Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

Effects of integrative telehealth-based nutrition care with and without oral nutritional supplements in patients with liver and colorectal cancer: A randomized controlled trial

OBJECTIVES

This study investigated the effects of post-discharge integrative telehealth-based nutritional care alone versus post-discharge integrative telehealth-based nutritional care combined with high-calorie/high-protein oral nutritional supplements (HCHP-ONS) on the nutritional status and quality of life in patients with hepatocellular carcinoma (HCC) or colorectal cancer (CRC) at risk of malnutrition.

METHODS

We recruited HCC or CRC patients who were at moderate to high risk of malnutrition, defined as a score of 4-9 on the abridged Patient-Generated Subjective Global Assessment (aPG-SGA), and randomly assigned them to either a telehealth nutritional care-control group (C group) or a telehealth nutritional care combined with HCHP-ONS group (C+O group) for a 3-month intervention. In group C, a dietitian provided monthly telehealth-based nutritional assessments and guidance through a mobile application (LINE) or phone calls. In the C+O group, in addition to telehealth-based nutritional assessments and guidance, patients received a daily can of HCHP-ONS, which provided 425 kcal and 19.1 g of protein per serving. Blood tests, anthropometric indicators, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and a nutritional status assessment were conducted monthly.

RESULTS

Results showed that the C+O group had significantly reduced malnutrition risk scores at the 1st, 2nd, and 3rd months. By the 3rd month, the C+O group showed significant improvement in the Prognostic Nutritional Index (PNI), and notable improvements in diarrhea and respiratory distress scores.

CONCLUSIONS

In patients with HCC and CRC who were at risk of malnutrition, integrative telehealth-based nutritional care via LINE or phone calls effectively reduced malnutrition risk, maintained PNI, and supported quality of life (QOL). The addition of HCHP-ONS further enhanced nutritional outcomes, leading to greater improvements in PNI, diarrhea, and dyspnea by the 3rd month.

Impact of prognostic nutritional index on oncological outcomes and mortality among advanced gastric cancer patients: European GASTRODATA registry analysis

While Prognostic Nutritional Index (PNI) is an established predictor of outcomes in Asian gastric cancer (GC) patients, data among Western populations are limited. This study assessed the predictive value of PNI in European GC patients undergoing multimodal treatment. Data from GASTRODATA, the largest European repository of GC patients undergoing gastrectomy, were collected between 2017 and 2022. The primary outcome was textbook outcome (TO) achievement, and the secondary was 90-day mortality. PNI was calculated one day before surgery, with a cut-off of 45.5 based on ROC analysis. Among 721 patients included 60.7% were men. Most patients had advanced tumors (cT3-4 = 75.2%) and metastatic lymph nodes (57.7%). Neoadjuvant chemotherapy (NAC) was administered to 46.7% of patients, and 32.9% received adjuvant chemotherapy. Median PNI was 49.5 (IQR 45.0-56.4). Low PNI was present among 30% of patients and was associated with decreased odds of TO achievement (OR = 0.57, 95% CI 0.37-0.89), higher 90-day mortality (OR = 4.99, 95% CI 2.32-10.73). NAC administration was associated with lower morbidity risk (OR = 0.56, p = 0.0408), and low PNI was a predictor of receiving AC (p = 0.0005). PNI was a valuable predictor for oncological outcomes and morbidity among European GC patients undergoing multimodal. While low PNI was associated with decreased odds of TO achievement and increased risk of 90-day mortality, further prospective and nutritional intervention studies are warranted to standardize the PNI threshold and improve its clinical applicability.

Parenteral nutrition with n-3 polyunsaturated fatty acids on nutrition inflammatory and immune status of gastrointestinal cancer patients: Meta-analysis

BACKGROUND

The incidence of malignant tumors in the digestive system is increasing and is a threat to human health. However, the long duration from tumor detection to radical resection, stress responses due to surgical trauma, and insufficient nutritional intake increases the risk of malnutrition, immune function reduction, postoperative complications, and intestinal dysfunction among patients.

AIM

To systematically investigate the association of parenteral nutrition enriched with n-3 polyunsaturated fatty acids (PUFAs) with the nutritional status of patients after gastrointestinal treatment.

METHODS

Randomized controlled trials associated with PUFA-enriched parenteral nutrition administration in patients with digestive system malignancies were retrieved from online databases such as PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network, China VIP, Wanfang, and China Biomedical Literature Database, with the retrieval time from database inception to present. Two researchers independently extracted data. Each article’s bias risk was assessed by referring to the Cochrane Handbook version 5.3 criteria and RevMan5.4 was used for data analysis.

RESULTS

This meta-analysis involved six randomized controlled trials involving a total of 505 cases. Random-effects model analysis indicated remarkably better improvements in various inflammatory factors in the study group (P < 0.05). Meta-analysis of nutritional indicators revealed that the study group had higher total protein, albumin, and prealbumin levels, as well as lower transferrin levels compared to the control group (P < 0.05). Meanwhile, meta-analysis of T-cell subsets revealed no remarkable inter-group difference in post-treatment CD8⁺ cells (P > 0.05). Moreover, the meta-analysis identified a notably lower incidence of adverse reactions in the study group (P < 0.05).

CONCLUSION

Administration of PUFAs helps improve the nutritional status of patients with digestive malignancies in the perioperative period. It promotes immune function recovery, reduces the inflammatory response, and decreases the risk of adverse effects. These beneficial effects make it worth investigating and promoting their use in appropriate patient populations. However, further validation via high-quality studies with long intervention time and extended follow-up periods is required.

A nomogram for predicting the risk of malnutrition in hospitalized older adults: a retrospective study

BACKGROUND

Malnutrition is highly prevalent but under-recognized in hospitalized older adults, which is closely related to increased risk of adverse clinical outcomes and mortality. It is crucial to identify high-risk individuals at an early stage and manage them promptly. This study aimed to explore the predictive factors and develop a nomogram model for predicting the risk of malnutrition in hospitalized elderly patients.

METHODS

We conducted a retrospective study of data collected from 456 older individuals admitted to geriatric wards from four hospitals in China between August 2020 and December 2020 (136 in the malnutrition group and 320 in the non-malnutrition group). Least Absolute Selection and Shrinkage Operator (LASSO) regression and stepwise multivariate logistic regression were applied to screen predictors and create a nomogram. The predictive performance of the model was assessed by receiver operating characteristic (ROC) curve, concordance index (C-index) and calibration curve. The clinical utility was estimated by decision curve analysis (DCA). Youden's Index was used to identify the optimal cut-point of the nomogram.

RESULTS

Four independent predictive factors were utilized to construct the nomogram model after being selected by LASSO regression and multivariate logistic regression, namely body mass index (BMI), heart failure, frailty and hemoglobin. C-index of the model was 0.906 (95% CI: 0.872-0.939) and the area under the curve (AUC) was 0.906. The optimal cut-point of the nomogram was 82.74 with a sensitivity of 78.7% and specificity of 92.2% (Youden's index: 0.709). The calibration curve demonstrated a high degree of consistency between predicted probability and actual observation. The DCA indicated a favorable clinical benefit for the nomogram.

CONCLUSIONS

We have established a multi-dimensional nomogram model to predict the risk of malnutrition in Chinese hospitalized older adults. The model yields favorable predictive performance and clinical utility, which provides an effective approach for rapid identification of high-risk malnourished older individuals in clinical practice.

Association between Clinical Characteristics and Sarcopenia or Sarcopenic Obesity in Crohn's Disease

Objective Crohn's disease (CD) is a chronic inflammatory bowel disease that is associated with malnutrition. Sarcopenia is a malnutrition condition characterized by skeletal muscle loss that impairs the physical function. We investigated the clinical characteristics of patients with CD with sarcopenia and sarcopenic obesity (sarcopenic-o). Methods The body composition of patients with CD was evaluated using a bioelectrical impedance analysis. The clinical characteristics of patients with sarcopenia and sarcopenic-o were analyzed, and a predictive model for sarcopenia was developed. Patients Patients with CD recruited from 2019 to 2021 were included. Results Among the 104 patients, 35 (33.7%) and 10 (9.6%) had sarcopenia and sarcopenic-o, respectively. In the sarcopenia group, the skeletal muscle index (SMI) and body mass index (BMI) were lower than those in the control group (SMI, 6.3 kg/m2 vs. 7.7 kg/m2, p<0.01; BMI, 18.8 kg/m2 vs. 22.6 kg/m2, p<0.01), whereas the Crohn's disease activity index (CDAI) was higher than in the control group (114.2 vs. 42.0, p<0.01). The predictive models of sarcopenia using the BMI and CDAI revealed high performance with areas under the receiver operating characteristic curve (AUC) of 0.87 and 0.72, respectively, and high specificity (0.94) and sensitivity (0.71), respectively. Sarcopenic-o patients could not be screened using the BMI (25 kg/m2), and the SMI and body fat percentage were negatively correlated in patients with sarcopenia (p<0.01). Conclusion Sarcopenia and sarcopenic-o are relatively common conditions among patients with CD. Sarcopenia can be predicted using the clinical parameters of BMI and CDAI. Sarcopenic-o can be a severe form of sarcopenia.

Retrospective Analysis of the Effect of Sarcopenia on Mortality and Morbidity in Liver Transplant Patients

BACKGROUND

Sarcopenia significantly influences morbidity and mortality in liver transplant recipients. The psoas muscle area index and prognostic nutritional index (PNI) are potential indicators of sarcopenia's impact on postoperative outcomes. However, their association with postoperative morbidity and mortality in cadaveric liver transplant recipients remains underexplored.

METHODS

Data from 52 patients who underwent cadaveric liver transplantation at Çukurova University over 10 years were analyzed. Sarcopenia was assessed using psoas muscle area index (cutoffs, 4.62 mm²/cm² for males and 2.66 mm²/cm² for females, based on Bahat et al) and PNI (cutoffs, ≤45 for low and >45 for high, based on Li et al). Postoperative morbidity was evaluated using the Clavien-Dindo classification. The main outcomes were overall survival and morbidity rates.

RESULTS

Sarcopenic patients had shorter survival (62.2 ± 16.4 months) compared with nonsarcopenic patients (83.6 ± 11.4 months), although this difference was not statistically significant (P = .370). Sarcopenia was more common in males, Child-Pugh C patients, those with ascites, American Society of Anesthesiologists score of ≥3, and a Clavien-Dindo grade of ≥3 patients. It was significantly associated with low body mass index and albumin levels (P < .05) and was more prevalent in the low PNI group. A significant correlation was observed between PNI and Child-Pugh score (P = .012), alpha fetoprotein, and albumin levels (P = .007 and P = .001).

CONCLUSION

Sarcopenia negatively impacts survival, whereas a higher PNI correlates with a lower mortality risk. Further multicenter prospective studies with a larger population are needed to validate these findings.

Complementarity of nutrition risk screening tools with malnutrition diagnosis in patients with cancer: A 12-month follow-up study assessing accuracy metrics and mortality

BACKGROUND

The Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition were established to provide a standardized approach for diagnosing malnutrition in clinical practice using a nutrition screening tool (NST) as the first step for this process. This study aimed to compare the complementarity of NSTs with the GLIM criteria for malnutrition diagnosis in patients with cancer.

METHODS

Hospitalized patients with different cancer types were evaluated in a prospective cohort study in which they were initially screened using the Patient-Generated Subjective Global Assessment (PG-SGA), Protocol for Nutritional Risk in Oncology (PRONTO), Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, Malnutrition Screening Tool, and NutriScore for nutrition risk. Malnutrition diagnosis involved phenotypic and etiological criteria as proposed by the GLIM. Complementarity of NST to GLIM criteria was evaluated by calculating accuracy metrics and investigating association with 12-month mortality.

RESULTS

Nutrition risk ranged from 14.8% (NutriScore) to 82.8% (PRONTO) and frequency of malnutrition from 13.8% (with NutriScore) to 88.9% (with PG-SGA). NutriScore presented the lowest negative predictive value (25.1%) whereas PG-SGA presented the highest (58.32%). Regardless of the NST applied, the risk of malnutrition and diagnosis of malnutrition according to the GLIM criteria, combined or isolated, increased the risk of 12-month mortality.

CONCLUSION

All NSTs presented low negative predictive value when their complementarity to GLIM criteria for malnutrition diagnosis was tested. Indeed, patients "at risk" presented similar increased risk of 12-month after discharge mortality in comparison with those at risk and malnourished by the GLIM criteria when all NSTs were applied.

Implication of Admission Eosinophil Count and Prognosis of Coronavirus Disease 2019 (COVID-19) in Elderly Patients With COPD: A Territory-Wide Cohort Study

OBJECTIVES

This study aims to investigate the association between elderly patients with COPD with different blood eosinophil on admission and those without COPD and the prognosis of COVID-19.

METHOD

A territory-wide retrospective study was conducted to investigate the association between elderly COPD patients with different blood eosinophil on admission and the prognosis of COVID-19. Elderly patients admitted to public hospitals and community treatment facility in Hong Kong for COVID-19 from January 23, 2020, to September 31, 2021, were included in the study. Severe diseases were defined as those who develop respiratory complications, systemic complications and death.

RESULTS

Among the 1925 patients included, 133 had COPD. Forty had admission blood eosinophil count ≥ 150 cells/μL, and 93 had blood eosinophil count < 150 cells/μL. Patients with COPD and admission blood eosinophil count ≥ 150 cells/μL, but not those with admission blood eosinophil count < 150 cells/μL, had severe COVID-19 with the development of respiratory and systemic complications. They were more likely to develop respiratory failure (OR = 5.235, 95% CI = 2.088-13.122, p < 0.001) and require invasive mechanical ventilation (OR = 2.433, 95% CI = 1.022-5.791, p = 0.045) and intensive care unit admission (OR = 2.214, 95% CI = 1.004-4.881, p = 0.049).

DISCUSSION

Our study suggested that the blood eosinophil count on admission could have significant prognostic implications among elderly patients with COPD. Patients with COPD and admission blood eosinophil count ≥ 150 cells/μL, but not those with admission blood eosinophil count < 150 cells/μL, have significantly increased risks of developing respiratory and systemic complications from COVID-19, when compared with non-COPD patients.

Geriatric nutritional risk index as a predictor of prognosis in hepatocellular carcinoma: A systematic review and meta-analysis

Objective

The geriatric nutritional risk index (GNRI) has found utility as a predictor of outcomes in several malignancies. However, does it predicts outcomes in hepatocellular cancer (HCC) is unclear. In this review, we present high-quality evidence on the prognostic ability of GNRI for HCC.

Methods

Two reviewers screened the websites of Embase, PubMed, Web of Science, and Scopus up to 20th June 2024 for relevant articles. We examined overall survival (OS) and progression-free survival (PFS) based on low vs high GNRI in HCC.

Results

Total 13 studies were included. Meta-analysis of 11 studies showed that low GNRI was significantly associated with poor OS (HR: 1.83 95% CI: 1.47, 2.29 I2=67%) and PFS (HR: 1.51 95% CI: 1.34, 1.69 I2=27%.) in HCC patients. No publication bias was noted. Most outcomes did not change on subgroup analysis based on country of origin, sample size, Child-Pugh Grade-B %, treatment, cut-off, follow-up, and method of analysis. Results remained significant on sensitivity analysis.

Conclusions

The GNRI can predict OS and PFS in HCC patients. Given its availability and ease of calculation, the tool can be incorporated into clinical practice to rapidly predict the prognosis of HCC patients.

NRI and SIRI are the optimal combinations for prognostic risk stratification in patients with non-small cell lung cancer after EGFR-TKI therapy

BACKGROUND

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have become the standard treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutations. However, NSCLC heterogeneity leads to differences in efficacy; thus, potential biomarkers need to be explored to predict the prognosis of patients. Recently, the prognostic importance of pre-treatment malnutrition and systemic inflammatory response in cancer patients has received increasing attention.

METHODS

In this study, clinical information from 363 NSCLC patients receiving EGFR-TKI treatment at our clinical center was used for analysis.

RESULTS

High nutritional risk index (NRI) and systemic inflammation response index (SIRI) were significantly associated with poor overall survival (OS) and progression-free survival (PFS) in NSCLC patients (P < 0.05). Importantly, NRI and SIRI were the best combination models for predicting clinical outcomes of NSCLC patients and independent OS and PFS predictors. Moreover, a nomogram model was constructed by combining NRI/SIRI, sex, smoking history, EGFR mutation, TNM stage, and surgery treatment to visually and personally predict the 1-, 2-, 3-, 4-, and 5-year OS of patients with NSCLC. Notably, risk stratification based on the nomogram model was better than that based on the TNM stage.

CONCLUSION

NRI and SIRI were the best combination models for predicting clinical outcomes of NSCLC patients receiving EGFR-TKI treatment, which may be a novel biomarker for supplement risk stratification in NSCLC patients.

Impact of preoperative malnutrition, based on albumin level and body mass index, on operative outcomes in noncirrhosis patients with colorectal liver metastasis

Background

Serum albumin level and body mass index (BMI), acting as indicators of nutritional status, are commonly applied to predict surgical outcomes in cancer patients. This study aimed to evaluate the impact of preoperative serum albumin level and BMI on the operative outcomes of noncirrhotic patients with colorectal cancer liver metastasis who underwent hepatectomy.

Methods

This was a retrospective study of medical records from the period between January 2013 and December 2022. Preoperative malnutrition was defined as hypoalbuminemia with a serum albumin level of <35 g/L before surgery or a BMI of <18.5 kg/m2 within 30 days before surgery. Multiple statistical methods were applied to analyze the data, including the two-independent sample t-test, analysis of variance, Chi-squared test, and multivariate analysis.

Results

Among the 159 eligible patients, 42 (26.4%) were classified into the preoperative malnutrition group. The incidence of blood transfusion (45.24% vs. 18.80%, P = 0.040) was significantly higher in the malnutrition group. The drainage volume was significantly higher on the first day [65 (115) vs. 60 (80), P < 0.05] and the second day [50 (95) vs. 40 (79) P < 0.05] in the malnutrition group than that in the nonmalnutrition group. Postoperative hemoglobin levels were significantly lower in the malnutrition group (101.20 ± 2.43 vs. 108.76 ± 1.61, P = 0.015). Therefore, the incidence of grade Ⅱ or Ⅲ/Ⅳ complications was significantly higher in the malnutrition group (16.67% vs. 5.31% or 11.9% vs. 3.42%, P = 0.001), and the length of hospital stay was significantly extended [18 (12) vs. 15 (8), P = 0.002]. In the multivariate analysis, preoperative malnutrition [odds ratio (OR) = 5.548, 95% CI 1.508-20.413, p = 0.010] and operation time (OR = 1.009, 95% CI 1.002-1.016, P = 0.0011) were identified as independent predictors of postoperative complications.

Conclusion

Preoperative malnutrition in patients who underwent hepatectomy for colorectal cancer liver metastasis was associated with worse surgical outcomes, especially aggrandizing the emergence of postoperative complications.

Preoperative Prediction of Sarcopenia in Patients Scheduled for Gastric and Colorectal Cancer Surgery

INTRODUCTION

Sarcopenia negatively impacts surgical outcomes in gastrointestinal cancer patients, yet practical preoperative screening tools are lacking. The CRP/ALB ratio, a novel biomarker of systemic inflammation and nutritional status, may enhance sarcopenia prediction but remains underexplored in surgical oncology. This study aims to identify the predictors for preoperative sarcopenia prediction in gastric and colorectal cancer patients.

METHODS

This retrospective study analyzed 145 patients undergoing curative surgery (2019-2021). Sarcopenia was defined by sex-specific CT-measured L3 skeletal muscle index (cutoffs, male ≤ 40.8 cm2/m2; female ≤ 34.9 cm2/m2). Multivariable logistic regression identified predictors, with model performance assessed via ROC analysis and Cohen's Kappa.

RESULTS

The cohort (median age 64 years; 73.8% male) comprised 66 gastric (45.5%) and 79 colorectal (54.5%) cancer patients, with 29 (20%) diagnosed with sarcopenia. Sarcopenic patients exhibited a higher NRS 2002 score (P < 0.001), lower PNI score (P < 0.05), and higher CRP/ALB ratio (P < 0.05). Multivariate logistic regression analysis results showed that CRP/ALB ratio (OR = 3.084, 95% CI 1.071-8.882, P = 0.037), age (OR = 1.074, 95% CI 1.021-1.130, P = 0.006), and BMI (OR = 0.667, 95% CI 0.542-0.820, P = 0.000) were associated with the increased risk of sarcopenia. The combined model achieved superior discrimination (AUC = 0.854, 95% CI 0.770-0.937), yielding 75.86% sensitivity and 84.82% specificity at optimal cutoff value - 1.0340, and a Cohen's Kappa coefficient of 0.542 when compared to CT results.

CONCLUSION

The CRP/ALB ratio combined with BMI and age is utilized as a convenient and effective tool for preoperative sarcopenia screening. This model-driven approach provides robust strategies to facilitate preoperative interventions, optimize perioperative care, and enhance long-term oncological outcomes for patients undergoing gastric and colorectal cancer surgery.

Association between the hemoglobin-to-red cell distribution width ratio and three-month unfavorable outcome in older acute ischemic stroke patients: a prospective study

Objective

Acute ischemic stroke (AIS) is a prevalent acute condition among older individuals. This study is the first investigation of the link between the HRR and unfavorable three-month outcome in older AIS patients.

Methods

This secondary research used data from a sample of 1,470 older AIS patients collected from a South Korean hospital between January 2010 and December 2016. Multiple imputation was applied to account for absent values. Binary logistic regression analysis was used to examine the relationship between the baseline HRR and adverse outcome at three-month. Restricted cubic spline analysis was employed to evaluate the correlation between HRR levels and adverse outcome. Interaction tests were performed to discern variations among subgroups.

Results

At 3 months, the overall incidence of adverse events was 31.43%, with a median HRR of 9.49. Compared to those with a lower HRR (Q1), the adjusted odds ratios (ORs) for the HRR in Q2, Q3, and Q4 were 0.61 (95% CI: 0.41-0.92, p = 0.017), 0.49 (95% CI: 0.31-0.78, p = 0.003), and 0.54 (95% CI: 0.31-0.92, p = 0.025), respectively. The correlation between the HRR and adverse outcome was non-linear (p < 0.05). An inflection point threshold of 10.70 was established via RCS analysis. Each 1-unit increase in HRR on the left side of the infection point was associated with a 24.0% decrease in the likelihood of adverse outcomes (OR = 0.76, 95% CI: 0.66-0.86, p < 0.001). ROC analysis revealed that HRR had the highest AUC (0.64, 95% CI: 0.61-0.67), followed by hs-CRP (0.60, 95% CI: 0.57-0.63), FPG/HbA1c (0.59, 95% CI: 0.55-0.63), and WBC (0.55, 95% CI: 0.51-0.58).

Conclusion

A lower HRR was correlated with a higher risk for adverse outcome in older AIS patients.

The adipokines in oral cancer pathogenesis and its potential as a new therapeutic approach

The involvement of adipose tissue in the development of cancer is currently the subject of an increasing number of research due to the growing relevance of lipid metabolism in tumor growth. Obesity influences the tumor immune microenvironment (TME) in oral cancer. Visceral white adipose tissue (WAT) consists of adipocytes, connective tissue, immune cells, and stromovascular cells. The metabolic processes of immune cells within the adipose tissue of individuals with obesity predominantly depend on oxidative phosphorylation (intrinsically) and are characterized by elevated levels of M2 macrophages, Treg cells, Th2 cells, and eosinophils from an extrinsic perspective. The adipokines secreted by adipocytes facilitate communication with adjacent tissues to regulate glucose and lipid metabolism. Obesity influences cancer progression through the dysregulation of adipocytokines, characterized by an augmented synthesis of the oncogenic adipokine leptin, coupled with a reduced secretion of adiponectin. Under standard physiological settings, these adipokines fulfill essential roles in sustaining homeostasis. This review analyzed the influence of adipocytes on oral cancer by detailing the mediators released by adipocytes. Comprehending the molecular foundations of the protumor roles of adipokines in oral cancers might provide novel treatment targets.

AGR, LMR and SIRI are the optimal combinations for risk stratification in advanced patients with non-small cell lung cancer following immune checkpoint blockers

Due to drug resistance, a majority of patients with non-small cell lung cancer (NSCLC) experience disease progression following immunotherapy. Therefore, there is an urgent need to develop novel biomarkers to predict the prognosis of NSCLC patients. Clinical data from 544 patients with advanced NSCLC who underwent immune checkpoint blockers (ICBs) at our clinical center were collected in this study. The results indicated that low Albumin-Globulin Ratio (AGR) and Lymphocyte-Monocyte Ratio (LMR) and high Systemic Immune-Inflammation Index (SIRI) were significantly correlated with both poor overall survival (OS) and progression-free survival (PFS) in NSCLC patients (P < 0.01). These three indicators collectively formed the most effective combined model for predicting the prognosis of NSCLC. Importantly, risk stratification based on AGR, LMR and SIRI was better than that based on the TNM stage, and served as an independent predictor of OS and PFS. Notably, the nomogram model developed by risk stratification, sex, age, smoking history, and pathological type demonstrated a good ability to predict the 1 to 5-year OS rates for NSCLC patients. In summary, AGR, LMR, and SIRI represented the optimal combined models for forecasting the prognosis of patients with advanced NSCLC who underwent ICBs, offering promising potential as biomarkers to direct personalized clinical interventions.

Novel indicator for erectile dysfunction: the CALLY index, evidence from data of NHANES 2001-2004

Purpose

This study explored the association between the C-reactive protein-albumin-lymphocyte (CALLY) index and erectile dysfunction (ED).

Patients and methods

Data from 2,128 participants in the 2001-2004 National Health and Nutrition Examination Survey (NHANES) were analyzed and classified into ED and non-ED groups.Additionally, a separate analysis of complete erectile dysfunction was conducted.A weighted multiple logistic regression model was used to assess the association between CALLY and ED, while smooth curve fitting was applied to explore their linear relationship.ROC analysis was conducted to compare the predictive accuracy (AUC) of CALLY, Systemic Inflammation Response Index (SIRI), Systemic Immune-Inflammation Index (SII), Aggregate Index of Systemic Inflammation (AISI), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and the product of platelet count and neutrophil count (PPN) for ED.

Results

After adjustment, Ln-CALLY was negatively associated with ED (OR = 0.77, 95% CI: 0.69-0.85, p < 0.0001) and complete ED (OR = 0.88, 95% CI: 0.78-1.00, p = 0.0450).The highest Ln-CALLY tertile (Q3) was associated with a significantly lower risk of ED compared to Q1 (OR = 0.40, 95% CI: 0.30-0.55, p < 0.0001).A similar trend was observed for complete ED (OR = 0.57, 95% CI: 0.38-0.85, p = 0.006).Curve fitting revealed a negative correlation between CALLY and both types of ED.Subgroup analysis confirmed the consistent and independent association.CALLY exhibited superior predictive performance for ED (AUC = 0.6512) and complete ED (AUC = 0.6237) compared to other markers.

Conclusion

Higher CALLY levels were linked to a reduced ED risk and proved a superior predictor compared to other inflammatory markers.

Comprehensive assessment in uro-oncologic geriatric patients: interdisciplinary management to improve survival

Urological cancers represent 13.1% of cancer cases in the world, with a mean age of diagnosis of 67 years, making it a geriatric disease. The lack of participation and evaluation of treatments by the geriatric oncologic population has made their mortality rate higher than that of other oncologic population groups, urologic cancers being no exception. The comprehensive management of older people with urological cancers is a bet that is presented to improve the quality of life and survival of this group. Managing elements such as nutritional, physical, cognitive, psychosocial, and sexual status improves the chances of adherence and treatment, contributing significantly to improving the quality of life. The integrated management of the geriatric oncology population has brought positive effects on quality of life, enhancing levels of depression and anxiety and also allowing the classification of oncology patients based on other criteria in addition to their chronologic age, contributing to the management of specialized treatments that have allowed the implementation of more specific interventions with better results.

Associations of triglyceride glucose-body mass index and the combination of sedentary behavior and physical activity with risks of all-cause mortality and myocardial infarction: a cohort study from the UK biobank

BACKGROUND

Triglyceride glucose-body mass (TyG-BMI) index, sedentary behavior (SB) and physical activity (PA) are independently associated with all-cause mortality and myocardial infarction (MI). However, it remains unclear whether TyG-BMI index and the combination of SB and PA exhibit joint effects on all-cause mortality and MI.

METHODS

Among 502 356 participants from the UK Biobank, 297 761 eligible participants were selected. The Cox proportional hazards model and the restricted cubic spline regression model were used to assess the associations of TyG-BMI with all-cause mortality and MI. To conduct stratified analysis, participants were classified into four groups by SB (<6 h/d and ≥ 6 h/d) and moderate to vigorous physical activity (MVPA) (<150 min/wk and ≥ 150 min/wk). Additionally, the multiplicative interaction was assessed between TyG-BMI and SB & MVPA. Furthermore, to estimate their joint associations, participants were conjointly classified into twelve new groups by TyG-BMI (tertiles) and SB & MVPA (four groups).

RESULTS

During a median follow-up of 13.8 and 13.6 years, 21 335 deaths and 9 116 MI were observed, respectively. The dose-response relationship of TyG-BMI with all-cause mortality was U-shaped with a cut-off point at 225.09, whereas the relationship with MI was positive nonlinear with a cut-off point at 266.87. A synergistic effect on all-cause mortality was observed between TyG-BMI tertile 1 and ≥ 6 h/d SB & <150 min/wk MVPA (P for interaction < 0.001). When MVPA ≥ 150 min/wk combined with SB either <6 h/d or not, TyG-BMI tertile 2 showed no significant association with all-cause mortality risk, with HRs(95%CIs) of 0.98 (0.93-1.03) for <6 h/d SB and 1.00 (0.94-1.07) for ≥ 6 h/d SB. When one of the two healthy behaviors was present (i.e., either <6 h/d SB with <150 min/wk MVPA, or ≥ 150 min/wk MVPA with ≥ 6 h/d SB), its combination with TyG-BMI tertile 1 showed no significant association with MI risk, with HRs(95%CIs) of 1.07(0.95-1.20) and 1.09(0.94-1.25), respectively.

CONCLUSIONS

TyG-BMI index and the combination of SB and PA were independently and jointly associated with risks of all-cause mortality and MI. Our findings highlight the importance of improving insulin resistance to reduce all-cause mortality risk, particularly in individuals with long-term SB and insufficient PA, who are more susceptible to the adverse effects of TyG-BMI index. In long-term sedentary individuals, meeting PA guidelines (≥ 150 min/wk of MVPA) effectively mitigated risks of all-cause mortality and MI associated with TyG-BMI index.

The prealbumin-CD19+ index predicts surgical survival in patients with GC

OBJECTIVE

This study aimed to establish a prealbumin (PALB)-CD19+ index that combines nutritional and immune statuses to comprehensively evaluate the prognosis of GC patients undergoing surgery.

METHODS

A total of 389 patients who were diagnosed with GC and who underwent surgical procedures at our institution between January 2016 and December 2020 were included in this study. Among them, 97 patients underwent subtotal gastrectomy, 271 underwent total gastrectomy, and 21 underwent palliative resection. The PALB-CD19+ index was developed using Cox regression analysis and regression coefficients, and LASSO regression analysis was employed to eliminate multicollinearity. Receiver operating characteristic (ROC) curves were used to calculate optimal cut-off values, and the prognostic value of different indices was compared using the area under the curve (AUC). Cox regression analysis was further utilized to identify independent prognostic factors. Survival analysis was conducted to explore differences in progression-free survival (PFS) and overall survival (OS) among patient groups. Finally, the prognostic significance of relevant factors was validated using a nomogram.

RESULTS

This study included 389 patients, 276 males and 113 females, with a mean age of 59.10 ± 10.19 years. Cox analysis identified PALB and CD19+ as significant factors influencing survival, forming the basis for the PALB-CD19+ index. The cut-off values for PALB and CD19+ were determined to be 230.50 mg/L and 15.40%, respectively. Cox regression analysis confirmed that the PALB-CD19+ index was an independent prognostic factor for both PFS and OS. Survival analysis demonstrated that patients with a lower PALB-CD19+ index had significantly shorter PFS and OS (χ² = 45.54, P < 0.001; χ² = 47.69, P < 0.001). Subgroup analysis across different TNM stages further validated the prognostic value of the PALB-CD19+ index (all P < 0.05). Nomograms incorporating the PALB-CD19+ index showed high accuracy, with concordance indices (C-index) in the training and validation cohorts approaching or exceeding 0.8.

CONCLUSIONS

The PALB-CD19+ index exhibits potential prognostic value in predicting surgical outcomes in GC patients. Its ability to integrate nutritional and immune parameters may provide clinicians with a novel and comprehensive tool for identifying high-risk patients and guiding personalized treatment strategies.

Cancer, malnutrition and inflammatory biomarkers. Why do some cancer patients lose more weight than others?

Introduction

Malnutrition is highly prevalent in cancer patients, significantly influencing their clinical outcomes and prognosis. The study was conducted to investigate the association between inflammatory biomarkers, nutritional status and progression of the disease across various types of cancers.

Material and methods

Retrospective data from 200 consecutive Caucasian cancer patients admitted to a major oncology hospital for cancer treatment were analyzed according to age, sex, cancer type, nutritional status (percentage body weight loss - %BWL), body mass index (BMI), percentage of dietary intake from the calculated requirement for nutrients (%DI)), and laboratory results (albumin levels, total protein concentration, C-reactive protein - CRP). Inflammatory biomarkers such as prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were assessed.

Results

Prognostic nutritional index (ρ = -0.464, p < 0.001), PLR (ρ = 0.293, p = 0.019), albumin level (ρ = -0.490, p < 0.001), platelet count (ρ = 0.114, p = 0.370), neutrophil count (ρ = 0.273, p = 0.030), CRP (ρ = 0.293, p = 0.019) and lymphocyte count (ρ = -0.288, p = 0.021) were significantly associated with %BWL. No significant association was found with NLR. Cancer dissemination was significantly associated with PNI (OR: 0.93, 95% CI: 0.88-0.98), PLR (OR: 1.00, 95% CI: 1.00-1.01), albumin (OR: 0.86, 95% CI: 0.80-0.93), platelet count (OR: 1.01, 95% CI: 1.00-1.01), %BWL (OR: 1.06, 95% CI: 1.02-1.10) and %DI (OR: 0.97, 95% CI: 0.96-0.99) but not with NLR, total protein level, total lymphocyte count, or BMI. For patients with albumin levels below 35 g/l, the likelihood of disseminated cancer was more than five times higher (OR: 5.45, 95% CI: 2.05-14.48).

Conclusions

The intensity of inflammation may be responsible for the severity of malnutrition and cancer prognosis.

Low body mass index demonstrates satisfactory specificity for diagnosing malnutrition and is associated with longer hospitalization in patients with gastrointestinal or head and neck cancer: a prospective cohort study

Background

The main causes of malnutrition in patients with gastrointestinal and head and neck cancers include metabolic alterations determined by the tumour and its stage, as well as low food intake caused by the disease itself and the effects of antineoplastic treatment. In the hospital environment, nutritional markers, such as body mass index (BMI), handgrip strength (HGS) and calf circumference (CC), can be used to identify malnutrition early, ensuring individualized and specific nutritional intervention. However, few studies have evaluated the individual performance of nutritional indicators in diagnosing malnutrition in a cancer setting. We aimed to assess the ability of these nutritional indicators to accurately diagnose malnutrition and their association with length of hospital stay (LOS) in patients with cancer.

Methods

This cohort study prospectively evaluated 171 patients with gastrointestinal or head and neck cancer. Nutritional status was assessed within 48 hours of hospital admission using BMI, CC and HGS as well as two reference standards: subjective global assessment (SGA) and patient-generated SGA (PG-SGA). The accuracy of each nutritional indicator was measured by the area under the receiver operating characteristic curve (AUC) compared with the reference standards. Multiple logistic regression analysis, adjusted for confounders, was used to determine whether malnutrition was associated with LOS.

Results

Of 171 patients, 59.1% had low CC, 46.2% had low HGS and 13.5% had low BMI. The SGA and PG-SGA scores indicated malnutrition in 57.4% and 87.2% of patients, respectively. All nutritional indicators had poor accuracy in diagnosing malnutrition (AUC < 0.70). However, compared with SGA and PG-SGA, low BMI had satisfactory specificity (>80%) and was associated with 1.79 times higher odds of LOS ≥ 6 days. Malnutrition diagnosed by SGA and PG-SGA increased the odds of LOS ≥ 6 days by 3.60-fold and 2.78-fold, respectively.

Conclusion

Low BMI showed adequate specificity for diagnosing malnutrition and was associated with longer LOS in patients with gastrointestinal or head and neck cancer. Further research is needed to explore how improved screening, interventions and nutritional support could reduce malnutrition rates in cancer patients.

Impact of prognostic nutritional index on mortality among patients receiving coronary artery bypass grafting surgery: a retrospective cohort study

BACKGROUND

The Prognostic Nutritional Index (PNI), calculated from serum albumin levels and lymphocyte counts, is a simple and objective measure of nutritional status. While PNI has been shown to be a significant prognostic tool in gastrointestinal surgery and heart failure, its role in patients undergoing coronary artery bypass grafting (CABG) remains unclear. This study aims to evaluate whether PNI can serve as a meaningful risk factor for patients undergoing CABG.

METHODS

This observational retrospective analysis involved a substantial sample of 2889 patients who underwent isolated CABG at one of four medical centres. The primary outcomes included short- and long-term mortality. Perioperative serum albumin levels and total lymphocyte counts used to calculate PNIs were collected 48 hours before the operation, 24 hours after the operation and at discharge. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors of short-term mortality. Survival and relative risks were assessed using Cox regression analysis and the Kaplan-Meier test.

RESULTS

Among the 2889 patients, 64 (2.2%) died within 30 days following CABG. Multivariate logistic regression revealed that higher preoperative PNI was independently associated with reduced short-term mortality (OR=0.852 per unit increase, 95% CI 0.802 to 0.904, p<0.001). Regarding long-term outcomes, among the 2825 patients who were discharged alive, 199 deaths occurred over a median follow-up period of 54.9 months. Patients with a normal PNI at discharge (>40) exhibited significantly higher long-term survival rates compared with those with a lower PNI (≤40) (log-rank p=0.003). Multivariate Cox regression analysis confirmed that a normal PNI at discharge(>40) independently predicted a lower risk of long-term all-cause mortality (HR=0.718, 95% CI 0.529 to 0.974, p=0.033).

CONCLUSIONS

PNI at various time points may play a crucial predictive role in mortality among CABG-treated patients, and a low PNI serves as a risk factor for both short- and long-term survival.

Nutritional status and quality of life of patients with advanced gastroenteropancreatic neuroendocrine neoplasms in Spain: the NUTRIGETNE (GETNE-S2109) study

Patients with advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) have impaired nutritional and physical performance due to the cancer pathophysiology and its treatment. The NUTRIGETNE study sought to characterize the nutritional status of patients with advanced GEP-NENs in Spain. This is a cross-sectional study that included patients with advanced GEP-NENs receiving active oncological treatment. Patients had a complete physical examination, anthropometry, bioelectrical impedance, dynamometry, laboratory analysis, and a comprehensive nutritional risk assessment. Malnutrition was defined according to Global Leadership Initiative on Malnutrition (GLIM) criteria. The study included 399 patients out of the 400 planned (Pearson's χ2; α 0.05). Median age was 62 years (22-83). Tumors most commonly originated in the small intestine (43.9%) and the pancreas (41.6%), 94.7% were metastatic, and 36.7%, 49.4%, and 12.5% were G1, G2, and G3, respectively. Malnutrition prevalence was 61.9% (25.8% moderate; 36.1% severe), mainly due to low muscle mass (50.9%), which was the most prevalent GLIM phenotypic criteria. Moreover, malnutrition showed a correlation with decreased hand grip strength (mean 23 vs 31.9 kg; P <.001) and phase angle (median 5o vs 5.6o; P <.001). The prevalence of sarcopenia was 15%. Malnutrition was more frequent in patients with diabetes (74.4% vs 56.7%; P <.001), NECs (82.1% vs 60.3%; P =.062), and in those treated with chemotherapy (71.2% vs 59.7%; P =.058), whereas it did not correlate with tumor origin (P =.507), histological grade (P =.781), or functionality (P =.465). Malnutrition was correlated to body mass index (BMI) (P =.015), although it was also diagnosed in a high proportion of patients with no weight loss (63%, 54.1%, and 65.1% of patients with normal BMI, overweight, and obesity, respectively). Cachexia was present in 109 (27.3%) patients. Malnutrition is very prevalent and commonly underdiagnosed in patients with GEP-NENs. It is associated with sarcopenia and a worse QoL, requiring a multifactorial nutritional assessment. Certain factors such as the presence of diabetes may require closer monitoring due to a higher risk of malnutrition.

The Value of Prognostic Nutritional Index in Patients with Deep Neck Space Infection

BACKGROUND

Antibiotic therapy is pivotal in deep neck space infections, yet inappropriate use and antibiotic resistance impact patient outcomes.

AIM

This study aimed to evaluate the clinical significance of admission prognostic nutritional index (PNI) as a prognostic marker.

METHODS

Data from 81 hospitalized patients (mean age 33.9 years) with deep neck space infections confirmed by CT scans were analyzed (Nov 2020 - Sep 2023). PNI, derived from serum albumin and lymphocyte count, was calculated. Primary outcome was antibiotic resistance; secondary outcome was length-of-stay.

RESULTS

Patients with antibiotic resistance (n = 24) had significantly lower PNI (mean 47.3, SD = 9.2) compared to the non-resistant group (n = 57, mean 57.5, SD = 12.2), P < 0.001. Adjusted multivariable analysis showed PNI as a significant predictor of antibiotic resistance (OR = 0.908, 95% CI 0.837-0.984, P = 0.004). ROC analysis established a PNI cut-off of 51.5 with 59% sensitivity and 80% specificity. Linear regression revealed decreasing PNI associated with prolonged length-of-hospital stays (adjusted R-squared = 0.40, P = 0.010).

CONCLUSIONS

The study underscores PNI's potential as a prognostic marker for deep neck space infections, particularly in predicting antibiotic resistance and length of hospital stay. Lower PNI values correlate with compromised nutritional and immune status, suggesting its clinical relevance for personalized treatment strategies.

Preoperative immunonutrition and postoperative outcomes in patients with cancer undergoing major abdominal surgery: Retrospective cohort study

BACKGROUND AND OBJECTIVES

Surgical resection is a first-line treatment for patients with cancer, but preoperative malnutrition is a risk factor for postoperative complications. This study aimed to evaluate the association between preoperative administration of an immunonutrition regimen and postoperative clinical outcomes in patients with cancer undergoing major abdominal surgery.

METHODS

The Surgical Prehabilitation Multimodal Oncology (SUPREMO) retrospective cohort study, conducted from January 2021 to December 2023, included patients with cancer undergoing major abdominal surgery. Patients were categorized based on whether they received a complete immunonutrition regimen or an incomplete or no regimen. Demographic and clinical data were extracted from electronic health records for descriptive analysis. Logistic regression was used to assess the impact of immunonutrition on the risk of infectious complications, with clinical and demographic variables as explanatory factors.

RESULTS

A total of 620 patients were included, with 49 % receiving a complete preoperative immunonutrition regimen. Bivariate analysis indicated that complete regimen administration was associated with lower intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and vasopressor support requirements (p = 0.005, p = 0.019, and p = 0.032, respectively). The logistic regression model showed a significant reduction in in-hospital infectious complications (odds ratio 0.54, 95 % confidence interval 0.31-0.98; p = 0.044).

CONCLUSION

Administering a complete preoperative immunonutrition regimen may be associated with reduced infectious complications, ICU and IMV requirements, and vasopressor support use.

Malnutrition Diagnosed by Patient-Generated Subjective Global Assessment and the Risk of All-Cause Mortality in Adults With Gastrointestinal Cancer: A Systematic Review and Meta-Analysis

INTRODUCTION

Several reviews have highlighted that the Patient-Generated Subjective Global Assessment (PG-SGA) is the best diagnostic tool for assessing nutritional status in cancer patients. However, previous meta-analyses summarizing the prevalence of malnutrition and overall survival in patients with gastrointestinal (GI) cancer are quite limited. This study aims to determine the overall prevalence and association between malnutrition, as defined by the PG-SGA, and mortality in adults with GI cancer.

METHODS

A comprehensive systematic review of articles published from 2005 to 2023 was conducted using Google Scholar, PubMed, Web of Sciences and Scopus. The PRISMA guideline was followed to organize the entire content. A random-effects meta-analysis model using R Studio was performed to quantify the pooled proportion and hazard ratios (HRs). Publication bias was assessed using Egger's test and funnel plots. Heterogeneity was evaluated using I2 and Baujat plots. This study was registered in PROSPERO under the protocol number CRD42023465685.

RESULTS

In this study, 46 publications with 23,235 participants were included in the final meta-analysis. The overall prevalence of malnutrition among adults with GI cancer, as determined by the PG-SGA, was 61% (95% CI: 51%-70%, I2 = 99%). The pooled prevalence of moderate and severe malnutrition were 38% (95% CI: 31%-45%, I2 = 96%) and 21% (95% CI: 13%-31%, I2 = 98%), respectively. By cancer type, malnutrition was more common in patients with oesophageal cancer (78%, 95% CI: 45%-94%, I2 = 99%) and gastric cancer (75%, 95% CI: 68%-81%, I2 = 87%). Additionally, the overall risk (pooled HR) of malnutrition on mortality among GI cancer patients was 2.02 (95% CI: 1.63%-2.5%, I2 = 23%).

CONCLUSION

Malnutrition is common in adults with GI cancer and doubles the risk of all-cause mortality. These results emphasize the importance of ongoing efforts in prevention, early assessment, and intervention for malnutrition to minimize mortality rates.

The Clinical Value of the Combined Detection of Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Prognostic Nutritional Index (PNI) in Early Diagnosis of Gastric Cancer

Objective

Gastric cancer (GC) is a common malignant tumor of the digestive tract. Accumulating studies suggest that inflammation is linked with the pathogenesis of GC. The study delves into novel hematological inflammatory markers, such as systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and prognostic nutritional index (PNI), to explore their potential applications in early diagnosis of GC.

Methods

From October 2020 and August 2024, 1339 GC patients admitted to our hospital were enrolled in this study. The pre-treatment SII, SIRI, and PNI was calculated from peripheral blood samples. Univariate and multivariate logistic regression analyses were utilized to verify independent risk factors for patients, and constructed the nomograms. The correlation between hematological indicators and tumor-node-metastasis (TNM) stage was assessed through Spearman's analysis.

Results

Eligible patients and healthy controls were grouped by gender. The diagnostic ability of PNI was significantly superior to other indicators to diagnose male GC (area under the curve [AUC]=0.908, 95% CI: 0.892-0.925) and female GC (AUC=0.890, 95% CI: 0.865-0.914). Besides, the combination of hematological indicators is more effective in diagnosing GC patients, especially for male patients (AUC=0.916, 95% CI: 0.901-0.932, sensitivity: 84.98%, specificity: 84.29%). The C-statistic of Nomogram model was 0.917 for males and 0.875 for females. In both male and female cohorts, CEA, SII, and SIRI were positively correlated with TNM stage, while PNI was negatively correlated. The AUC of CEA, SII, SIRI, and PNI combined for the diagnosis in the early stage of male GC patients was 0.897 (95% CI: 0.875-0.918, sensitivity: 86.57%, specificity: 80.30%) is higher than that of in the advanced stage (AUC: 0.745, 95% CI: 0.710-0.780, sensitivity: 56.53%, specificity: 82.86%).

Conclusion

The combined CEA, SII, PNI, and SIRI could be used as screening biomarkers in diagnosing GC, especially in the early stage of male GC patients.

Nutritional Status of Patients with Neoplasms Undergoing Ambulatory Chemotherapy and Associated Factors

BACKGROUND/OBJECTIVES

Cancer, a leading cause of mortality globally and in Brazil, is influenced by environmental and behavioral factors, often linked to nutritional deficiencies such as low body mass index and muscle wasting, exacerbating prognostic outcomes and mortality rates. Timely nutritional interventions during chemotherapy are pivotal, necessitating continuous nutritional assessment for effective patient care management. This study aimed to assess the nutritional status of non-metastatic cancer patients undergoing chemotherapy and identify factors influencing their nutritional status. Patient evaluation involved sociodemographic data, clinical profiles, anthropometric measurements, blood biochemical analyses, and nutritional status classification employing the Patient-Generated Subjective Global Assessment (PG-SGA) criteria. Statistical analysis was performed using R software.

RESULTS

Suspected malnutrition was identified in 5.81% of patients, with a significant association observed with gender, indicating a higher prevalence among men. Cancer stages II and III, along with a positive family history, correlated with heightened risk of malnutrition. Patients with suspected malnutrition exhibited older age, lower weight, body mass index (BMI), and reduced circumferences, underscoring the necessity of comprehensive nutritional assessment for optimized patient management during treatment.

CONCLUSIONS

This study underscores a notable prevalence of malnutrition, particularly among patients with lower weight and BMI, affirming the reliability of PG-SGA criteria.

Sarcopenia and cachexia: molecular mechanisms and therapeutic interventions

Sarcopenia is defined as a muscle-wasting syndrome that occurs with accelerated aging, while cachexia is a severe wasting syndrome associated with conditions such as cancer and immunodeficiency disorders, which cannot be fully addressed through conventional nutritional supplementation. Sarcopenia can be considered a component of cachexia, with the bidirectional interplay between adipose tissue and skeletal muscle potentially serving as a molecular mechanism for both conditions. However, the underlying mechanisms differ. Recognizing the interplay and distinctions between these disorders is essential for advancing both basic and translational research in this area, enhancing diagnostic accuracy and ultimately achieving effective therapeutic solutions for affected patients. This review discusses the muscle microenvironment's changes contributing to these conditions, recent therapeutic approaches like lifestyle modifications, small molecules, and nutritional interventions, and emerging strategies such as gene editing, stem cell therapy, and gut microbiome modulation. We also address the challenges and opportunities of multimodal interventions, aiming to provide insights into the pathogenesis and molecular mechanisms of sarcopenia and cachexia, ultimately aiding in innovative strategy development and improved treatments.

Calf circumference-albumin index significantly predicts the prognosis of older patients with cancer cachexia: A multicenter cohort study

OBJECTIVES

The aim of this study was to evaluate the combined prognostic value of calf circumference (CC) and serum albumin on mortality in patients with cancer cachexia aged ≥65 years.

METHODS

This multicenter cohort study involved 5322 older patients in hospital with cancer cachexia. The combined indicator of CC and albumin was defined as the calf circumference-albumin (CCA) index. Harrell's C index, a time-dependent receiver operating characteristic curve analysis, was used to assess the prognostic performance of the CCA index and other indices. The optimal thresholds method was used to determine the cutoff values of CC and albumin, and the association between the CCA index and all-cause mortality was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models.

RESULTS

A total of 3875 men and 1447 women with a mean age of 72.0 years (range: 68.0-78.0 years) and a mean follow-up time of 55.0 months (range: 25.0-85.0 months) were included in the study. A total of 1269 patients were classified into the low CCA index group (0 score) by the optimal thresholds method. In the overall population, the CCA index showed better differentiating power at predicting mortality in older patients with cancer cachexia compared with CC or albumin alone (C index = 0.639; 95% CI: 0.612-0.666; P < 0.05). The time-dependent receiver operating characteristic curve showed that the CCA index had the highest prognostic value of all the measures studied (P < 0.05). In the overall population, male and female patients with a high CCA index (2 score) showed better performance than those with a low CCA index (0 or 1 score).

CONCLUSIONS

The CCA index could significantly predict the mortality of older patients with cancer cachexia, which might provide renewed assistance for future clinical management.

Prognostic Nutritional Index and the Survival of Patients with Endometrial cancer: A Meta-analysis

The prognostic nutritional index (PNI) has emerged as a potential predictor of clinical outcomes in various cancers. However, a quantativetily analysis of its role in endometrial cancer (EC) remains lacking. This meta-analysis aims to evaluate the prognostic value of PNI on the survival outcomes of patients with EC. A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, Wanfang, and CNKI to identify relevant cohort studies. Studies were included if they provided sufficient data to calculate hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) based on PNI levels. Data extraction and quality assessment were performed independently by two reviewers. Pooled HRs with 95% confidence intervals (CIs) were calculated using a random-effects model to account for heterogeneity. A total of 10 studies, encompassing 3656 patients, met the inclusion criteria. The meta-analysis revealed that a low PNI was significantly associated with poorer OS (HR = 2.01, 95% CI = 1.62-2.49, p < 0.05; I2 = 54%) and PFS (HR = 2.75, 95% CI = 1.74-4.33, p < 0.05; I2 = 78%) in patients with EC. Subgroup analyses indicated that the prognostic impact of PNI was consistent in studies from Asian and non-Asian countries, and across studies with different ages of the patients, cutoff values of PNI, and follow-up duration (p for subgroup difference all > 0.05). In conclusion, the PNI is a prognostic marker for survival in patients with EC.

Subjective global assessment for nutritional screening and its impact on surgical outcomes: A prospective study in older patients with colorectal cancer

PURPOSE

Our perioperative management center provides preoperative intervention and functional and nutritional assessments for colorectal cancer patients aged over 75 years. This study evaluated the associations of preoperative nutritional status with postoperative outcomes and prognosis in colorectal cancer patients aged 75 years or older.

METHODS

This was a prospective, observational study of 71 colorectal cancer patients aged 75 years or older who underwent surgery between July 2020 and September 2022. The Subjective Global Assessment (SGA) was evaluated as a nutritional index. The patients were classified into three groups: SGA-A (well nourished), B (moderately malnourished), and C (severely malnourished), and the correlations with postoperative outcomes and prognosis were examined.

RESULTS

The median age of the 71 patients (34 males, 37 females) was 78 (75-92) years, and their median body mass index (BMI) was 22.3 (13.4-31.9) kg/m2. Forty-eight patients had colon cancer, and 23 had rectal cancer. On the SGA, 28 patients were SGA-A, 25 SGA-B, and 18 SGA-C. The SGA-B/C group had significantly higher BMI (p < 0.01) and more ICU admissions (p = 0.02). The G8 score was significantly lower (p = 0.03) in the SGA-B/C group, suggesting coexisting functional decline. In terms of postoperative outcomes, the SGA-B/C group had a significantly longer postoperative hospital stay (p = 0.04). The 3-year OS rates for all stages were 100% in the SGA-A group and 49.7% in the SGA-B/C group (p = 0.03), while the 3-year OS rates for patients excluding Stage IV were 100% in the SGA-A group and 68.5% in the SGA-B/C group, not significantly different (p = 0.14). The 3-year RFS rate was 95.5% in the SGA-A group and 65.3% in the SGA-B/C group (p = 0.15).

CONCLUSION

The SGA is a promising nutritional index associated with short-term outcomes in older patients undergoing colorectal cancer surgery. The SGA can be assessed in a few minutes during an outpatient visit, making it useful for routine clinical use.

"The association between HALP score and infection in acute ischemic stroke patients"

BACKGROUND AND PURPOSE

Stroke-associated infection (SAI) is related to increased mortality in acute ischemic stroke (AIS) cases. The HALP index is used to evaluate nutrition and inflammation. Our research aimed to assess the relation between HALP scores and infection risk in AIS cases.

MATERIALS AND METHODS

132 cases of acute ischemic stroke were registered. 77 cases were male and 55 cases were female. The median age of the attending cases was 66 (35-104) years. Laboratory variables were assessed within 24 h after hospitalization in the neurology care unit. The HALP score is evaluated utilizing the formula "Hemoglobin (g/dL) × Albumin (g/dL) × Lymphocyte (/10^3/uL) / Platelet (/10^3/uL)".

RESULTS

Cases were separated into two groups according to their corresponding HALP score. Group-1 cases have a low HALP score (HALP score ≤ 18227,93). Group-2 cases have a high HALP score (HALP score > 18227,93). 26 (19.6 %) cases were diagnosed with various infections after hospitalization in the neurology care unit. Urinary tract infections were frequent infection causes in AIS cases (13 cases, 50 %). Pneumonia was observed in 8 cases, making up 30 % of the total cases. Another infection was seen in 5 (20 %) of the cases. The frequently encountered bacteria were Escherichia coli ESBL + (n = 7, 27 %) and Staphylococcus aureus (n = 6, 23 %). The mortality ratio was higher in Group-1 cases than in Group-2 cases (34 % vs 7 %).

CONCLUSIONS

This investigation has suggested a relationship between infection and HALP score in AIS patients.

The Added Value of Controlling Nutritional Status (Conut) Score for Preoperative Counselling on Significant Early Loss of Renal Function After Radical Nephrectomy for Renal Cell Carcinoma

BACKGROUND AND OBJECTIVES

We aimed at evaluating the impact of Controlling Nutritional Status (CONUT) score on clinically significant decline in estimated glomerular filtration rate (eGFR) in patients with non-metastatic Clear Cell Renal Cell Carcinoma (ccRCC) undergoing radical nephrectomy (RN).

MATERIALS AND METHODS

We retrospectively analyzed a multi-institutional cohort of 140 patients with ccRCC who underwent RN between 2016 and 2018 at three Urological Centers. The CONUT score was calculated with an algorithm including serum albumin, total lymphocyte count, and cholesterol. Clinical and pathologic features were analyzed using Fisher's exact test for categorical variables and a Mann-Whitney U test for continuous variables. To define the independent predictors of clinically significant eGFR decline, univariable (UVA) and multivariable (MVA) binomial logistic regression analyses were performed in order to assess the Odds Ratio (OR) with 95% Confidence Intervals (CIs).

RESULTS

The optimal cut-off value to discriminate between a low and high CONUT score was assessed by calculating the ROC curve. The area under the curve (AUC) was 0.67 (95%CI 0.59-0.78) with the most appropriate cut-off value at 2 points. Overall, 46 patients (32.9%) had a high CONUT score (>2). Statistically significant variables associated with eGFR decline at 24 months were age ≥ 70 (OR 2.01; 95%CI 1.17-3.09; p 0.05), stage II-III chronic kidney disease (CKD) (OR 6.05; 95%CI 1.79-28.3; p 0.001), and a high CONUT score (OR 3.98; 95%CI 1.58-10.4; p 0.004).

CONCLUSIONS

The CONUT score is a low-time-consuming, cost-effective, and promising tool able to preoperatively screen patients at risk of developing CKD after a RN.

Documentation of anthropometrics in people with cancer: a cross-site collaboration audit in four hospital settings in the UK

BACKGROUND

Malnutrition is a significant risk for patients during cancer treatment. Neglecting to monitor or provide timely dietetic support can result in lower tolerance to treatments and reduced quality of life. This audit aimed to assess the completeness and accuracy of the documentation of anthropometric measurements in medical records and dietetic referral practices across four day-treatment units (DTUs) in England.

METHODOLOGY

Data were collected from electronic patient records of 100 patients in each DTU attending for systemic anti-cancer treatment (SACT) over a 2-week period. Data collected included patients' demographics, anthropometric data, referrals to dietitians, and whether the patients referred had a MUST score ≥ 2, which was calculated by the authors.

RESULTS

Findings revealed that weights and heights were documented for 58-85% and 94-98% of patients attending DTUs, respectively. On average, 55% (range of 7-85%) of patients had their body mass index (BMI) documented on the day of SACT. The Malnutrition Universal Screening Tool (MUST) was rarely completed (≤ 3% in each centre). Dietetic referral practices varied across centres.

CONCLUSIONS

Findings highlight the need to improve anthropometric documentation practices in cancer centres, in order to allow better monitoring of malnutrition risk and early nutritional support interventions when needed.

Hypoalbuminemia is Highly Prevalent in Patients with Periprosthetic Joint Infection and Strongly Associated with Treatment Failure

OBJECTIVE

The role of hypoalbuminemia throughout the course of chronic periprosthetic joint infection (PJI) remains poorly understood. This study aimed to determine the prevalence and risk factors of hypoalbuminemia in periprosthetic joint infection (PJI) patients and to explore the association between hypoalbuminemia and treatment outcomes.

METHODS

This retrospective cohort study included 387 PJI cases who underwent two-stage exchange arthroplasty between January 2007 and August 2020, of which 342 were reimplanted. The mean follow-up period was 7.9 years. Multivariate logistic regression analyses were performed to identify risk factors for hypoalbuminemia and to assess the effect of hypoalbuminemia at 1st- and 2nd-stage exchange on the treatment outcome. Furthermore, the impact of dynamic changes in hypoalbuminemia was investigated.

RESULTS

The prevalence of hypoalbuminemia at 1st- and 2nd-stage exchange was 22.2% and 4.7%, respectively. Patients with age ≥ 68 years and those with isolation of Staphylococcus aureus, Streptococcus, or Gram-negative bacteria exhibited a higher risk of hypoalbuminemia. Hypoalbuminemia at 1st-stage was significantly related to treatment failure (OR = 3.3), while hypoalbuminemia at 2nd-stage raised the OR to 10.0. Patients with persistent hypoalbuminemia at both the 1st- and 2nd-stage exchanges had a significantly higher rate of treatment failure than patients with hypoalbuminemia at the 1st-stage but normal albumin levels at the 2nd-stage exchange (55.6% vs 20.0%, p = 0.036).

CONCLUSION

One in five patients with chronic PJI exhibits hypoalbuminemia. Hypoalbuminemia is more likely to develop in patients of advanced age and those infected by specific highly virulent organisms. Also, our results highlight the close association between hypoalbuminemia and treatment outcomes.

The relationship between nutritional status and prognosis in advanced gastrointestinal cancer patients in palliative care: a prospective cohort study

OBJECTIVE

The study aimed to determine the nutritional status and its prognostic effect on the survival of patients with advanced gastrointestinal cancer.

METHODS

A prospective cohort study design was conducted in a tertiary hospital in Shanghai, China. The study consisted of 202 advanced gastrointestinal (GI) cancer patients from a palliative care unit. The following data were collected from the patients: biochemical indicators, i.e., anemia (hemoglobin levels), albumin, pre-albumin, C-reactive protein (CRP), and anthropometric parameters, i.e., body mass index (BMI), nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA), and performance status by Karnofsky Performance Status (KPS). Severe malnutrition was confirmed with the PG-SGA score of ≥ 9. Kaplan-Meier survival analysis and the log-rank test were used to calculate overall survival (OS). The effect of nutritional status on survival was performed by Cox regression analysis.

RESULTS

Severe malnutrition was found in 71.3% of patients according to the cutoff of the PG-SGA. PG-SGA score ≥ 9, albumin level < 35 g/L, and CRP level ≥ 10 mg/L predicted shortened life expectancy. Multivariate Cox regression analysis results showed that the PG-SGA score ≥ 9 and the albumin level < 35 g/L were predictive of OS.

CONCLUSION

Our data support that severe malnutrition is a predictor for OS in patients with advanced GI cancer. Information on nutritional status should be considered to individualize palliative care plan for these patients, and hence improve their quality of life.

Mood, Anxiety, and Cognitive Alterations in Cancer Patients

BACKGROUND AND OBJECTIVE

To analyze the cytokine profile in cerebrospinal fluid (CSF), as well as mood, anxiety, and cognition profiles in patients with CC.

METHODS

One hundred and nine individuals were evaluated, 37 controls, 18 CWC, and 54 CC patients. Assessments included BDI, HADS, Digit Span, FAS-verbal, Animals/WMS-R, Matrix Reasoning and Vocabulary (WASI), and QLQ-C30.

RESULTS

The CC group exhibited 62.96% depression and probable anxiety/depression, with 75.92% showing attention deficits. The CC and CWC groups demonstrated significant cognitive impairment on the WASI-Vocabulary test (CWC: 13.4 ± 2.2; CC: 15.9 ± 1.1) compared to the control group (Ct: 22.8 ± 1.6; p = 0.0002). In the QLQ-C30 scores, the CC group reported a greater perceived loss of quality of life and health deterioration (score of 17.5 ± 2.6) and lower scores on the Functional Scale (49.8 ± 4.5). The CC group had 18.52% illiteracy, 18.52% incomplete higher education, and 22.22% complete elementary education. The CC group also had lower weight (Ct: 67.8 ± 1.4; CWC: 61.7 ± 3.1; CC: 59.6 ± 1.7; p = 0.0023) and BMI (CC: 21.5 [18.3; 24.8]; Ct: 24.9 [23; 25.8]; p = 0.0021) compared to controls. Cytokines detected in the CSF were MCP-1, VEGF, IL-8, IP-10, and MIP-1β. Higher concentrations of MCP-1 were found in cancer patients (CSC: 571.2 ± 105.8; CC: 399.5 ± 65.9; Ct: 1477 ± 0.1; p < 0.0001), along with lower levels of MIP-1β (CC: 4345 [3060; 7353]) and VEGF (CC: 48.3 ± 2.0; CWC: 49.8 ± 3.8; Ct: 64.8 ± 3.2; p < 0.0001).

CONCLUSIONS

The level of mental impairment (mood, anxiety, and cognitive deficits) correlated with cancer-associated and cachexia-associated inflammation, weight loss, low BMI, elevated C-reactive protein (CRP), leukocytosis, lymphopenia, anemia, hypoalbuminemia, and low scores on the QLQ-C30 questionnaire (Global Health Status, Functional Scale, Symptom Scale). The CC group exhibited a higher prevalence of depression/anxiety, a stronger correlation between depression and inflammation, and greater cognitive impairment in attention, reasoning, and language, alongside lower average educational attainment. The low concentration of certain cytokines in the CSF combined with elevated systemic CRP in cancer and cachexia, associated with mental disorders, presents a paradox that requires further investigation. Higher concentrations of the cytokine MCP-1 in cancer patient groups indicated a positive correlation with the preservation of language abilities in these patients.

Effect of body mass index on post-treatment oral function in patients with oral cancer: a cross-sectional study

This single-center cross-sectional study used sequential sampling to examine the influence of body mass index (BMI) on oral function after oral cancer treatment. Patients who completed primary oral cancer treatment between September 2019 and March 2023 (102 patients, 74 male [72.5%] and 28 female [27.5%]; mean age, 69.6 years) were analyzed. Patient background data were collected from electronic medical records. Post-treatment oral function measurements were conducted on all patients using six assessment tools. Statistical analysis was conducted using Pearson's correlation coefficient, one-way analysis of variance, the Jonckheere-Terpstra test, and multiple linear regression. Pre-treatment BMI showed a statistically significant relationship with postoperative oral function, particularly tongue pressure (P = 0.01). While the mean values of the groups showed no significant differences, the Jonckheere-Terpstra test revealed a statistically significant trend toward a stepwise increase in tongue pressure for each BMI group (P = 0.03). Multiple linear regression analysis revealed a statistically significant correlation between tongue pressure and pre-treatment BMI (P < 0.05). Pre-treatment BMI was significantly associated with tongue pressure. Since BMI is a variable factor that can be controlled by nutritional therapy even before treatment, nutritional intervention, weight control, and treatment strategies including reconstructive interventions to maintain tongue pressure may be important in oral cancer treatment.

Preoperative Serum Albumin Level Predicts Length of Stay and Perioperative Adverse Events Following Vertebral Corpectomy and Posterior Stabilization for Metastatic Spine Disease

STUDY DESIGN

Retrospective review of a prospectively collected national database.

OBJECTIVES

To determine the association between preoperative serum albumin levels and perioperative adverse events (AEs) following vertebral corpectomy and posterior stabilization for metastatic spine disease.

METHODS

The 2010 to 2019 American College of Surgeons' National Surgical Quality Improvement (ACS-NSQIP) database was used to identify all patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Receiver operative characteristic (ROC) curve analysis was used to determine preoperative serum albumin cut-off values for predicting perioperative AEs. Low preoperative serum albumin was defined as serum albumin below this cut-off value.

RESULTS

A total of 301 patients were included in the study. ROC curve analysis demonstrated serum albumin < 3.25 g/dL as a cut-off value for predicting perioperative AEs. The low serum albumin group had a higher overall perioperative AEs (P = .041), longer post-operative LOS (P < .001), higher 30-day reoperation rate (P = .014), and a higher in-hospital mortality rate (P = .046). Multivariate analysis demonstrated that low preoperative serum albumin was associated with higher perioperative AEs.

CONCLUSIONS

Low serum albumin level is associated with higher perioperative AEs, longer postoperative LOS, and higher rates of 30-day reoperation and in-hospital mortality among patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Strategies to improve preoperative nutritional status in patients undergoing this procedure may improve these perioperative outcome measures within this surgical population.

LEVEL OF EVIDENCE

III.

Systematic nutritional screening and assessment in older patients: Rationale for its integration into oncology practice

As the global population ages, so does the number of older people being diagnosed, treated and surviving cancer. Challenges to providing appropriate healthcare management stem from the heterogeneity common in this population. Although malnutrition is highly prevalent in older people with cancer, ranging between 30 % and 80 % according to some analyses, is associated with frailty, and has been shown to be a major risk factor for poor treatment response and worse overall survival, addressing nutrition status is not always a priority among oncology healthcare providers. Evaluation of nutritional status is a two-step process: screening identifies risk factors for reduced nutritional intake and deficits that require more in-depth assessment. Screening activities can be as simple as taking weight and BMI measurements or using short nutritional questionnaires and asking the patient about unintentional weight loss to identify potential nutritional risk. Using geriatric assessment, deficits in the nutritional domain as well as in others reveal potentially reversible geriatric and medical problems to guide specific therapeutic interventions. The authors of this paper are experts in the fields of geriatric medicine, oncology, and nutrition science and believe that there is not only substantial evidence to support regularly performing screening and assessment of nutritional status in older patients with cancer, but that these measures lead to the planning and implementation of patient-centered approaches to nutrition management and thus enhanced geriatric-oncology care. This paper presents rationale for systematic nutrition screening and assessment in older adults with cancer.

Phase angle: A robust predictor of malnutrition and poor prognosis in gastrointestinal cancer

OBJECTIVES

The aim of this study was to investigate the relationship among phase angle (PA), malnutrition, and prognosis in patients with gastrointestinal cancer.

METHODS

In total, 870 patients with gastrointestinal cancer were enrolled. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate the association between PA and survival risk. Restricted cubic spline regression was used for flexibility analysis to explore sex-specific associations between PA and survival. Logistic regression was used to assess the relationships among PA, malnutrition, and cachexia.

RESULTS

Low PA was closely associated with poor physical conditions, diminished quality of life, and malnutrition. Patients with low PA had a significantly worse prognosis than those with high PA (60.6% versus 72.8%; log-rank P < 0.001). PA was suitable for the prognostic assessment of patients with advanced-stage tumors. Regardless of sex, patients with lower PA showed significantly poorer survival rates. Cox proportional hazards models identified PA as an independent predictor of prognosis in patients with gastrointestinal cancer (hazard ratio (HR)=0.534; 95% confidence interval (CI)=0.409-0.696, P < 0.001). Subgroup analysis indicated that a high PA was an independent risk factor affecting the prognoses of patients with esophageal, liver, and intrahepatic bile duct cancers. Interestingly, variations in PA had a more significant prognostic effect on survival in men than in women. The logistic regression model confirmed that PA is a valuable indicator for assessing malnutrition and cachexia in patients with gastrointestinal cancer. Among all body composition indicators, PA demonstrated the highest accuracy for prognostic prediction.

CONCLUSIONS

PA was identified as a robust predictor of malnutrition and poor prognosis in patients with gastrointestinal cancer.

Neutrophil-to-Lymphocyte Ratio and Prognostic Nutritional Index Are Predictors for Overall Survival after Primary Pancreatic Resection of Pancreatic Ductal Adenocarcinoma: A Single Centre Evaluation

PURPOSE

Prognostic inflammation-based parameters have been reported as useful tools in various oncologic diseases. Pancreatic ductal adenocarcinoma (PDAC) is characterized by a high mortality rate, making reliable prognostic markers highly desirable. However, there is still inconsistency in the literature regarding the efficacy of the different available scores.

METHODS

A total of 207 patients, who underwent primary resection of PDAC from January 2000 to December 2018 at the University Hospital of Erlangen, were included in this retrospective single-center study. Different biomarkers, including the preoperative neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the c-reactive protein (CRP)-albumin ratio (CAR), the lymphocyte-CRP ratio (LCR), the prognostic nutritional index (PNI) and the modified Glasgow prognostic score (mGPS) were analyzed for their ability to predict overall survival (OS).

RESULTS

In our cohort, the median overall survival was 20.7 months. Among the investigated biomarkers, NLR and PNI were identified as independent prognostic markers (Hazard Ratio (HR) 1.6 (1.0-2.5), p = 0.048 and HR 0.6 (0.4-0.9), p = 0.018), whereas PLR, CAR, LCR and mGPS did not reach significance in the multivariate analysis. Subgroup analysis revealed that the prognostic value of NLR and PNI is particularly evident in locally advanced tumor stages (pT3/4 and pN+).

CONCLUSIONS

The NLR and PNI could serve as valuable tools for estimating prognosis in patients with PDAC undergoing pancreatic resection in curative intention, especially in locally advanced tumor stages. However, conflicting results in the current literature highlight the need for further prospective studies to validate these findings.

Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study

OBJECTIVE

Skeletal muscle mass (SMM) is an important biomarker for prognosis and health in older patients with cancer. Limited information is available on the recovery course of SMM after oesophagectomy following neoadjuvant chemotherapy (NAC) in older patients. This study was performed to investigate the recovery course of SMM after oesophagectomy following NAC and the preoperative predictors of delayed recovery in older patients with locally advanced oesophageal cancer (LAEC).

METHODS

This single-centre retrospective cohort study involved older (≥65 years) and non-older (<65 years) patients with LAEC who underwent oesophagectomy following NAC. The SMM index (SMI) was calculated using CT images. One-way analysis of variance and multivariate logistic regression analysis were performed.

RESULTS

In total, 110 older patients and 57 non-older patients were analysed. Loss of the SMI after NAC to 12 months postoperatively was significantly greater in older patients than in non-older patients (p<0.01). The significant preoperative predictor of delayed recovery of the SMI 12 months after surgery was loss of the SMI during NAC in older patients (per 1%: adjusted OR 1.249; 95% CI 1.131 to 1.403; p<0.001), but not in non-older patients (per 1%: OR 1.074; 95% CI 0.988 to 1.179; p=0.108).

CONCLUSIONS

There is an especially large unmet need for preventing the long-term sequelae of SMM loss in older patients with LAEC after oesophagectomy following NAC. In older patients, loss of SMM during NAC is an especially useful biomarker for prescribing postoperative rehabilitation to prevent postoperative loss of SMM.

A new parameter in predicting contrast-induced nephropathy: Osaka prognostic score

OBJECTIVE

Nowadays, the frequency of complications is also increasing following the increasing frequency of coronary angiography and percutaneous coronary intervention. Contrast-induced nephropathy is one of the most common of these complications. This study aimed to investigate the relationship between the Osaka prognostic score, which has previously been shown to have prognostic importance in gastrointestinal malignancies, and the development of contrast-induced nephropathy.

METHODS

The study retrospectively examined the data of 1,498 patients who underwent coronary angiography and percutaneous coronary intervention due to acute coronary syndrome between 2018 and 2023. Demographic characteristics and laboratory findings were retrospectively collected from patients' charts and electronic medical records.

RESULTS

Osaka prognostic score (0.84±0.25 vs. 2.2±0.32, p<0.001) was higher in patients who developed contrast-induced nephropathy. Also, Osaka prognostic score [OR 2.161 95%CI (1.101-4.241), p<0.001] was found to be an independent risk factor along with age, diabetes mellitus, systolic pulmonary artery pressure, hemoglobin, hemoglobin, C-reactive protein, albumin, N-terminal brain natriuretic peptide, and systemic immune-inflammation index. The receiver operating characteristic curve showed that the optimal cutoff value of Osaka prognostic score to predict the development of contrast-induced nephropathy was 1.5, with a sensitivity of 83.4 and a specificity of 65.9% [area under the curve: 0.874 (95%CI: 0.850-0.897, p≤0.001)].

CONCLUSION

Osaka prognostic score may be an easily calculable, user-friendly, and useful parameter to predict the development of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention after acute coronary syndromes.

Effect of physical activity on patients of NSCLC

OBJECTIVE

The purpose of this study is to assess the impact of physical activity on both therapeutic efficacy and immune-related adverse events (irAEs) during immunotherapy for non-small cell lung cancer (NSCLC).

METHODS

Physical activity was divided into three groups: light physical activity (LPA), moderate physical activity (MPA), and vigorous physical activity (VPA) for laboratory indexes, efficacy, and irAEs. A multivariate logistic regression was employed to analyze the relationship between sedentary behavior with efficacy and irAEs.

RESULTS

The study included 121 patients. The three levels of physical activity were not significantly associated with efficacy or irAEs. However, noteworthy disparities were observed in base-hemoglobin levels (F = 3.4, P = 0.037) and base-lymphocyte levels (χ2 = 6.13, P = 0.047) among the three groups. After treatment, we identified statistically significant variations in albumin levels (P = 0.012) and lymphocyte counts (P = 0.035). Furthermore, a negative correlation emerged between pre-treatment sedentary behavior duration and immune-efficacy (β: -0.005, P = 0.027).

CONCLUSIONS

In summary, within the cohort of NSCLC patients undergoing single immunotherapy or a combination of immunotherapy and chemotherapy, physical activity is closely related to immune and inflammatory indicators in patients, and prolonged sitting will reduce the therapeutic effect.

Value of the modified Patient-Generated Subjective Global Assessment in indicating the need for nutrition intervention and predicting overall survival in patients with malignant tumors in at least two organs

BACKGROUND

Although the Patient-Generated Subjective Global Assessment (PG-SGA) is a reference standard used to assess a patient's nutrition status, it is cumbersome to administer. The aim of the present study was to estimate the value of a simpler and easier-to-use modified PG-SGA (mPG-SGA) to evaluate the nutrition status and need for intervention in patients with malignant tumors present in at least two organs.

METHODS

A total of 591 patients (343 male and 248 female) were included from the INSCOC study. A Pearson correlation analysis was conducted to assess the correlation between the mPG-SGA and nutrition-related factors, with the optimal cut-off defined by a receiver operating characteristic curve (ROC). The consistency between the mPG-SGA and PG-SGA was compared in a concordance analysis. A survival analysis was used to determine the effects of nutritional intervention among different nutrition status groups. Univariable and multivariable Cox analyses were applied to evaluate the association of the mPG-SGA with the all-cause mortality.

RESULTS

The mPG-SGA showed a negative association with nutrition-related factors. Individuals with an mPG-SGA ≥ 5 (rounded from 4.5) were considered to need nutritional intervention. Among the malnourished patients (mPG-SGA ≥ 5), the overall survival (OS) of those who received nutrition intervention was significantly higher than that of patients who did not. However, the OS was not significantly different in the better-nourished patients (mPG-SGA < 5).

CONCLUSION

Our findings support that the mPG-SGA is a feasible tool that can be used to guide nutritional interventions and predict the survival of patients with malignant tumors affecting at least two organs.

Advancing the Understanding of Malnutrition in the Elderly Population: Current Insights and Future Directions

Malnutrition is a growing public health problem leading to increased morbidity and mortality worldwide. Up to 50% of elderly patients are hospitalized due to this condition. In this review, we focused on analyzing the current diagnostic criteria for malnutrition among the elderly population and proposing promising solutions. Currently used diagnostic methods such as BMI or serum albumin levels are not sufficient to indicate malnutrition, which is affected by many factors, including the number of chronic diseases, multiple medications taken, or physical condition. Moreover, current recommendations are inadequate because they fail to account for various factors such as chronic illnesses, multiple medications, and bodily changes that are crucial in diagnostic evaluations. There is a noticeable gap between these recommendations and actual clinical practice. Nevertheless, developing more precise, non-invasive biomarkers and personalized nutrition strategies has to be explored. One of these strategies we discuss in our review is multidisciplinary approaches that combine nutrition, physical activity, and psychosocial support. Addressing malnutrition among the elderly should rely on standardized protocols and personalized interventions to enhance their nutritional health and overall well-being.

Advanced Lung Cancer Inflammation Index: A Novel Comprehensive Biomarker of Host Status for Patients with Metastatic Colorectal Cancer

Numerous biomarkers that reflect host status have been identified for patients with metastatic colorectal cancer (mCRC). However, there has been a paucity of biomarker studies that comprehensively indicate body composition, nutritional assessment, and systemic inflammation status. The advanced lung cancer inflammation index (ALI), initially introduced as a screening tool for patients with non-small-cell lung cancer in 2013, emerges as a holistic marker encompassing all body composition, nutritional status, and systemic inflammation status. The index is calculated by the simple formula: body mass index × albumin value / neutrophil-to-lymphocyte ratio. Given its accessibility in routine clinical practice, the ALI has exhibited promising clinical utility in prognosticating outcomes for patients with multiple types of cancer. In this review, we focus on the significance of host status and the clinical applicability of the ALI in the treatment and management of patients with malignancies, including mCRC. We also suggest its potential in guiding the formulation of treatment strategies against mCRC and outline future perspectives.

How Immunonutritional Markers Are Associated with Age, Sex, Body Mass Index and the Most Common Chronic Diseases in the Hospitalized Geriatric Population-A Cross Sectional Study

The aim of this study was to assess the relationship of different chronic diseases with immunonutritional markers in the senior population.

METHODS

this study included 1190 hospitalized geriatric patients. The criteria to participate were ability to communicate, given consent and C-reactive protein (CRP) lower than 6 mg/dL.

RESULTS

the mean age of the study population was 81.7 ± 7.6 years. NLR (neutrophil-to-lymphocyte ratio), LMR (lymphocyte-to-monocyte ratio), MWR (monocyte-to-white blood cell ratio), SII (systemic immune-inflammation index), PNI (prognostic nutritional index) and CAR (C-reactive protein-to-albumin ratio) were related to age. NLR and MWR were higher, while LMR, PLR (platelet-to-lymphocyte ratio and SII were lower in men. All markers were related to BMI. NLR, LMR, LCR (lymphocyte-to-CRP ratio), MWR, PNI and CAR were related to several concomitant chronic diseases. In multivariate analyses, age and BMI were selected as independent predictors of all studied immunonutritional markers. Atrial fibrillation, diabetes mellitus and dementia appear most often in the models. PNI presented the most consistent statistical association with age, BMI and concomitant chronic diseases.

CONCLUSIONS

this study reveals the pivotal role of aging and BMI in inflammatory marker levels and the association of immunonutritional markers with different chronic diseases. Atrial fibrillation seems to have the most dominant connection to the immunonutritional markers.