Data_Sheet_1_Prevalence and Prognostic Value of Malnutrition Among Elderly Cancer Patients Using Three Scoring Systems.pdf

Background: Malnutrition is common in patients with cancer and is associated with adverse outcomes, but few data exist in elderly patients. The aim of this study was to report the prevalence of malnutrition using three different scoring systems and to examine the possible clinical relationship and prognostic consequence of malnutrition in elderly patients with cancer.
Methods: Nutritional status was assessed by using controlling nutritional status (CONUT), the prognostic nutritional index (PNI), and the nutritional risk index (NRI). Quality-of-life (Qol) was assessed during admission by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30. Performance status (PS) was assessed by using the Eastern Cooperative Oncology Group (ECOG) classification. The relationship between nutritional status and overall survival and Qol were examined.
Results: Data were available for 1,494 elderly patients with cancer (63.65% male), the mean age was 70.76 years. According to the CONUT, NRI, and PNI, 55.02, 58.70, and 11.65% patients were diagnosed with malnutrition, respectively. Worse nutritional status was related to older, lower BMI, lower hand grip strength, and more advanced tumor stage. All malnutrition indexes were correlated with each other (CONUT vs. PNI, r = −0.657; CONUT vs. NRI scores, r = −0.672; PNI vs. NRI scores, r = 0.716, all P < 0.001). During a median follow-up of 43.1 months, 692 (46.32%) patients died. For patients malnourished, the incidence rate (events-per-1,000person-years) was as follows: CONUT (254.18), PNI (429.91), and NRI (261.87). Malnutrition was associated with increased risk for all-cause mortality (adjust HR [95%CI] for CONUT: 1.09 [1.05–1.13], P < 0.001; PNI: 0.98[0.97–0.99], P < 0.001; NRI: 0.98 [0.98–0.99], P < 0.001). All malnutrition indexes improved the predictive ability of the TNM classification system for all-cause mortality. Deterioration of nutritional status was associated with deterioration in Qol parameters and immunotherapeutic response (P < 0.001).
Conclusions: Malnutrition was prevalent in elderly patients with cancer, regardless of the assessment tools used, and associated with lower Qol and the immunotherapy response.

背景：营养不良在癌症患者中十分常见，且与不良预后相关，但目前针对老年癌症患者的相关数据仍较为匮乏。本研究旨在采用三种不同的评分系统评估营养不良的患病率，并探讨老年癌症患者营养不良的潜在临床关联及预后影响。
方法：分别采用控制营养状况评分（controlling nutritional status, CONUT）、预后营养指数（prognostic nutritional index, PNI）及营养风险指数（nutritional risk index, NRI）评估患者的营养状态。于患者入院期间，采用欧洲癌症研究与治疗组织生活质量问卷C-30评估其生活质量（Quality-of-life, QoL）；采用东部肿瘤协作组（Eastern Cooperative Oncology Group, ECOG）体能状态评分系统评估患者的体能状态（Performance status, PS）。本研究还分析了营养状态与总生存期及生活质量之间的关联。
结果：本研究共纳入1494例老年癌症患者，其中男性占比63.65%，平均年龄为70.76岁。依据CONUT、NRI及PNI评分标准，分别有55.02%、58.70%及11.65%的患者被诊断为营养不良。营养状态越差，患者年龄越大、体质量指数（Body Mass Index, BMI）越低、握力越差，且肿瘤分期越晚。各营养不良评估指标间均存在显著相关性（CONUT与PNI：r=-0.657；CONUT与NRI：r=-0.672；PNI与NRI：r=0.716，所有P<0.001）。中位随访时间为43.1个月，期间共692例（46.32%）患者死亡。在营养不良患者中，每千人年事件发生率如下：CONUT组为254.18，PNI组为429.91，NRI组为261.87。营养不良与全因死亡率升高显著相关（校正后风险比[95%置信区间]：CONUT：1.09[1.05–1.13]，P<0.001；PNI：0.98[0.97–0.99]，P<0.001；NRI：0.98[0.98–0.99]，P<0.001）。所有营养不良评估指标均能提升TNM分期系统对全因死亡率的预测能力。营养状态恶化与生活质量参数及免疫治疗应答不佳显著相关（P<0.001）。
结论：无论采用何种评估工具，老年癌症患者中营养不良的患病率均较高，且该人群的营养不良状态与更低的生活质量及较差的免疫治疗应答相关。