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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (2): 261-268. doi: 10.19723/j.issn.1671-167X.2020.02.011

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Enteral nutrition support reduces toxicity of chemotherapy in patients with advanced or metastatic esophageal cancer

Zhi-wei SUN,Jun JIA,Ying YANG,Chuan-ling LIU,Yan-jie XIAO,Jing YU,Xiao-dong ZHANG   

  1. VIP-Ⅱ Gastrointestinal Cancer Division of the Department of Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China
  • Received:2019-11-19 Online:2020-04-18 Published:2020-04-18
  • Contact: Xiao-dong ZHANG

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Abstract:

Objective: To assess the impact of enteral nutrition support on response and toxicity of the first-line chemotherapy in those patients with advanced or metastatic esophageal cancer.Methods: We collected the clinical data of 118 patients with unresectable advanced or metastatic esophageal cancer who received the first-line chemotherapy in our center from July 2014 to December 2016. All these 118 eso-phageal cancer patients were then divided into two groups: the nutrition group (received enteral nutrition support in addition to chemotherapy) and the control group (received chemotherapy only). Differences were analyzed before and after chemotherapy in each of the nutritional indicators including Karnofsky performance status (KPS), weight, body mass index (BMI), hemoglobin (Hb), number of lymphocytes (Lymph), total protein (TP), albumin (Alb), triglycerides (TG), total cholesterol (TC) in both groups. And differences of the efficacy and toxicities of the first-line chemotherapy between the two groups were also analyzed.Results: (1) Weight, BMI and Hb were all significantly decreased after chemotherapy in the control group (P<0.001), while there was no significant change of weight and BMI in the nutrition group, just with Hb decrease only. However, there was no significant change of all the other nutrition indicators after chemotherapy in both groups. (2) Compared with the control group, the nutrition group had significantly lower incidence of grade 3 to 4 hematologic toxicities after chemotherapy (15.4% vs. 42.1%, P=0.004). In addition, the incidence of grade 3 to 4 nonhematologic toxicities after chemotherapy was also lower in the nutrition group but without statistical significance (0 vs. 9.2%, P=0.123). Logistic regression model was then used for multivariate analysis to identify the factors that affected the toxicity of chemotherapy in these patients, and the results showed that nutrition therapy was an independent influencing factor of grade 3 or higher hematological toxicity after chemotherapy in the patients with esophageal cancer (P=0.008, RR=6.048, 95%CI: 1.589-23.027). (3) The response rate of chemotherapy between the control group and the nutrition group had not significant difference.Conclusion: Enteral nutrition support in addition to chemotherapy could improve nutrition status and reduce toxicity of chemotherapy in advanced or metastatic esophageal cancer patients.

Key words: Esophageal neoplasms, Chemotherapy, Enteral nutrition support

CLC Number: 

  • R735.1

Table 1

Patient characteristics"

Items Control group, n (%) Nutrition group, n (%) P value
Gender 0.084
Male 60 (76.9) 36 (90.0)
Female 18 (23.1) 4 (10.0)
Age/years 0.824
≤70 73 (93.6) 37 (92.5)
>70 5 (6.4) 3 (7.5)
KPS 0.438
≥90 73 (93.6) 35 (87.5)
80-70 5 (6.4) 5 (12.5)
Grade 0.888
Well 51 (65.4) 24 (60.0)
Poorly 24 (30.8) 12 (30.0)
Not known 3 (3.8) 4 (10.0)
Stage 0.147
Locally advanced 57 (73.1) 24 (60.0)
Recurrent/metastatic 21 (26.9) 16 (40.0)

Table 2

Nutritional indicators before chemotherapy"

Items Control group, $\bar{x}±s$ Nutrition group, $\bar{x}±s$ P value
KPS 89.49±2.74 88.75±3.35 0.234
BMI/(kg/m2) 22.65±3.81 20.64±2.73 0.004
Hb/(g/L) 141.65±14.26 130.31±25.86 0.003
Lymph/(×109/L) 1.82±0.68 1.63±0.47 0.104
TP/(g/L) 70.24±4.47 69.57±6.77 0.577
Alb/(g/L) 43.11±3.13 41.47±7.64 0.200
TG/(mmol/L) 1.12±0.50 1.17±0.88 0.693
TC/(mmol/L) 4.93±1.10 4.74±1.04 0.394

Table 3

Changes of nutritional indicators before and atter chemotherapy in all patients（$\bar{x}±s$） "

Table 4

Changes of nutritional indicators before and after chemotherapy in patients with advanved esophageal cancer（$\bar{x}±s$）"

Table 5

Changes of nutritional indicators before and after chemotherapy in patients with recurrent/metastatic esophageal cancer ($\bar{x}$ ±s)"

Items KPS Weight/kg BMI/(kg/m2) Hb/(g/L)
Nutrition group
B 88.75±3.42 58.70±8.95 21.01±2.36 135.12±11.93
A 89.38±2.50 57.49±9.64 20.56±2.58 123.81±9.37
Δ(B-A) -0.63±2.50 1.21±2.77 0.45±1.05 11.31±14.46
P 0.333 0.112 0.119 0.007
Control group
B 89.05±3.01 64.11±10.37 22.82±2.52 139.84±15.67
A 88.10±4.02 62.60±10.54 22.29±2.74 124.11±14.89
Δ(B-A) 0.95±3.01 1.51±1.89 0.53±0.70 15.74±11.74
P 0.160 0.003 0.004 <0.001
Items Lymph/(×109/L) TP/(g/L) Alb/(g/L) TG/(mmol/L) TC/(mmol/L)
Nutrition group
B 1.69±0.50 71.30±5.63 42.65±3.38 1.04±0.35 4.79±1.11
A 1.55±0.51 72.46±3.88 42.49±4.12 1.23±0.71 4.73±1.67
Δ(B-A) 0.14±0.35 -1.16±5.53 0.16±5.37 -0.19±0.63 0.07±1.70
P 0.134 0.417 0.909 0.237 0.874
Control group
B 1.63±0.65 71.18±4.15 43.33±2.59 1.05±0.39 4.82±1.24
A 1.55±0.61 69.89±3.07 42.56±3.10 1.21±0.47 4.62±1.10
Δ(B-A) 0.08±0.56 1.29±4.20 0.78±2.66 -0.17±0.39 0.20±0.61
P 0.539 0.208 0.231 0.093 0.191

Table 6

The correlation between chemotherapy efficacy and enteral nutrition support"

Stage Efficacy Control group Nutrition group P value
All Response rate 43.7% 41.7% 0.844
Disease control rate 95.8% 100.0% 0.528
Locally advanced Response rate 41.5% 27.3% 0.246
Disease control rate 96.2% 100.0% 1.000
Recurrent/metastatic Response rate 50.0% 64.3% 0.490
Disease control rate 94.4% 100.0% 1.000

Table 7

Correlation between toxicity of chemotherapy and enteral nutrition support"

Stage Efficacy Control group Nutrition group P value
All Response rate 43.7% 41.7% 0.844
Disease control rate 95.8% 100.0% 0.528
Locally advanced Response rate 41.5% 27.3% 0.246
Disease control rate 96.2% 100.0% 1.000
Recurrent/metastatic Response rate 50.0% 64.3% 0.490
Disease control rate 94.4% 100.0% 1.000

Table 8

Logistic regression multivariate analysis of factors related to toxicity of chemotherapy in patients with esophageal cancer"

Variables Wald OR 95%CI P
Gender 0.227 0.705 0.167-2.976 0.634
Age 0.335 0.558 0.077-4.026 0.563
KPS 1.862 5.174 0.488-54.851 0.172
Grade 0.238 0.755 0.244-2.335 0.626
Stage 0.066 1.163 0.368-3.678 0.797
BMI 0.910 1.074 0.927-1.245 0.340
Hb 2.435 0.966 0.924-1.009 0.119
Lymph 0.175 1.192 0.524-2.712 0.675
TP 0.735 1.064 0.923-1.227 0.391
Alb 1.551 1.150 0.923-1.434 0.213
TG 0.846 0.589 0.191-1.820 0.358
TC 0.046 1.063 0.607-1.863 0.831
Nutrition support 6.962 6.048 1.589-23.027 0.008
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