Prognostic Impact of Preoperative Nutritional Risk in Patients Who Undergo Surgery for Pancreatic Adenocarcinoma
Prognostic Impact of Preoperative Nutritional Risk in Patients Who Undergo Surgery for Pancreatic Adenocarcinoma
复制标题
术前营养风险对接受胰腺腺癌手术的患者预后的影响
DOI：
--
复制
发表时间：
2020
影响因子：
3.7
通讯作者：
M. Milella
中科院分区：
文献类型：
--
作者：
I. Trestini;S. Paiella;M. Sandini;I. Sperduti;G. Elio;T. Pollini;D. Melisi;A. Auriemma;C. Soldà;C. Bonaiuto;D. Tregnago;A. Avancini;E. Secchettin;D. Bonamini;M. Lanza;S. Pilotto;G. Malleo;R. Salvia;C. Bovo;L. Gianotti;C. Bassi;M. Milella
背景营养紊乱是胰腺癌(PC)的共同特征。它们的早期发现和处理在日常实践中往往被忽视。本研究旨在探讨PC手术患者的术前营养状况及其预后价值。方法回顾分析2015年11月至2018年1月在意大利维罗纳大学医院胰腺研究所胰腺外科接受PC手术的73例患者的资料。采用营养风险筛选(NRS)-2002对患者进行术前营养风险评估。在手术前一天使用生物阻抗向量分析(BIVA)评估身体成分。临床、病理和营养特征对总生存率(OS)的影响采用Cox和Logistic回归模型。Kaplan-Meier曲线比较采用对数等级检验。结果大多数患者(80.8%)有营养不良的危险(NRS-2002 ≥ 3)，尽管平均体重指数为24.1g/m2(± 4.3)。24例患者(32.9%)在手术前接受了新辅助治疗。手术前NRS-2002在这一亚组患者中显著升高(p = 0.026)，不同化疗方案有显著差异(支持Folfiinox，p = 0.035)。在多变量分析中，影响OS的唯一独立预后因素是NRS-2002评分(HR5.24，p = 0.013)。特别是，NRS <； 3的两年存活率更高(p = 0.009)。结论我们的分析证实，术前营养不良对接受PC根治术的PC患者的OS有不利影响。应强制对PC患者进行仔细的术前营养评估，特别是对那些接受新辅助治疗的患者。
Background Nutritional derangements are common hallmarks of pancreatic cancer (PC). Their early detection and management are usually overlooked in routine practice. This study aimed to explore preoperative nutritional status and its prognostic value in patients undergoing surgery for PC. Methods Data from 73 patients who underwent surgery for PC from November 2015 to January 2018 at the General and Pancreatic Surgery Unit, The Pancreas Institute, University Hospital of Verona Hospital, Verona, Italy, were retrospectively evaluated. The Nutritional Risk Screening (NRS)-2002 was used to evaluate the preoperative nutritional risk. Body composition was assessed using bioimpedance vectorial analysis (BIVA) on the day prior to surgery. The effect of clinical, pathological, and nutritional characteristics on overall survival (OS) was investigated using a Cox and logistic regression model. Kaplan–Meier curves were compared using the log-rank test. Results Most patients (80.8%) were at preoperative risk of malnutrition (NRS-2002 ≥ 3) despite a mean BMI of 24.1 kg/m 2 (± 4.3). Twenty-four patients (32.9%) received neoadjuvant therapy prior to surgery. Preoperative NRS-2002 was significantly higher in this subset of patients ( p = 0.026), with a significant difference by chemotherapy regimens (in favor of FOLFIRINOX, p = 0.035). In a multivariate analysis, the only independent prognostic factor for OS was the NRS-2002 score (HR 5.24, p = 0.013). Particularly, the likelihood of 2-year survival was higher in NRS < 3 ( p = 0.009). Conclusions Our analysis confirms that preoperative malnutrition has a detrimental impact on OS in PC patients undergoing radical surgery for PC. Careful preoperative nutritional evaluation of PC patients should be mandatory, especially in those who are candidates for neoadjuvant therapy.
影响因子：
4.7
作者：
Dalal, Shalini;Hui, David;Bidaut, Luc;Lem, Kristen;Del Fabbro, Egidio;Crane, Christopher;Reyes-Gibby, Cielito C.;Bedi, Deepak;Bruera, Eduardo
通讯作者：
Bruera, Eduardo