Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma.
Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma.
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营养筛查与接受靶向药物治疗转移性肾细胞癌的患者的总生存期密切相关。
DOI：
10.1002/jcsm.12025
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Ye D
中科院分区：
文献类型：
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作者：
Gu W;Zhang G;Sun L;Ma Q;Cheng Y;Zhang H;Shi G;Zhu Y;Ye D
虽然经常观察到，营养不良的特点不佳，经常在转移性肾细胞癌（RCC）患者的诊断不足。营养筛查工具预测肾细胞癌患者总生存期（OS）的能力尚未得到充分验证。本研究的目的是调查营养筛查工具的性能及其在接受靶向治疗的转移性RCC患者中的额外预后价值。研究对象为2009年至2013年间从三家三级医院前瞻性招募的患者。采用老年营养风险指数（GNRI）和简易营养评估量表（MNA-SF）评估营养状况。他们的OS和早期3/4级不良事件被记录为关注的结果，并分别使用考克斯回归和logistic回归评估其与营养状况的相关性。使用一致性指数和决策曲线分析来评估统计学的增量值。在300例入组患者中，根据GNRI和MNA-SF，分别有95例（31.7%）和64例（21.3%）被归类为营养不良风险。在多变量分析中，GNRI和MNA-SF均为OS的独立预测因子，并为Heng风险分类提供了显著的额外获益。与MNA-SF相比，GNRI对一致性指数的贡献更大（0.041 vs. 0.016）。然而，在多变量分析中，营养筛查与早期3/4级不良事件无关。需要使用更全面和准确的评估工具进行进一步调查。这项前瞻性研究证实了营养筛查工具在转移性肾细胞癌患者生存预测中的重要性。标准化和客观的测量将使临床医生能够识别具有不良生存结局风险的转移性RCC患者。多学科治疗中可能包括个性化的营养评估和干预策略。
Although commonly observed, malnutrition is poorly characterized and frequently underdiagnosed in patients with metastatic renal cell carcinoma (RCC). The ability of nutritional screening tools to predict overall survival (OS) in patients with RCC has not been adequately validated. The objective of this study was to investigate the performance of nutritional screening tools and their additional prognostic value in patients with metastatic RCC treated with targeted therapies. Patients were prospectively recruited from three tertiary hospitals between 2009 and 2013. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment–Short Form (MNA–SF). Their OS and early grade 3/4 adverse events were recorded as outcomes of interest, and their associations with nutritional status were assessed using Cox regression and logistic regression, respectively. The incremental value in prognostication was evaluated using concordance index and decision curve analyses. Of the 300 enrolled patients, 95 (31.7%) and 64 (21.3%) were classified as being at risk of malnutrition according to the GNRI and MNA–SF, respectively. Both GNRI and MNA–SF were independent predictors of OS in multivariate analyses and provided significant added benefit to Heng risk classification. Compared with the MNA–SF, the GNRI contributed a higher increment to the concordance index (0.041 vs. 0.016). Nutritional screening, however, was not associated with early grade 3/4 adverse events in multivariate analyses. Further investigations are needed using more comprehensive and accurate assessment tools. This prospective study confirmed the importance of nutritional screening tools in survival prognostication in patients with metastatic RCC. The standardized and objective measurements would allow clinicians to identify metastatic RCC patients at risk of poor survival outcomes. Individualized nutritional assessment and intervention strategies may be included in the multidisciplinary treatment.