The association between weight stability and parenteral nutrition characteristics and survival in patients with colorectal cancer  

体质量稳定及肠外营养特征与结直肠癌患者预后的相关性

作　　者：Wenli Liu Aiham Qdaisat Eric Lee Jason Yeung Khanh Vu Jun-Zhong Lin Todd Canada Shouhao Zhou Lorenzo Cohen Eduardo Bruera Sai-Ching J.Yeung 

机构地区：[1]Department of Palliative,Rehabilitation and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,TX,USA [2]Department of Emergency Medicine,The University of Texas MD Anderson Cancer Center,Houston,TX,USA [3]McGovern Medical School,Houston,TX,USA [4]Biomedical Science,Texas A&M University,College Station,TX,USA [5]Department of General Internal Medicine,The University of Texas MD Anderson Cancer Center,Houston,TX,USA [6]Department of Colorectal Surgery,Sun Yat-sen University Cancer Center,Guangzhou,Guangdong,P.R.China [7]Division of Pharmacy,The University of Texas MD Anderson Cancer Center,Houston,TX,USA [8]Department of Public Health Sciences,Pennsylvania State University School of Medicine,Hershey,PA,USA [9]Department of Endocrine Neoplasia and Hormonal Disorders,The University of Texas MD Anderson Cancer Center,Houston,TX,USA

出　　处：《Gastroenterology Report》2019年第6期419-425,I0002,共8页胃肠病学报道（英文）

基　　金：The University of Texas MD Anderson Cancer Center was supported in part by the NIH through Cancer Center Support Grant P30 CA016672.

摘　　要：Objective:Knowledge about the impact of metabolic disturbances and parenteral nutrition(PN)characteristics on the survival of cancer patients receiving PN is limited.We aimed to assess the association between clinical and PN characteristics and survival in colorectal-cancer patients receiving PN support.Methods:Our study included 572 consecutive colorectal-cancer patients who had received PN support between 2008 and 2013.Patient characteristics,body mass index,weight,medical/surgical history,indication for PN,PN data and survival were recorded.Associations between clinical and PN characteristics and survival were analysed with important confounding factors.Results:The final cohort included 437 evaluable patients,with a mean age of 57 years.Eighty-one percent of the study population had advanced stage of colorectal cancer.Unstable weight(weight change≥2.5%)prior to PN initiation[hazard ratio(HR)=1.41,P=0.023]was adversely associated with survival after adjusting for multiple factors including cancer stage.Bowel obstruction(HR=1.75,P=0.017)as a PN indication was associated with worse survival when compared with without bowel obstruction.Higher PN amino acid by ideal body weight(g•kg^(-1))(HR=0.59,P=0.029)was associated with longer survival,whereas a higher percentage of non-PN intravenous calories(HR=1.04,P=0.011)was associated with shorter survival independently of confounding factors.Conclusions:Body mass index and weight stability can be useful nutritional indices for survival prediction in cancer patients receiving PN.PN planning should take into account of non-PN calories to achieve optimal energy support and balance.Future research is needed to define optimal PN amino-acid requirement and energy balance.背景:代谢紊乱及肠外营养(PN)特征对接受肠外营养的癌症患者生存的影响,目前所知有限。本研究旨在评估临床方法:研究纳入美国MD Anderson癌症中心2008-2013年接受肠外营养支持的572例结直肠癌患者。记录病例特征、体质指数、体质量、药物/手术治疗史、PN适应证、PN相关数据及生存情况。分析临床及PN特征与患者生存的相关性。结果:437例患者纳入最终分析,平均年龄57岁,81%为进展期结直肠癌。经多因素校正后,PN开始前体质量不稳定(变化≥2.5%)与生存负相关(HR=1.41,P=0.023)。肠梗阻作为PN适应证者较无肠梗者预后更差(HR=1.75,P=0.017)。PN配方中每千克理想体质量的氨基酸含量(g/kg)更高者,其生存时间更长(HR=0.59,P=0.029);而非PN配方中的静脉卡路里摄入量更高者,其生存时间更短(HR=1.04,P=0.011)。结论:体质指数和体质量稳定可能是预测接受PN支持的结直肠癌患者预后的有效营养学指标。制定PN计划时应考虑到非PN卡路里的摄入量,从而获得最佳的能量支持和能量平衡。进一步研究需明确PN配方中最优的氨基酸需求量和能量平衡。

关 键 词：BMI weight loss non-parenteral calorie energy balance parenteral nutrition 

分 类 号：R735.35[医药卫生—肿瘤]