肠内营养支持治疗减轻晚期食管癌患者化疗不良反应

doi:10.19723/j.issn.1671-167X.2020.02.011

Abstract

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

Zhi-wei SUN,Jun JIA,Ying YANG,Chuan-ling LIU,Yan-jie XIAO,Jing YU,Xiao-dong ZHANG. Enteral nutrition support reduces toxicity of chemotherapy in patients with advanced or metastatic esophageal cancer[J].Journal of Peking University (Health Sciences), 2020, 52(2): 261-268.

Figures/Tables 8

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

Table 7

Table 8

References 24

[1]	于振涛 . 食管癌围手术期营养治疗[J]. 肿瘤代谢与营养电子杂志, 2015,2(2):19-22.
[2]	Bozzetti F, Mariani L, Lo VS , et al. The nutritional risk in onco-logy: a study of 1,453 cancer outpatients[J]. Support Care Cancer, 2012,20(8):1919-1928.
[3]	Cong MH, Li SL, Cheng GW , et al. An interdisciplinary nutrition support team improves clinical and hospitalized outcomes of esophageal cancer patients with concurrent chemoradiotherapy[J]. Chin Med J (Engl), 2015,128(22):3003-3007.
[4]	Wu W, Zhong M, Zhu DM , et al. Effect of early full-calorie nutrition support following esophagectomy: a randomized controlled trial[J]. JPEN J Parenter Enteral Nutr, 2017,41(7):1146-1154.
[5]	Takesue T, Takeuchi H, Ogura M , et al. A prospective rando-mized trial of enteral nutrition after thoracoscopic esophagectomy for esophageal cancer[J]. Ann Surg Oncol, 2015,22(3):S802-809.
[6]	Peng J, Cai J, Niu ZX , et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis[J]. Dis Esophagus, 2016,29(4):333-341.
[7]	Moro K, Koyama Y, Kosugi SI , et al. Low fat-containing elemental formula is effective for postoperative recovery and potentially useful for preventing chyle leak during postoperative early enteral nutrition after esophagectomy[J]. Clin Nutr, 2016,35(6):1423-1428.
[8]	Odelli C, Burgess D, Bateman L , et al. Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer[J]. Clin Oncol (R Coll Radiol), 2005,17(8):639-645.
[9]	吕家华, 李涛, 谢丛华 , 等. 食管癌放疗患者肠内营养专家共识[J]. 肿瘤代谢与营养电子杂志, 2015,2(4):29-32.
[10]	Arends J, Bachmann P, Baracos V , et al. ESPEN guidelines on nutrition in cancer patients[J]. Clin Nutr, 2017,36(1):11-48.
[11]	Nicolini A, Ferrari P, Masoni MC , et al. Malnutrition, anorexia and cachexia in cancer patients: A mini-review on pathogenesis and treatment[J]. Biomed Pharmacother, 2013,67(8):807-817.
[12]	Zhang XL, Xu L, Shen JM , et al. Metabolic signatures of esophageal cancer: NMR-based metabolomics and UHPLC-based focused metabolomics of blood serum[J]. Biochim Biophys Acta, 2013,1832(8):1207-1216.
[13]	Trachootham D, Songkaew W, Hongsachum B , et al. Nutri-jelly may improve quality of life and decrease tube feeding demand in head and neck cancer patients[J]. Support Care Cancer, 2015,23(5):1421-1430.
[14]	Martin RC, Cannon RM, Brown RE , et al. Evaluation of quality of life following placement of self-expanding plastic stents as a bridge to surgery in patients receiving neoadjuvant therapy for esophageal cancer[J]. Oncologist, 2014,19(3):259-265.
[15]	Andreyev HJ, Norman AR, Oates J , et al. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies?[J]. Eur J Cancer, 1998,34(4):503-509.
[16]	Chau I, Norman AR, Cunningham D , et al. Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer-pooled analysis from three multicenter, randomized, controlled trials using individual patient data[J]. J Clin Oncol, 2004,22(12):2395-2403.
[17]	Crumley AB ,McMillan DC, McKernan M, et al. Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-esophageal cancer[J]. Br J Cancer, 2006,94(5):637-641.
[18]	Lecleire S, Di Fiore F, Antonietti M , et al. Undernutrition is predictive of early mortality after palliative self-expanding metal stent insertion in patients with inoperable or recurrent esophageal cancer[J]. Gastrointest Endosc, 2006,64(4):479-484.
[19]	Miyata H, Yano M, Yasuda T , et al. Randomized study of clinical effect of enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esopha-geal cancer[J]. Clin Nutr, 2012,31(3):330-336.
[20]	Miyata H, Yano M, Yasuda T , et al. Randomized study of the clinical effects ω-3 fatty acid-containing enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer[J]. Nutrition, 2017,33:204-210.
[21]	Enzinger PC, Ilson DH, Kelsen DP . Chemotherapy in esophageal cancer[J]. Semin Oncol, 1999,26(5):12-20.
[22]	Bleiberg H, Conroy T, Lacave AJ , et al. Randomised phase Ⅱ study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer[J]. Eur J Cancer, 1997,33(8):1216-1220.
[23]	Huang J, Zhou Y, Zhang H , et al. A phase Ⅱ study of biweekly paclitaxel and cisplatin chemotherapy for recurrent or metastatic esophageal squamous cell carcinoma: ERCC1 expression predicts response to chemotherapy[J]. Med Oncol, 2013,30(1):343.
[24]	Lu M, Wang X, Shen L , et al. Nimotuzumab plus paclitaxel and cisplatin as the first line treatment for advanced esophageal squamous cell cancer: A single centre prospective phase Ⅱ trial[J]. Cancer Sci, 2016,107(4):486-490.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Comments

Recommended 10

[1]	Author. English Title Test[J]. Journal of Peking University(Health Sciences), 2010, 42(1): 1 -10 .
[2]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 188 -191 .
[3]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(3): 376 -379 .
[4]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(4): 459 -462 .
[5]	. [J]. Journal of Peking University(Health Sciences), 2010, 42(1): 82 -84 .
[6]	. [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 319 -322 .
[7]	. [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 333 -336 .
[8]	. [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 337 -340 .
[9]	. [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 225 -328 .
[10]	. [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 346 -350 .

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)

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

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

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

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

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

RICH HTML

PDF (PC)

Abstract

Cite this article

share this article

Figures/Tables 8

References 24

Related Articles 4

Metrics

Comments

Recommended 10

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

[1]	Liang GENG,Jing LV,Jing FAN. Effect of Fei-Liu-Ping ointment combined with cyclophosphamide on lung cancer cell proliferation and acidic microenvironment [J]. Journal of Peking University (Health Sciences), 2020, 52(2): 247-253.
[2]	Yi-xiang MA,Jing-wei LIU,Kang QI,Ji-xin ZHANG,Gang LIN,Hai-bo LIU,Xue-qian SHANG,Jian LI. Diagnosis and treatment of seven primary mediastinal yolk sac tumors [J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1091-1095.
[3]	Jia-xuan XU,Hong-zhi WANG,Jun DONG,Xiao-jie CHEN,Yong YANG,Ren-xiong CHEN,Guo-dong WANG. Analysis of risk factors for acute lung injury/acute respiratory distress syndrome after esophagectomy [J]. Journal of Peking University(Health Sciences), 2018, 50(6): 1057-1062.
[4]	CHEN Yang, WANG Yan-rong, SHI Yan, DAI Guang-hai. Prognostic value of chemotherapy-induced neutropenia in metastatic colon cancer patients undergoing first-line chemotherapy with FOLFOX [J]. Journal of Peking University(Health Sciences), 2017, 49(4): 669-674.