no studies reporting adverse events attributable to dietary intervention. Individualized dietary counseling interventions tended to lead to between-group differences favoring the intervention group in regard to improved nutritional status, maintenance or attenuation of loss of body mass, improved quality of life, and reduced radiation-induced toxicities. Diets that encouraged/discouraged specific nutrients tended to recruit patients receiving radiation to the pelvic area and resulted in positive or neutral effects on gastrointestinal symptoms. In conclusion, nutritional interventions appear to be feasible, safe, and effective during radiotherapy for various symptom outcomes.
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Affiliation(s)
- Alexie Oppermann
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Shalet James
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Mackenzie M Minotti
- University of Maryland Medical System, Baltimore, Maryland, USA
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Kaitlin M Schotz
- University of Maryland Medical System, Baltimore, Maryland, USA
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | | | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Melissa A L Vyfhuis
- University of Maryland Medical System, Baltimore, Maryland, USA
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew J Ferris
- University of Maryland Medical System, Baltimore, Maryland, USA
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Amber S Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
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11
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Zhang M, Chen G, Jin X, Wang J, Yu S. Pre-Operative Immunonutrition Enhances Postoperative Outcomes and Elevates Tumor-Infiltrating Lymphocyte Counts in Colorectal Cancer Patients: A Meta-Analysis of Randomized Controlled Trials. Nutr Cancer 2024; 76:499-512. [PMID: 38655678 DOI: 10.1080/01635581.2024.2344250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study (CRD42023464989) aimed to explore the effects of pre-operation immunonutrition on safety and immune related factors in colorectal cancer patients undergoing surgery. METHODS We systematically searched PubMed, Embase, and Wanfang databases to collect all clinical randomized controlled trials of the application of pre-operation immunonutrition for patients with colorectal cancer, published until July 2023. The primary outcomes were safety and immune related factors. RESULTS A total of 16 studies were finally included. Preoperative immunonutrition could reduce the postoperative infection rate (risk ratio (RR) = 0.56, 95% confidence interval (CI): 0.36, 0.88; p = .01), and wound infection rate (RR = 0.44, 95% CI: 0.27, 0.70; p < .001) in patients with colorectal cancer. For length of stay (mean difference (MD) = -1.10, 95% CI: -2.70, 0.49; p = .17), it was similar between groups. Meanwhile, patients in the pre-operation immune nutrition group also had significantly increased infiltrative lymphocytes CD16+ (MD = 0.04, 95% CI: 0.02, 0.06; p < .001), and CD56+ (MD = 0.05, 95% CI: 0.03, 0.06; p < .001) cells in the tumor tissues, compared to the control group. CONCLUSION Immunonutrition intervention has the potential to reduce postoperative infectious complications and improve tumor infiltrative lymphocytes in patients with colorectal cancer undergoing surgery.
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Affiliation(s)
- Mingqi Zhang
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guofeng Chen
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoli Jin
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jun Wang
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shaojun Yu
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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12
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Zhao L, Shen X, Yang L, Wang P, Zhang J, Liu N, Xie Y. Association of prognostic nutritional index with mortalities in American adult cancer survivors: A cohort study based on NHANES, 1999-2018. Food Sci Nutr 2024; 12:1834-1846. [PMID: 38455180 PMCID: PMC10916647 DOI: 10.1002/fsn3.3877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 03/09/2024] Open
Abstract
The prognostic nutritional index (PNI) has been associated with disease progression and overall survival among cancer patients. Nonetheless, the association between PNI and mortality risk in adult cancer patients within the United States remains unexplored. This study aims to elucidate the connection between PNI and prognostic outcomes in American adult cancer patients. This cohort study derived data from the National Health and Nutrition Examination database, involving 4366 American adults diagnosed with cancer between 1999 and 2018. The nutritional status was assessed using the PNI, with higher PNI scores indicating a more favorable nutritional status. The study employed Kaplan-Meier curves and Cox proportional hazard regression to investigate the impact of PNI on various outcomes, including all-cause mortality (ACM), cardiovascular mortality (CAM), and malignancy tumor mortality (MTM) among adult cancer patients. Furthermore, restricted cubic spline models were used to examine the potential nonlinear relationship between the variables by creating hazard ratio (HR) curves at four specific points. The median follow-up duration was 84 months, during which 1530 (35.04%) cases of ACM occurred, including 331 (13.67%) CAM and 449 (10.45%) MTM. COX regression analysis revealed a significant inverse association between PNI and patient prognosis, with HRs of 0.95 (95% CI: 0.93-0.96, p < .001) for ACM, 0.93 (95% CI: 0.90-0.96, p < .001) for CAM, and 0.94 (95% CI: 0.91-0.97, p < .001) for MTM. Both Kaplan-Meier analyses and restricted cubic spline curves showed significant differences in mortality rates related to PNI (p < .001, nonlinear p < .001). Our study provides compelling evidence of a clear association between PNI and reduced risk of ACM, CAM, and MTM in adult cancer patients in the United States. These findings underscore the significance of incorporating PNI as a possible prognostic indicator for individuals diagnosed with cancer.
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Affiliation(s)
- Li Zhao
- Department of Nursing, Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan UniversityJiangnan UniversityWuxiJiangsuChina
| | - Xia Shen
- Department of Nursing, Wuxi Medical CollegeJiangnan UniversityWuxiJiangsuChina
| | - Long Yang
- College of PediatricsXinjiang Medical UniversityUrumqiChina
| | - Pengfei Wang
- Department of Anorectal SurgeryChina Academy of Chinese Medical Sciences Xi Yuan HospitalBeijingChina
| | - Jianfeng Zhang
- Department of Nursing, Wuxi Medical CollegeJiangnan UniversityWuxiJiangsuChina
| | - Ning Liu
- Department of the Office of Science and Education, Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan UniversityJiangnan UniversityWuxiJiangsuChina
| | - Yan Xie
- Department of Hospital Sentinel Medicine, Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan UniversityJiangnan UniversityWuxiJiangsuChina
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13
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Bai S, Wu Q, Wu W, Song L. Discussion on the influence of optimizing the perioperative management on the recovery after laparoscopic hysterectomy. Medicine (Baltimore) 2023; 102:e36396. [PMID: 38115304 PMCID: PMC10727684 DOI: 10.1097/md.0000000000036396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023] Open
Abstract
The concept of enhanced recovery after surgery (ERAS) was first proposed by Professor Kehlet from the University of Copenhagen in Denmark in 1997. The aim is to optimize multiple perioperative management measures, promote rapid postoperative recovery, shorten hospital stay, and reduce surgical related costs, this article explores the effect of optimizing perioperative bowel preparation and diet management under the strategy of ERAS on the postoperative recovery of patients undergoing laparoscopic hysterectomy for benign gynecological diseases. We selected 90 patients who underwent laparoscopic total hysterectomy for benign gynecological diseases at Hebei General Hospital from June 2018 to June 2019, these patients are between the ages of 40 and 65. Divide these 90 patients into an experimental group and a control group using a random number table method (n = 45). The experimental group of patients applied the concept of accelerated rehabilitation surgery for perioperative intestinal preparation and dietary management. The control group patients received routine perioperative management. Compare the first postoperative exhaust time, first postoperative defecation time, incision healing status 7 days after surgery, and pelvic infection status 1 month after surgery between 2 groups of patients. The first postoperative exhaust time and first postoperative bowel movement time of the experimental group patients were shorter than those of the control group (P < .05), and the difference was statistically significant; The incidence of poor incision healing 7 days after surgery was lower than that of the control group (P < .05), and the difference was statistically significant; There was no statistically significant difference in the incidence of postoperative pelvic infection between the experimental group and the control group (P > .05). Perioperative intestinal preparation and dietary management under the concept of accelerated rehabilitation surgery can promote postoperative recovery of patients undergoing laparoscopic total hysterectomy, promote incision healing, and have good safety.
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Affiliation(s)
- Suning Bai
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Qi Wu
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Wenfei Wu
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Liyun Song
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
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14
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Niu Z, Yan B. Prognostic and clinicopathological effect of the prognostic nutritional index (PNI) in patients with cervical cancer: a meta-analysis. Ann Med 2023; 55:2288705. [PMID: 38039954 PMCID: PMC10836274 DOI: 10.1080/07853890.2023.2288705] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Numerous studies have explored whether the prognostic nutritional index (PNI) can predict the prognosis of cervical cancer (CC); however, their findings remain controversial. This meta-analysis focused on evaluating the relationship between the PNI and the prognosis of patients with CC. METHODS Relevant articles were collected from specific databases up to March 16, 2023. The relationship between the PNI and survival outcomes in patients with CC was estimated using combined hazard ratios (HRs) and associated 95% confidence intervals (CIs). The association of the PNI with clinicopathological features in patients with CC was assessed by combining odds ratios (ORs) and associated 95% CIs. RESULTS Nine articles with 2508 cases were included in the meta-analysis. According to our pooled findings, a decreased PNI showed a significant association with worse overall survival (OS) (HR = 2.98, 95% CI = 2.22-3.99, p < .001) as well as progression-free survival (PFS) (HR = 2.43, 95% CI = 1.92-3.07, p < .001) in patients with CC. The subgroup analysis indicated that the results were reliable. Moreover, the decreased PNI showed a significant association with the presence of lymph node metastasis (LN metastasis, OR = 1.53, 95% CI = 1.04-82.24, p = .030) and maximum tumor size >4 cm (OR = 1.73, 95% CI = 1.21-2.46, p = .002). However, the PNI was not significantly associated with histology, differentiation, or FIGO stage. CONCLUSION In this study, a low PNI predicted dismal OS and PFS in patients with CC, who also tend to suffer from LN metastasis and larger tumor size. PNI is a promising biomarker for predicting the prognosis of patients with CC in clinical practice.
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Affiliation(s)
- Zheng Niu
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bing Yan
- Department of Pharmacy, The First Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, China
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15
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Miralpeix E, Fabregó B, Rodriguez-Cosmen C, Solé-Sedeño JM, Gayete S, Jara-Bogunya D, Corcoy M, Mancebo G. Prehabilitation in an ERAS program for endometrial cancer patients: impact on post-operative recovery. Int J Gynecol Cancer 2023; 33:528-533. [PMID: 36898697 DOI: 10.1136/ijgc-2022-004130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES Enhanced recovery after surgery (ERAS) and prehabilitation programs are multidisciplinary care pathways that aim to reduce stress response and improve perioperative outcomes. However, literature is limited regarding the impact of ERAS and prehabilitation in gynecologic oncology surgery. The aim of this study was to assess the impact of implementing an ERAS and prehabilitation program on post-operative outcomes of endometrial cancer patients undergoing laparoscopic surgery. METHODS We evaluated consecutive patients undergoing laparoscopy for endometrial cancer that followed ERAS and the prehabilitation program at a single center. A pre-intervention cohort that followed the ERAS program alone was identified. The primary outcome was length of stay, and secondary outcomes were normal oral diet restart, post-operative complications and readmissions. RESULTS A total of 128 patients were included: 60 patients in the ERAS group and 68 patients in the prehabilitation group. The prehabilitation group had a shorter length of hospital stay of 1 day (p<0.001) and earlier normal oral diet restart of 3.6 hours (p=0.005) in comparison with the ERAS group. The rate of post-operative complications (5% in the ERAS group and 7.4% in the prehabilitation group, p=0.58) and readmissions (1.7% in the ERAS group and 2.9% in the prehabilitation group, p=0.63) were similar between groups. CONCLUSIONS The integration of ERAS and a prehabilitation program in endometrial cancer patients undergoing laparoscopy significantly reduced hospital stay and time to first oral diet as compared with ERAS alone, without increasing overall complications or the readmissions rate.
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Affiliation(s)
- Ester Miralpeix
- Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Berta Fabregó
- Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Catalunya, Spain
| | | | | | - Sonia Gayete
- Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Catalunya, Spain
| | - David Jara-Bogunya
- Family and Community Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Marta Corcoy
- Department of Anesthesia, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Catalunya, Spain
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16
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Muacevic A, Adler JR, Konanur Srinivasa NK, Gande A, Anusha M, Dar H. Nutrition Care in Cancer Surgery Patients: A Narrative Review of Nutritional Screening and Assessment Methods and Nutritional Considerations. Cureus 2022; 14:e33094. [PMID: 36721576 PMCID: PMC9884126 DOI: 10.7759/cureus.33094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
Malignancy is a catabolic state, which is precipitated with surgical intervention. Malnutrition is one of the main risk factors for poor outcomes of cancer surgery. We need to screen oncological patients for malnutrition using standardized screening tools, by which patients found to be at nutritional risk are then referred to a registered dietitian for further management. A detailed assessment is required in such patients, which helps in categorizing the patients based on the severity and rendering proper care. Preoperative nutrition care is often overlooked because of the urgency of operating on a cancer patient. Still, studies have shown preoperative nutritional building gives better surgical outcomes and good postoperative quality of life. Preoperative nutrition care includes both early and late preoperative care. For efficient preoperative nutrition care publishing, standard operating procedures at every healthcare center are recommended. Postoperative nutrition care is given to build the patient tackle the surgical trauma, and their diet mainly includes protein to minimize catabolism. Regardless of the route of nutrition delivery, providing appropriate nutrition care in the postoperative period improves cancer patients' condition drastically. Early postoperative nutrition is studied in different cancer surgeries and is considered ideal in cancer surgical patients. There is a need for consensus on the composition of postoperative nutrition. The diet of a cancer patient should include micronutrients like vitamins D and B and minerals along with the usual nutrition care. The use of special diets like branched-chain amino acids and immune nutrition is to be considered on a case-by-case basis and introducing them into the routine care of a patient needs to be studied extensively.
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17
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Ścisło L, Bodys-Cupak I, Walewska E, Kózka M. Nutritional Status Indicators as Predictors of Postoperative Complications in the Elderly with Gastrointestinal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13453. [PMID: 36294035 PMCID: PMC9603671 DOI: 10.3390/ijerph192013453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
In patients scheduled for surgery, nutritional disorders worsen during the perioperative period, which is often a risk factor for postoperative complications. The aim of the study was to determine relationship between the preoperative nutritional status of elderly people with stomach, pancreatic and colon cancer and the incidence of postoperative complications and the length of hospital stay. The study included 143 patients with gastrointestinal cancer, aged 65-68, qualified for surgery. Mini Nutritional Assessment, body mass index questionnaires and medical records were used. Malnutrition was found in 9.8%, and a risk of malnutrition in 53.5% of the respondents. Body mass index showed overweight in 28% and obesity in 14% of the patients. Complications occurred in all types of nutritional status, the most common were those requiring intensive care unit treatment (36.8%), pancreatic and biliary fistulas (29.4%) and surgical site infections (58.2%). Gastric cancer patients at risk of malnutrition stayed longer in the hospital. Postoperative complications and longer hospital stays were observed more frequently in cases of overweight, obesity, malnutrition and its risk. Disturbances in the nutritional status, in the form of malnutrition and its risk, as well as overweight and obesity, determined more frequent occurrence of postoperative complications and longer hospital stay.
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Affiliation(s)
- Lucyna Ścisło
- Department of Clinical Nursing, Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Iwona Bodys-Cupak
- Laboratory of Theory and Fundamentals of Nursing, Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, 31-126 Krakow, Poland
| | - Elżbieta Walewska
- Department of Clinical Nursing, Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, 31-501 Krakow, Poland
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18
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Ferrero A, Vassallo D, Geuna M, Fuso L, Villa M, Badellino E, Barboni M, Coata P, Santoro N, Delgado Bolton RC, Biglia N. Immunonutrition in ovarian cancer: clinical and immunological impact? J Gynecol Oncol 2022; 33:e77. [PMID: 36047379 DOI: 10.3802/jgo.2022.33.e77] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 06/23/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Malnutrition is frequent in ovarian cancer (OC) patients and may compromise post-operative outcomes. The aim of this study is to evaluate the impact of pre-operative immunonutrition on the surgical outcome of OC patients, and on their nutritional, inflammatory and peripheral blood immune status. METHODS A prospective study was performed between September 2016 and April 2020. Immune-enhancing enteral nutrition was administered to 42 patients before surgery according to their nutritional status assessed by the Malnutritional Universal Screening Tool. Biochemical and hematological monitoring was performed before and after immunonutrition. Post-operative outcomes were assessed and compared with those of a similar group of patients treated without nutritional support. RESULTS Of the 42 immune-nourished patients, 23 (54.8%) had a low, 11 (26.2%) an intermediate and 8 (19%) a high risk of malnutrition. After the immunonutritional intake, significant variations of prealbumin, creatinine and white blood cells were detected. All T cell populations had an increasing trend, in particular CD3+ T lymphocytes (p=0.020), CD3+CD8+ cytotoxic T lymphocytes (p=0.046) and lymphocyte with HLA-DR expression (p=0.012). The rate of grade II-III post-operative complications was lower (21.4% vs. 42.9%, p=0.035) and the time of hospitalization was shorter (7.5 vs. 9.2, p=0.009) in the immune-nourished group. CONCLUSION Pre-operative immunonutrition improves the surgical outcome of OC patients. After immunonutrition, an increase of CD3+CD8+ cytotoxic T lymphocytes was observed.
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Affiliation(s)
- Annamaria Ferrero
- Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, University of Torino, Torino, Italy.
| | - Daniela Vassallo
- Division of Dietetics, Mauriziano Hospital, University of Torino, Torino, Italy
| | - Massimo Geuna
- Laboratory of Immunopathology, Division of Pathology, Mauriziano Hospital, University of Torino, Torino, Italy
| | - Luca Fuso
- Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, University of Torino, Torino, Italy
| | - Michela Villa
- Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, University of Torino, Torino, Italy
| | - Enrico Badellino
- Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, University of Torino, Torino, Italy
| | - Martina Barboni
- Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, University of Torino, Torino, Italy
| | - Paola Coata
- Division of Dietetics, Mauriziano Hospital, University of Torino, Torino, Italy
| | - Nathalie Santoro
- Laboratory of Immunopathology, Division of Pathology, Mauriziano Hospital, University of Torino, Torino, Italy
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, Spain
| | - Nicoletta Biglia
- Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, University of Torino, Torino, Italy
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19
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Hu CG, Hu BE, Zhu JF, Zhu ZM, Huang C. Prognostic significance of the preoperative hemoglobin to albumin ratio for the short-term survival of gastric cancer patients. World J Gastrointest Surg 2022; 14:580-593. [PMID: 35979426 PMCID: PMC9258240 DOI: 10.4240/wjgs.v14.i6.580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/20/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemoglobin and albumin are associated with the prognosis of gastric cancer (GC) patients. However, the prognostic value of the hemoglobin to albumin ratio (HAR) for the short-term survival of GC patients with D2 radical resection has not been studied. AIM To investigate the significance of the HAR in evaluating the short-term survival of GC patients after D2 radical resection and to construct a nomogram to predict the prognosis in GC patients after surgery, thus providing a reference for the development of postoperative individualized treatment and follow-up plans. METHODS Cox regression and Kaplan-Meier analysis was used for prognostic analysis. Logistic regression was used to analyze the relationships between HAR and the clinicopathological characteristics of the GC patients. A prognostic nomogram model for the short-term survival of GC patients was constructed by R software. RESULTS HAR was an independent risk factor for the short-term survival of GC patients. GC patients with a low HAR had a poor prognosis (P < 0.001). Low HAR was markedly related to high stage [odds ratio (OR) = 0.45 for II vs I; OR = 0.48 for III vs I], T classification (OR = 0.52 for T4 vs T1) and large tumor size (OR = 0.51 for ≥ 4 cm vs < 4 cm) (all P < 0.05). The nomogram model was based on HAR, age, CA19-9, CA125 and stage, and the C-index was 0.820. CONCLUSION Preoperative low HAR was associated with short-term survival in GC patients. The prognostic nomogram model can accurately predict the short-term survival of GC patients with D2 radical resection.
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Affiliation(s)
- Ce-Gui Hu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Bai-E Hu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jin-Feng Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zheng-Ming Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Chao Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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20
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Advocating for prehabilitation for patients undergoing gynecology-oncology surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1875-1881. [DOI: 10.1016/j.ejso.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 12/18/2022]
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21
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Jiang Y, Gu H, Zheng X, Pan B, Liu P, Zheng M. Pretreatment C-Reactive Protein/Albumin Ratio is Associated With Poor Survival in Patients With 2018 FIGO Stage IB-IIA HPV-Positive Cervical Cancer. Pathol Oncol Res 2022; 27:1609946. [PMID: 34992504 PMCID: PMC8724028 DOI: 10.3389/pore.2021.1609946] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022]
Abstract
Objectives: The present study aimed to identify the predictive value of inflammatory indexes stratified according to human papillomavirus (HPV) infection status in women with FIGO 2018 stage IB∼IIA cervical cancer. We also explored the influences of HPV infection status on the survival of cervical cancer patients. Methods: We collected data for 583 women with stage IB∼IIA cervical cancer in Sun Yat-sen University Cancer Center between 2009 and 2017. The t-test, chi-squared (χ2) test and Fisher’s exact test were applied to compare the differences of inflammatory indexes and clinicopathological features between HPV-positive and HPV-negative groups. Univariate and multivariate analyses were used to identify clinicopathological factors that were associated with the prognosis of cervical cancer patients. Results: There were no differences in overall survival (OS) and progression-free survival (PFS) between HPV-positive and HPV-negative groups. In HPV-positive group, the maximum tumor size, neoadjuvant chemotherapy and the body mass index (BMI) correlated significantly with C-reactive protein/albumin ratio (CAR). The maximum tumor size and the prognostic nutritional index (PNI) correlated significantly with the platelet-lymphocyte ratio (PLR). The maximum tumor size, neoadjuvant chemotherapy and PLR correlated significantly with PNI. Univariate and multivariate analyses showed that the depth of tumor invasion (HR: 3.651, 95% CI: 1.464–9.103, p = 0.005; HR: 2.478, 95% CI: 1.218–5.043, p = 0.012) and CAR (HR: 5.201, 95% CI: 2.080–13.004, p < 0.0001; HR: 2.769, 95% CI: 1.406–5.455, p = 0.003) were independent predictors of poor OS and PFS. PNI was an independent protective factor of OS (HR: 0.341, 95% CI: 0.156–0.745, p = 0.007). PLR was an independent factor of PFS (HR: 1.991, 95% CI: 1.018–3.894, p = 0.044). In HPV-negative group, BMI correlated significantly with CAR. Only depth of invasion (HR: 9.192, 95% CI: 1.016–83.173, p = 0.048) was the independent predictor of poor OS, and no inflammation indexes were independent predictors of prognosis. Conclusion: In patients with HPV-positive cervical cancer, depth of invasion, PNI and CAR are independent factors of OS, and depth of invasion, PLR and CAR are independent factors for PFS. For patients with HPV-negative disease, no inflammation indexes had predictive value for prognosis. The predictive value of inflammation indexes on prognosis is more significant in patients with HPV-positive cervical cancer. Stratification of HPV infection status promotes a more precise clinical application of inflammation indexes, thus improving their accuracy and feasibility.
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Affiliation(s)
- Yinan Jiang
- Department of Gynecology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Haifeng Gu
- Department of Gynecology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xiaojing Zheng
- Department of Gynecology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Baoyue Pan
- Department of Gynecology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Pingping Liu
- Department of Gynecology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Min Zheng
- Department of Gynecology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
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22
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Miralpeix E, Sole-Sedeno JM, Rodriguez-Cosmen C, Taus A, Muns MD, Fabregó B, Mancebo G. Impact of prehabilitation during neoadjuvant chemotherapy and interval cytoreductive surgery on ovarian cancer patients: a pilot study. World J Surg Oncol 2022; 20:46. [PMID: 35197061 PMCID: PMC8864603 DOI: 10.1186/s12957-022-02517-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/10/2022] [Indexed: 12/13/2022] Open
Abstract
Background Cytoreductive surgery followed by systemic chemotherapy is the standard of treatment in advanced ovarian cancer where feasible. Neoadjuvant chemotherapy (NACT) followed by surgery is applicable where upfront cytoreductive surgery is not feasible because of few certain reasons. Nevertheless, surgical interventions and the chemotherapy itself may be associated with postoperative complications usually entailing slow postoperative recovery. Prehabilitation programs consist of the patient’s preparation before surgery to improve the patient’s functional capacity. The aim of this study was to evaluate the impact of a prehabilitation program during neoadjuvant treatment and interval cytoreductive surgery for ovarian cancer patients. Methods A retrospective observational pilot study of patients with advanced ovarian cancer treated with NACT and interval cytoreductive surgery was conducted. The prehabilitation group received a structured intervention based on physical exercise, nutritional counseling, and psychological support. Nutritional parameters were assessed preoperatively and postoperatively, and functional parameters and perioperative and postoperative complications were also recorded. Results A total of 29 patients were included in the study: 14 in the prehabilitation group and 15 in the control group. The patients in the prehabilitation program showed higher mean total protein levels in both preoperative (7.4 vs. 6.8, p = 0.004) and postoperative (4.9 vs. 4.3, p = 0.005) assessments. Up to 40% of controls showed intraoperative complications vs. 14.3% of patients in the prehabilitation group, and the requirement of intraoperative blood transfusion was significantly lower in the prehabilitation group (14.3% vs. 53.3%, p = 0.027). The day of the first ambulation, rate of postoperative complications, and length of hospital stay were similar between the groups. Finally, trends towards shorter time between diagnosis and interval cytoreductive surgery (p = 0.097) and earlier postoperative diet restart (p = 0.169) were observed in the prehabilitation group. Conclusion Prehabilitation during NACT in women with ovarian cancer candidates to interval cytoreductive surgery may improve nutritional parameters and thereby increase postoperative recovery. Nevertheless, the results of this pilot study are preliminary, and further studies are needed to determine the clinical impact of prehabilitation programs.
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Affiliation(s)
- Ester Miralpeix
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, E-08003, Barcelona, Spain. .,Universitat Pompeu Fabra, Barcelona, Spain.
| | - Josep-Maria Sole-Sedeno
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, E-08003, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Alvaro Taus
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain.,Cancer Research Program, IMIM (Hospital del Mar Institute of Medical Research), Barcelona, Spain
| | | | - Berta Fabregó
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, E-08003, Barcelona, Spain
| | - Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, E-08003, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
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23
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Sutton EH, Plyta M, Fragkos K, Di Caro S. Pre-treatment sarcopenic assessments as a prognostic factor for gynaecology cancer outcomes: systematic review and meta-analysis. Eur J Clin Nutr 2022; 76:1513-1527. [PMID: 35194194 DOI: 10.1038/s41430-022-01085-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Gynaecology cancers, including ovarian (OC), endometrial (EC), and cervical (CC), are prevalent with high mortality. Sarcopenia is found in 38.7% of cancer patients, adversely affecting prognosis. Computed tomography (CT) is performed routinely in oncology, yet CT assessments of sarcopenia are not commonly used to measure prognosis. This systematic review and meta-analysis aimed to evaluate the prognostic potential of pre-treatment sarcopenia assessments on overall survival (OS) and progression free survival (PFS) in gynaecology cancer. METHODOLOGY Four electronic databases were systematically searched from 2000 to May 2020 in English: Ovid Medline, EMBASE, Web of Science, and CINAHL plus. Titles and abstracts were screened, eligible full-texts were reviewed, and data from included studies was extracted. Meta-analyses were conducted on homogenous survival data, heterogenous data were narratively reported. RESULTS The initial search yielded 767 results; 27 studies were included in the systematic review (n = 4286), all published between 2015 and 2020. Meta-analysis of unadjusted results revealed a negative effect of pre-treatment sarcopenia on OS in OC (HR: 1.40, 1.20-1.64, p < 0.0001) (n = 10), EC (HR: 1.42, 0.97-2.10, p = 0.07) (n = 4) and CC (HR: 1.10, 0.93-1.31, p = 0.28) (n = 5), and a negative effect on PFS in OC (HR: 1.28, 1.11-1.46, p = 0.0005) (n = 8), EC (HR: 1.51, 1.03-2.20, p = 0.03) (n = 2) and CC (HR: 1.14, 0.85-1.53, p = 0.37) (n = 2). Longitudinal analysis indicated negative effects of muscle loss on survival. Overall, there was a high risk of bias. CONCLUSION Pre-treatment sarcopenia negatively affected survival in gynaecology cancers. Incorporating such assessments into cancer management may be beneficial. Heterogeneity in sarcopenia assessments makes data interpretation challenging. Further research in prospective studies is required.
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Affiliation(s)
| | - M Plyta
- University College London, London, UK
| | - K Fragkos
- University College London, London, UK
| | - S Di Caro
- University College London, London, UK
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24
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Croisier E, Morrissy A, Brown T, Grigg A, Chan P, Goh J, Bauer J. Nutrition risk screening and implications for patients with gynaecological cancers undergoing pelvic radiotherapy and/or other treatment modalities: A retrospective observational study. Nutr Diet 2021; 79:217-228. [PMID: 34854202 DOI: 10.1111/1747-0080.12712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/31/2021] [Accepted: 09/21/2021] [Indexed: 12/26/2022]
Abstract
AIM There is scarcity of research for the nutritional management of pelvic radiotherapy in gynaecological malignancies and delivery of specialised nutrition care is limited due to the current knowledge gap in guidelines. This study aimed to better understand the nutritional risk, weight changes and pattern of nutrition impact symptoms occurring at various treatment timepoints in this population, to inform an effective model of care. METHODS This retrospective, observational study included women with gynaecological cancers receiving pelvic radiotherapy at a tertiary hospital from January 2017 to December 2018 (n = 104). Information was collected on: first day of radiotherapy; weekly during treatment; acute-phase post-treatment (0-6 weeks); and intermediate-phase post-treatment (6 weeks to 6 months). This study reported on incidence of clinically significant weight change (±5%), documented nutrition impact symptoms and the current nutrition care model (nutrition screening, referral, assessment and interventions). RESULTS Clinically significant weight loss was experienced by 38% (n = 40/104) of patients prior to commencing treatment and 19% (n = 14/73) during treatment. Diarrhoea (n = 40/79), fatigue (n = 54/79), nausea (n = 38/79) and pain (n = 31/79) were frequently reported during treatment, and fatigue (n = 33/92) and pain (n = 25/92) continued acutely post-treatment. Despite high rates of weight loss and prevalence of nutrition impact symptoms, only 38% (n = 40/104) of patients were referred to a dietitian. CONCLUSIONS A considerable proportion of patients with gynaecological cancers are at nutrition risk before and during treatment due to clinically significant weight loss and prevalence of nutrition impact symptoms experienced. This highlights the importance of nutrition-risk screening and access to specialised dietetic care as part of their model of care.
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Affiliation(s)
- Emilie Croisier
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia.,Department of Nutrition and Dietetics, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alana Morrissy
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia.,Department of Nutrition and Dietetics, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alice Grigg
- Department of Cancer Care Services, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Philip Chan
- Department of Cancer Care Services, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Jeffrey Goh
- Department of Cancer Care Services, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
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25
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Chen Q, Mariano ER, Lu AC. Enhanced recovery pathways and patient-reported outcome measures in gynaecological oncology. Anaesthesia 2021; 76 Suppl 4:131-138. [PMID: 33682089 DOI: 10.1111/anae.15422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
Comprehensive peri-operative care for women with gynaecological malignancy is essential to ensure optimal clinical outcomes and maximise patient experience through the continuum of care. Implementation of peri-operative enhanced recovery pathways in gynaecological oncology have been repeatedly shown to improve postoperative recovery, decrease complications and reduce healthcare costs. With increasing emphasis being placed on patient-centred care in the current healthcare environment, incorporation of patient-reported outcome data collection and analysis within the enhanced recovery pathway as part of quality measurement is not only useful, but necessary. Inclusion of patient-reported outcome enhanced recovery pathway evaluation enables clinicians to capture authentic patient-reported parameters such as subtle symptoms, changes in function and multiple dimensions of well-being, directly from the source. These data guide the treatment course by encouraging shared decision-making between the patient and clinicians and provide the necessary foundation for ongoing peri-operative quality improvement efforts. Elements of the gynaecological oncology enhanced recovery pathway are divided into five phases of care: pre-admission; pre-operative; intra-operative; postoperative; and post-discharge. The development process starts with detailing each step of the patient's journey in all five phases, then identifying stakeholder groups responsible for care at each of these phases and assembling a multidisciplinary team including: gynaecologists; anaesthetists; nurses; nutritionists; physical therapists; and others, to provide input into the institutional pathway. To practically integrate patient-reported outcomes into an enhanced recovery pathway, a validated measurement tool should be incorporated into the peri-operative workflow. The ideal tool should be concise to facilitate longitudinal assessments by the clinical staff.
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Affiliation(s)
- Q Chen
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - E R Mariano
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Peri-operative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - A C Lu
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Quality, Safety and Clinical Effectiveness, Stanford Health Care, Stanford, CA, USA
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26
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Kuroda K, Tasaki S, Horiguchi A, Ito K. Postoperative C-reactive protein-to-albumin ratio predicts poor prognosis in patients with bladder cancer undergoing radial cystectomy. Mol Clin Oncol 2021; 14:54. [PMID: 33604044 PMCID: PMC7849063 DOI: 10.3892/mco.2021.2216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/18/2020] [Indexed: 01/04/2023] Open
Abstract
The purpose of the present study was to investigate the prognostic value of the postoperative C-reactive protein/albumin ratio (CAR) in patients with bladder cancer undergoing radial cystectomy. The present study retrospectively reviewed 102 patients who underwent radical cystectomy and were followed for ≥6 months postoperatively at our institution, and evaluated clinicopathological factors and laboratory parameters for cancer-specific survival (CSS) and extraurothelial recurrence-free survival (ERFS). Multivariate analysis using the Cox proportional hazards model revealed that only postoperative CAR ≥0.27 [hazard ratio (HR), 3.368; 95% confidence interval (CI), 1.674-6.731; P<0.001] was an independent factor for poor CSS rate. Higher postoperative CAR was also the only significant factor for shortened ERFS time (HR, 2.401; 95% CI, 1.196-4.684; P=0.015). No significant association was identified between postoperative CAR ≥0.27 and any pathological factors or postoperative laboratory markers besides postoperative neutrophil-to-lymphocyte ratio. Furthermore, postoperative CAR (≥0.27) was an independent factor for poor CSS and ERFS rates in 48 patients with advanced pT stage (≥pT3) in the multivariate analysis (P=0.026 and P=0.036, respectively). A higher postoperative CAR value can provide additional information about the possibility of poor CSS and ERFS rates in patients with bladder cancer undergoing radical cystectomy.
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Affiliation(s)
- Kenji Kuroda
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shinsuke Tasaki
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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Clinical malnutrition predictive model among gynecologic cancer patients prior to elective operation: A cross-sectional study. Clin Nutr 2021; 40:4373-4379. [PMID: 33485706 DOI: 10.1016/j.clnu.2021.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Malnutrition is common among cancer patients regardless of stage of cancer. Given the strong association between malnutrition with prolonged hospitalization, delayed recovery and even higher post-operative complications among gynaecologic cancer (GC) patients, it is important to understand its predictive factors. The current study aimed to determine malnutrition predictors among GC patients before elective operation. METHOD A cross-sectional study was conducted among surgical GC patients who were admitted for elective surgery. Data on socio-demographic characteristics, clinical status (diagnosis, the staging of cancer, comorbidities and family history on cancer), anthropometric measures [ Body Mass Index (BMI), weight changes, the percentage of weight loss past one month, muscle mass, fat mass, fat-free mass and mid-upper arm circumference (MUAC)], biochemical profiles [C-reactive protein, albumin and C-reactive protein (CRP) to albumin ratio (CAR)], handgrip strength, total daily energy and protein intake, and malnutrition status [scored Patient Generated-Subjective Global Assessment (PG-SGA)] were assessed during admission. RESULTS Study recruited 124 participants and 57.2% (n = 71) were malnourished. Mean for age, weight changes past one month, handgrip strength, total daily energy and protein intake, PG-SGA score and CAR of participants were 49.9 ± 12.5 years, -4.9 ± 7.2%, 15.6 ± 6.2 kg, 25±7 kcal/kg/day, 1.0 ± 0.3 g/kg/day, 6.5 ± 5.4 and 0.7 ± 1.9, respectively. Multiple linear regression test revealed that the percentage of weight loss past one month, haemoglobin, CRP and handgrip strength were the significant predictors of malnutrition. CONCLUSION Malnutrition is common among GC patient even before elective operation. The early malnutrition screening following with proper nutritional intervention is crucial to optimize nutritional status among GC patients before elective operation.
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Jou J, Coulter E, Roberts T, Binder P, Saenz C, McHale M, Plaxe S, Mayadev J, Eskander RN. Assessment of malnutrition by unintentional weight loss and its implications on oncologic outcomes in patient with locally advanced cervical cancer receiving primary chemoradiation. Gynecol Oncol 2020; 160:721-728. [PMID: 33342621 DOI: 10.1016/j.ygyno.2020.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/09/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To determine the prevalence, risk factors for, and clinical implications of unintentional weight loss on oncologic outcomes in locally advanced cervical cancer (LACC) treated with concurrent chemotherapy and contemporary radiation techniques. METHODS This a single-institution, retrospective cohort study of patients with LACC who received definitive chemoradiation (CRT) from 2010 to 2015. Clinicopathologic factors were abstracted by chart review and characterized using descriptive statistics. Factors associated with severe weight loss (≥10% from baseline) were determined by Chi-square test. Time-to-event analysis was performed using the Kaplan Meier method and regression was performed using the Cox Proportional hazards model. RESULTS One hundred and eight patients comprised the cohort. The majority of patients were White, obese, and had squamous histology. Almost 80% of patients experienced at least some weight loss, with 14% of patients experiencing severe weight loss. Patients with FIGO 2009 stage 3 or 4 disease had a 3.4-fold increased risk of severe weight loss compared to those with earlier stage disease. Patients who had severe weight loss had a higher risk for death (HR = 2.37, 95% confidence interval [CI] 1.77, 7.37, p = 0.036) and a trend toward high risk for recurrence (HR = 1.43, 95% CI 0.46, 3.32, p = 0.107) compared to patients without severe weight loss. CONCLUSION Unintentional weight loss is a common symptom of patients with LACC receiving CRT that affects oncologic outcomes, yet it remains under-recognized. Increased awareness of weight loss and malnutrition may encourage interventions to improve this potentially modifiable risk factor for worse prognosis and quality of life.
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Affiliation(s)
- Jessica Jou
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America.
| | - Elizabeth Coulter
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Traci Roberts
- Nutrition Services, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Pratibha Binder
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Cheryl Saenz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Michael McHale
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Steven Plaxe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Jyoti Mayadev
- Division of Clinical and Translational Research, Department of Radiation Medicine and Applied Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
| | - Ramez N Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, United States of America
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Acarbaş A, Baş NS. Which Objective Nutritional Index Is Better for the Prediction of Adverse Medical Events in Elderly Patients Undergoing Spinal Surgery? World Neurosurg 2020; 146:e106-e111. [PMID: 33068798 DOI: 10.1016/j.wneu.2020.10.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The relationship of preoperative malnutrition with perioperative adverse medical events (PAMEs) has not been well studied in elderly patients undergoing spinal surgery (SS). We aimed to compare the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and Geriatric Nutritional Risk Index (GNRI) for prediction of PAMEs in elderly patients undergoing SS. METHODS Data of 454 patients ≥65 years old undergoing SS were reviewed. PAMEs were defined as death, cardiopulmonary complications, respiratory failure, acute kidney injury, pneumonia, delirium, cerebrovascular events, and sepsis. The area under the receiver operating characteristic curve was used to compare the predictive value of each nutritional index for PAMEs. RESULTS Incidence of PAMEs was 15.3%. Patients who had PAMEs had significantly lower GNRI and PNI but higher CONUT score before surgery compared with patients without PAMEs. Multivariate analysis showed that age (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.01-4.75, P = 0.014), chronic renal failure (OR 1.34, 95% CI 1.03-3.82, P = 0.002), coronary artery disease (OR 1.12, 95% CI 1.11-3.54, P = 0.028), PNI <45.4 (OR 2.12, 95% CI 1.16-4.80, P = 0.011), CONUT score >5 (OR 2.17, 95% CI 1.03-3.76, P = 0.001), and GNRI <92 (OR 2.68, 95% CI 1.20-6.45, P < 0.001) were significant predictors of PAMEs. The receiver operating characteristic curve showed that GNRI had much greater discriminatory ability regarding PAMEs than PNI and CONUT score. CONCLUSIONS Preoperative malnutrition is associated with PAMEs in elderly patients undergoing SS. GNRI had the highest accuracy for predicting PAMEs among the nutritional indices studied.
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Affiliation(s)
- Arsal Acarbaş
- Department of Neurosurgery, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Nuri Serdar Baş
- Department of Neurosurgery, Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Turkey
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Ho CY, Ibrahim Z, Abu Zaid Z, Mat Daud Z'A, Md Yusop NB. Fast-track- recovery surgery with a whey-protein-infused carbohydrate-loading drink pre-operatively and early oral feeding post-operatively among surgical gynaecological cancer patients: study protocol of an open-labelled, randomised controlled trial. Trials 2020; 21:533. [PMID: 32546217 PMCID: PMC7298941 DOI: 10.1186/s13063-020-04462-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/27/2020] [Indexed: 02/04/2023] Open
Abstract
Introduction There has been growing evidence on the favourable outcomes of fast-track-recovery (FTR) surgery; to expedite recovery, minimise complications, and reduce the length of hospital stay for surgical patients. However, there is lack of evidence on the effectiveness of FTR in surgical gynaecological cancer (GC) patients. Most of the previous studies did not focus on feeding composition in the FTR surgery protocol. This study aims to determine the effectiveness of FTR feeding with a whey-protein-infused carbohydrate-loading drink pre-operatively and early oral feeding post-operatively on post-operative outcomes among surgical GC patients. Methods/design This open-labelled, randomised controlled trial (RCT) will randomly allocate patients into intervention and control groups. Ambulated Malaysian aged over 18 years and scheduled for elective surgery for (suspected) GC, will be included in this study. The intervention group will be given whey-protein-infused carbohydrate-loading drinks on the evening before their operation and 3 h before their operation as well as started on early oral feeding 4 h post-operatively. The control group will be fasted overnight pre-operation and only allowed plain water, and return to a normal diet is allowed when bowel sounds return post-operatively. The primary outcomes of study are length of post-operative hospital stay, length of clear-fluid tolerance, solid-food tolerance and bowel function. Additional outcome measures are changes in nutritional status, biochemical profile and functional status. Data will be analysed on an intention-to-treat basis. Trial registration ClinicalTrials.gov, ID: NCT03667755. Retrospectively registered on 12 September 2018; Protocol version: version 3 dated 27 September 2017.
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Affiliation(s)
- Chiou Yi Ho
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.,Dietetics and Food Service Department, National Cancer Institute, Ministry of Health, Jalan P7, Precint 7, 62250, Putrajaya, Malaysia
| | - Zuriati Ibrahim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Zalina Abu Zaid
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Zulfitri 'Azuan Mat Daud
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Nor Baizura Md Yusop
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
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Ravasco P. Nutrition in Cancer Patients. J Clin Med 2019; 8:E1211. [PMID: 31416154 PMCID: PMC6723589 DOI: 10.3390/jcm8081211] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. Methods: A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using "OR" as a Boolean function and the results of the four components were combined by utilizing the "AND" Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Results: Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1-2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.
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Affiliation(s)
- Paula Ravasco
- University Hospital of Santa Maria, 1649-035 Lisbon, Portugal.
- University of Lisbon, 1649-028 Lisbon, Portugal.
- Centre for Interdisciplinary Research in Health (CIIS) of the Portuguese Catholic University, 1649-023 Lisbon, Portugal.
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The prognostic nutritional index is prognostic factor of gynecological cancer: A systematic review and meta-analysis. Int J Surg 2019; 67:79-86. [DOI: 10.1016/j.ijsu.2019.05.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/06/2019] [Accepted: 05/28/2019] [Indexed: 01/11/2023]
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Pache B, Grass F, Hübner M, Kefleyesus A, Mathevet P, Achtari C. Prevalence and Consequences of Preoperative Weight Loss in Gynecologic Surgery. Nutrients 2019; 11:nu11051094. [PMID: 31108841 PMCID: PMC6566827 DOI: 10.3390/nu11051094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022] Open
Abstract
Preoperative malnutrition and weight loss negatively impact postoperative outcomes in various surgical fields. However, for gynecologic surgery, evidence is still scarce, especially if surgery is performed within enhanced recovery after surgery (ERAS) pathways. This study aimed to assess the prevalence and impact of preoperative weight loss in patients undergoing major gynecologic procedures within a standardized ERAS pathway between October 2013 and January 2017. Out of 339 consecutive patients, 33 (10%) presented significant unintentional preoperative weight loss of more than 5% during the 6 months preceding surgery. These patients were less compliant to the ERAS protocol (>70% of all items: 70% vs. 94%, p < 0.001) presented more postoperative overall complications (15/33 (45%) vs. 69/306 (22.5%), p = 0.009), and had an increased length of hospital stay (5 ± 4 days vs. 3 ± 2 days, p = 0.011). While patients experiencing weight loss underwent more extensive surgical procedures, after multivariate analysis, weight loss ≥5% was retained as an independent risk factor for postoperative complications (OR 2.44; 95% CI 1.00-5.95), and after considering several surrogates for extensive surgery including significant blood loss (OR 2.23; 95% CI 1.15-4.31) as confounders. The results of this study suggest that systematic nutritional screening in ERAS pathways should be implemented.
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Affiliation(s)
- Basile Pache
- Department of Gynecology, Department "Femme-Mère-Enfant", Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Amaniel Kefleyesus
- Department of Visceral Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Patrice Mathevet
- Department of Gynecology, Department "Femme-Mère-Enfant", Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Chahin Achtari
- Department of Gynecology, Department "Femme-Mère-Enfant", Lausanne University Hospital, 1011 Lausanne, Switzerland.
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Li Z, Xu Z, Huang Y, Zhao R, Cui Y, Zhou Y, Wu X. Prognostic values of preoperative platelet-to-lymphocyte ratio, albumin and hemoglobin in patients with non-metastatic colon cancer. Cancer Manag Res 2019; 11:3265-3274. [PMID: 31114364 PMCID: PMC6489677 DOI: 10.2147/cmar.s191432] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/12/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose: Preoperative platelet-to-monocyte ratio (PLR), albumin and hemoglobin are suggested prognostic indicators in various malignancies. However, the prognostic values of PLR, albumin and hemoglobin remain elusive. The objective of the present study was to evaluate the prognostic values of PLR, albumin and hemoglobin in stage I-III colon cancer. Patients and methods: A total of 312 patients with non-metastatic colon cancer undergoing curative resection were enrolled in this study. The prognostic values of PLR, albumin and hemoglobin were identified by receiver operating characteristics, and univariate and multivariate analyses. Results: Univariate analysis revealed that preoperative PLR, albumin and hemoglobin were significantly associated with overall survival (OS) and that preoperative PLR and albumin were significantly associated with progression-free survival (PFS). Multivariate analysis revealed that preoperative PLR was significantly associated with OS. Conclusion: Reduced preoperative PLR was significantly associated with better OS in patients with stage I-III colon cancer. Preoperative PLR was an independent prognostic indictor for OS in patients with colon cancer undergoing curative resection.
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Affiliation(s)
- Zhigui Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Zhaofen Xu
- Department of Pathology, The Second People's Hospital, Neijiang, Sichuan 641000, People's Republic of China
| | - Yuqian Huang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Rui Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yaping Cui
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yong Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Xiaoting Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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Lemoine A, Lambaudie E, Bonnet F, Leblanc E, Alfonsi P. [Perioperative care of epithelial ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:187-196. [PMID: 30686730 DOI: 10.1016/j.gofs.2018.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 01/28/2023]
Abstract
The following recommendations cover the perioperative management of ovarian, Fallopian tube and primary peritoneal cancers. Five questions related to pre-habilitation and enhanced recovery after surgery were evaluated. The conclusions and recommendations are based on an analysis of the level of evidence available in the literature. These recommendations are part of the overall recommendations for improving the management of ovarian, fallopian or primary peritoneal cancer, made with the support of INCa (Institut National du Cancer). The main preoperative measures are screening for nutritional deficiencies (Grade B) and for anaemia (GradeC) in patients with ovarian cancer. It is not possible to make recommendations on the correction of malnutrition and/or anemia or on the contribution of pre-operative immuno-nutrition due to the absence of data in ovarian cancer, tube cancer or primary peritoneum cancer. For the same reasons, no recommendation can be made on the value of preoperative digestive preparation in ovarian, fallopian tube or primary peritoneum cancer. During surgery, goal-directed fluid therapy for patients with advanced ovarian cancer is recommended (Grade B). A single dose infusion of tranexamic acid is recommended for patients with ovarian, fallopian tube or primary peritoneal cancer (GradeC). For postoperative analgesia, epidural analgesia is recommended for patients undergoing cyto-reduction surgery by laparotomy (Grade B). In the absence of epidural analgesia, patient controlled analgesia with morphine without continuous infusion (Grade B) is recommended. No recommendation can be given regarding intravenous administration of lidocaine and/or ketamine during surgery, or, regarding peri-operatively prescription of gabapentin or pregabalin. In the absence of studies on the impact of different non-opiate analgesic combinations for ovarian cancer surgery, no recommendations can be made. Early oral feeding is recommended, including in cases of digestive resection (Grade B). The implementation of enhanced recovery programs, including early mobilization, is recommended (GradeC).
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Affiliation(s)
- A Lemoine
- Service d'anesthésie, hôpital Tenon, médecine Sorbonne université, 75020 Paris, France.
| | - E Lambaudie
- Inserm, département de chirurgie oncologique, institut Paoli Calmettes, Aix-Marseille université, CNRS, 13000 Marseille, France
| | - F Bonnet
- Service d'anesthésie, hôpital Tenon, médecine Sorbonne université, 75020 Paris, France
| | - E Leblanc
- Département de chirurgie oncologique, centre Oscar Lambret, 59000 Lille, France
| | - P Alfonsi
- Service d'anesthésie, université Paris Descartes, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
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Kalogera E, Nelson G, Liu J, Hu QL, Ko CY, Wick E, Dowdy SC. Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. Am J Obstet Gynecol 2018; 219:563.e1-563.e19. [PMID: 30031749 DOI: 10.1016/j.ajog.2018.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Armstrong Institute at Johns Hopkins, developed the Safety Program for Improving Surgical Care and Recovery, which integrates principles of implementation science into adoption of enhanced recovery pathways and promotes evidence-based perioperative care. OBJECTIVE The objective of this study is to review the enhanced recovery pathways literature in gynecologic surgery and provide the framework for an Improving Surgical Care and Recovery pathway for gynecologic surgery. STUDY DESIGN We searched PubMed and Cochrane Central Register of Controlled Trials databases from 1990 through October 2017. Studies were included in hierarchical and chronological order: meta-analyses, systematic reviews, randomized controlled trials, and interventional and observational studies. Enhanced recovery pathways components relevant to gynecologic surgery were identified through review of existing pathways. A PubMed search for each component was performed in gynecologic surgery and expanded to include colorectal surgery as needed to have sufficient evidence to support or deter a process. This review focuses on surgical components; anesthesiology components are reported separately in a companion article in the anesthesiology literature. RESULTS Fifteen surgical components were identified: patient education, bowel preparation, elimination of nasogastric tubes, minimization of surgical drains, early postoperative mobilization, early postoperative feeding, early intravenous fluid discontinuation, early removal of urinary catheters, use of laxatives, chewing gum, peripheral mu antagonists, surgical site infection reduction bundle, glucose management, and preoperative and postoperative venous thromboembolism prophylaxis. In addition, 14 components previously identified in the colorectal Improving Surgical Care and Recovery pathway review were included in the final pathway. CONCLUSION Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.
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Affiliation(s)
| | - Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Jessica Liu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, Emory University, Atlanta, GA
| | - Q Lina Hu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, University of California, Los Angeles, CA
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, University of California, Los Angeles, CA
| | - Elizabeth Wick
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN.
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Al Mutairi N, Le T. Does Neoadjuvant Chemotherapy Impact Prognosis in Advanced-Stage Epithelial Ovarian Cancer Optimally Debulked at Surgery? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:185-190. [PMID: 30316718 DOI: 10.1016/j.jogc.2018.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Neoadjuvant chemotherapy (NAC) has been shown to be noninferior to primary surgery in advanced stage ovarian cancer. We examined the impact of the neoadjuvant approach in patients with optimal residuals (<1 cm). METHODS Retrospective review of optimally debulked stage 3/4 ovarian cancer was performed. Chi-square tests were used to detect significant associations between categorical variables. A Cox regression model was built to predict patients' overall survival, adjusting for age, tumour grade, histology, use of adjuvant intraperitoneal chemotherapy, residual status, and primary treatment modality. RESULTS One hundred one patients were reviewed. Median age was 60.5 (range 39-85). NAC was used in 34 patients. Serous histology was documented in 60 of 101 patients (59%). Microscopic residuals were achieved in 70 patients (69%). There was no significant association between primary treatment modality and microscopic residuals status. With a median follow-up time of 33 months, progression was observed in 53% of patients, with a median progression-free survival of 19.4 months. The use of NAC was an independent adverse prognostic factor (hazard ratio 5.79; 95% CI 2.15-15.55, P = 0.001) for overall survival. Macroscopic residual was an independent adverse prognostic factor (hazard ratio 10.76; 95% CI 2.98-38.89, P < 0.001). The overall Kaplan-Meier median survival estimate was 54.5 months (95% CI 50.64-58.36) in the primary surgery group compared with 41.43 months (95% CI 35.58-47.29) in those given NAC (P = 0.002) CONCLUSION: Primary surgery should be the preferred approach in patients with an initial high likelihood of being optimally cytoreduced.
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Affiliation(s)
- Nashmia Al Mutairi
- Division of Gynecology Oncology, Oncology Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Tien Le
- Division of Gynecologic Oncology, University of Ottawa, Ottawa, ON.
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Glaser G, Dowdy SC, Peedicayil A. Enhanced recovery after surgery in gynecologic oncology. Int J Gynaecol Obstet 2018; 143 Suppl 2:143-146. [DOI: 10.1002/ijgo.12622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Gretchen Glaser
- Division of Gynecologic Oncology; Mayo Clinic; Rochester MN USA
| | - Sean C. Dowdy
- Division of Gynecologic Oncology; Mayo Clinic; Rochester MN USA
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Zhang W, Liu K, Ye B, Liang W, Ren Y. Pretreatment C-reactive protein/albumin ratio is associated with poor survival in patients with stage IB-IIA cervical cancer. Cancer Med 2018; 7:105-113. [PMID: 29193777 PMCID: PMC5773960 DOI: 10.1002/cam4.1270] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 10/29/2017] [Accepted: 11/02/2017] [Indexed: 12/13/2022] Open
Abstract
Previous studies have shown that the C-reactive protein/albumin ratio (CAR) is a prognostic indicator in multiple types of carcinomas. This study is the first to evaluate the prognostic significance of CAR in stage IB-IIA cervical cancer patients treated with radical surgery, as well as that of several other inflammation-based factors, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI). A total of 235 patients were enrolled in this study. The optimal cut-off values of CAR and other inflammation-based factors were determined by receiver operating characteristic curves. The Kaplan-Meier method and Cox regression model analysis were performed to determine the independent predictors of progression-free survival (PFS) and overall survival (OS). At a cut-off value of 0.15, patients with a high CAR had significantly shorter PFS and OS than those with a lower CAR (P < 0.001). A higher CAR was significantly associated with elevated scores of NLR and PLR and a decreased PNI (P < 0.001). Univariate analyses showed that elevated CAR preoperatively was significantly associated with poor survival; a similar trend was also noted for the NLR, PLR, and PNI. Multivariate analyses demonstrated that only CAR was an independent indicator for PFS (hazard ratio [HR]: 5.164; 95% confidence interval [CI]: 2.495-10.687; P < 0.001) and OS (HR: 4.729; 95% CI: 2.263-9.882; P < 0.001). In conclusion, preoperative CAR is a novel and superior predictor of poor survival in patients with stage IB-IIA cervical cancer.
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Affiliation(s)
- Weiwei Zhang
- Department of Medical OncologyThe Sixth People's Hospital of Chengdu610051SichuanChina
| | - Kejun Liu
- Department of Medical OncologyDongguan People's Hospital523059GuangdongChina
| | - Bin Ye
- Department of Medical OncologyThe Sixth People's Hospital of Chengdu610051SichuanChina
| | - Weijiang Liang
- Department of Medical OncologyNanfang HospitalSouthern Medical University510515GuangdongChina
| | - Yazhou Ren
- Big Data Research CenterSchool of Computer Science and EngineeringUniversity of Electronic Science and Technology of China611731SichuanChina
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