Follow-up Study Of Nutritional Status Of Patients With Gastric Cancer On Different Stages Of Treatment

ObjectiveThe aim of this study was to investigate nutritional status of newly diagnosed patients with gastric cancer in a tumor hospital,to compare application of different nutritional assessment tools in them,and to investigate changes of nutritional status at different stages of chemotherapy after gastrectomy treatment for gastric cancer.Methods(1)Patient generated-subjective global assessment(PG-SGA),nutrition risk screening 2002(NRS-2002)and traditional nutrition evaluations were used to evaluate nutritional status of gastric cancer patients.And then we described the prevalence of malnutrition by different nutritional assessment tools,and analyzed the influencing factors of nutritional status and the correlation between patient generated-subjective global assessment/nutrition risk screening 2002 and traditional nutrition evaluation.(2)Nutritional status were tracked at different times from pre-operation to chemotherapy while following up those patients undergoing gastrectomy treatment for gastric cancer.The toxic reactions of chemotherapy were recorded for analyzing the correlation between toxic reactions and nutritional status.Results(1)196 patients were recruited,the average age of patients was 59.32±11.86 years old.There were 138 male(70.41%)and 58 female(29.59%)among them.54(27.55%)cases were at stage ?,51(26.02%)cases were at stage ?,75(38.27%)cases were at stage ?,and 16(8.16%)cases were at stage ?.The number of patients with tumor metastasis was 102(52.04%)cases,the number of cases with no metastasis was 94 cases(47.96%).PG-SGA mean score was 4.06±2.87,the prevalence of malnutrition by PG-SGA was 80.61%;NRS-2002 mean score was 2.24±1.28,the prevalence of nutrition at risk by NRS-2002 was 37.76%;the range of prevalence of malnutrition by traditional nutrition evaluation was 1.53%?31.12%.The prevalence of malnutrition was higher in aged patients than that in younger patients.The prevalence of malnutrition was higher in patients with underlying other diseases than that patients without underlying other diseases.(2)The sensitivity and specificity of NRS-2002 was 44.94%and 92.11%respectively.NRS-2002 was not as sensitive as PG-SGA,and easy to lose some patients with malnutrition.Traditional nutrition evaluations have their own limitations.There were positive correlations between PG-SGA score and age,PLT,and PS;there were negative correlations between PG-SGA scores and weight,BMI,TSF,TP,Alb,Hb,and KPS.There were positive correlations between NRS-2002 score and age,PLT,PS;there were negative correlations between NRS-2002 scores and weight,BMI,AC,TSF,AMC,TP,Alb,Hb,KPS.There was good correlation between PG-SGA and NRS-2002.(3)45 cases who needed gastrectomy and postoperative chemotherapy were recruited.Compared to preoperative index,the score of PG-SGA increased significantly,the value of weight,BMI,AC,TSF,Alb,Hb,PLT,RBC and WBC decreased significantly at post-operation,the nutritional status of patients became worse.Compared to pre-chemotherapy,the score of PG-SGA decreased significantly at post-chemotherapy,the value of weight,BMI,AC,TSF,AMC,TP,Hb,PLT and RBC continued to decrease.But the score of PG-SGA increased at the fourth cycle of chemotherapy again,the values of Hb and Alb were higher at the fourth cycle of chemotherapy than that at the third cycle.(4)The mean weight of patients was 66.32±11.40 kg at pre-operation,and decreased to 56.61±9.46 kg after operation.After operation,median of weight loss was 7.84%,and median of weight losses were 1.96%,2.08%,0%,0.81%respectively at four cycles of chemotherapy.(5)The prevalence of gastrointestinal side effect,bone marrow suppression,liver damage and kidney damage were 28.89%,68.89%,35.56%,26.67%respectively after chemotherapy.During chemotherapy,with the increasing times of chemotherapy,toxic reactions became more serious.And as the grade of toxic reactions became higher,the score of PG-SGA increased.Conclusion(1)The prevalence of malnutrition of gastric cancer was high.The score of PG-SGA at post-operation was higher than that at pre-operation.The score of PG-SGA decreased during the first three cycles of chemotherapy,and increased at the fourth cycle of chemotherapy.The indexs measured by traditional nutrition evaluation continued to decrease during the operation and chemotherapeutic period.(2)NRS-2002 and traditional nutrition evaluation were inadequacy for screening and evaluating malnutrition of gastric cancer patients.As there was a good relationship between PG-SGA and NRS-2002/traditional nutrition evaluation,NRS-2002 and traditional nutrition evaluation could be used to evaluate nutrition of gastric cancer patients as an auxiliary means.(3)Nutritional status of aged gastric cancer patients should get more attention for their high prevalence of malnutrition.The prevalence of malnutrition was higher in patients with underlying diseases than that patients without underlying diseases.(4)With the increasing times of chemotherapy,toxic reactions became more serious.And as the grade of toxic reactions became higher,the score of PG-SGA increased.