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Нутриционный статус у больных распространенным раком поджелудочной железы
Нутриционный статус у больных распространенным раком поджелудочной железы
Кирюкова М.А., Бордин Д.С., Жукова Л.Г., Дубцова Е.А., Хатьков И.Е. Нутриционный статус у больных распространенным раком поджелудочной железы. Терапевтический архив. 2024;96(2):127–133.
DOI: 10.26442/00403660.2024.02.202600
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
DOI: 10.26442/00403660.2024.02.202600
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Обоснование. Внешнесекреторная недостаточность поджелудочной железы (ВНПЖ) встречается у большинства больных распространенным раком поджелудочной железы (РПЖ) и чаще – при локализации в головке поджелудочной железы (ПЖ). Однако диагностике ВНПЖ и оценке нутриционного статуса (НС) уделяется недостаточное внимание, что негативно отражается на результатах лечения.
Материалы и методы. Проведено ретроспективное исследование, включившее 158 больных местно-распространенным и метастатическим РПЖ. Для сравнения частоты встречаемости клинических и лабораторных параметров НС со значениями ниже нижней границы нормы в зависимости от локализации опухоли в ПЖ использован расчет отношения шансов с 95% доверительным интервалом (ДИ) с оценкой значения p по критерию χ2 Пирсона.
Результаты. Определение уровня фекальной эластазы для диагностики ВНПЖ проводилось только 19 (12%) пациентам. В данной группе частота ВНПЖ составила 73,6%. Заместительная ферментная терапия в минимальной достаточной дозе назначалась 17,1% пациентов общей группы. Уровень гемоглобина, эритроцитов и альбумина ниже нижней границы нормы встречался у больных с образованием в головке ПЖ соответственно в 2,742 (95% ДИ 1,27–5,92), 3,788 (95% ДИ 1,554–9,232) и 9,767 (95% ДИ 1,255–76,027) раза чаще по сравнению с больными, у которых рак локализовался в теле–хвосте ПЖ. У пациентов с образованием в головке ПЖ по сравнению с пациентами с образованием в теле–хвосте ПЖ оказались ниже уровни гемоглобина (медианы 125 г/л vs 132 г/л соответственно), эритроцитов (4,19 млн/мкл vs 4,51 млн/мкл), общего белка (69,6 г/л vs 71,5 г/л) и альбумина (40,1 г/л vs 42 г/л), а также значения нутриционных индексов: прогностического нутриционного индекса, индекса нутриционного риска, индекса соотношения гемоглобина, альбумина, лимфоцитов и тромбоцитов и прогностического иммунного нутриционного индекса.
Заключение. Диагностика и лечение ВНПЖ у больных РПЖ остаются вне поля зрения врачей. Значения параметров НС у больных РПЖ с опухолью в головке ниже, чем у больных с образованием в теле–хвосте ПЖ, что отражает вклад ВНПЖ.
Ключевые слова: распространенный рак поджелудочной железы, внешнесекреторная недостаточность поджелудочной железы, нутриционный статус
Materials and methods. One hundred fifty eight patients with primary diagnosed locally advanced and metastatic PC were included in the retrospective study. We used the calculation of the odds ratio with 95% CI with an assessment of the p value using the Pearson χ2 test to compare the incidence of clinical and laboratory parameters of nutritional status with values below the lower limit of normal (LLN) depending on the location of the tumor in the pancreas.
Results. Fecal elastase test was performed in only 19 (12%) patients. In this group, the incidence of EPI was 73.6%. Pancreatic enzyme replacement therapy in the minimal sufficient dose was prescribed in 17.1% of the general cohort. The level of hemoglobin, erythrocytes and albumin below the LLN was found in patients with the tumor in the pancreatic head, respectively, 2.742 (95% CI 1.27–5.92), 3.788 (95% CI 1.554–9.232) and 9.767 (95% CI 1.255–76.027) times more often than in patients with cancer in the body-tail of the pancreas. In patients with the tumor in the pancreatic head, the lower levels of hemoglobin (median 125 g/l vs 132 g/l, respectively), erythrocytes (4.19 mil/μl vs 4.51 mil/μl), total protein (69.6 g/l vs 71.5 g/l), and albumin (40.1 g/l vs 42 g/l), as well as the values of nutritional indices: prognostic nutritional index, nutritional risk index, hemoglobin, albumin, lymphocyte and platelet ratio index, and prognostic immune nutritional index were observed.
Conclusion. Diagnosis and treatment of EPI remains inadequately attended. The values of nutritional status parameters in patients with PC in the head are lower than in patients with a tumor in the body-tail of the pancreas, which reflects the contribution of EPI.
Keywords: advanced pancreatic cancer, exocrine pancreatic insufficiency, nutritional status
Материалы и методы. Проведено ретроспективное исследование, включившее 158 больных местно-распространенным и метастатическим РПЖ. Для сравнения частоты встречаемости клинических и лабораторных параметров НС со значениями ниже нижней границы нормы в зависимости от локализации опухоли в ПЖ использован расчет отношения шансов с 95% доверительным интервалом (ДИ) с оценкой значения p по критерию χ2 Пирсона.
Результаты. Определение уровня фекальной эластазы для диагностики ВНПЖ проводилось только 19 (12%) пациентам. В данной группе частота ВНПЖ составила 73,6%. Заместительная ферментная терапия в минимальной достаточной дозе назначалась 17,1% пациентов общей группы. Уровень гемоглобина, эритроцитов и альбумина ниже нижней границы нормы встречался у больных с образованием в головке ПЖ соответственно в 2,742 (95% ДИ 1,27–5,92), 3,788 (95% ДИ 1,554–9,232) и 9,767 (95% ДИ 1,255–76,027) раза чаще по сравнению с больными, у которых рак локализовался в теле–хвосте ПЖ. У пациентов с образованием в головке ПЖ по сравнению с пациентами с образованием в теле–хвосте ПЖ оказались ниже уровни гемоглобина (медианы 125 г/л vs 132 г/л соответственно), эритроцитов (4,19 млн/мкл vs 4,51 млн/мкл), общего белка (69,6 г/л vs 71,5 г/л) и альбумина (40,1 г/л vs 42 г/л), а также значения нутриционных индексов: прогностического нутриционного индекса, индекса нутриционного риска, индекса соотношения гемоглобина, альбумина, лимфоцитов и тромбоцитов и прогностического иммунного нутриционного индекса.
Заключение. Диагностика и лечение ВНПЖ у больных РПЖ остаются вне поля зрения врачей. Значения параметров НС у больных РПЖ с опухолью в головке ниже, чем у больных с образованием в теле–хвосте ПЖ, что отражает вклад ВНПЖ.
Ключевые слова: распространенный рак поджелудочной железы, внешнесекреторная недостаточность поджелудочной железы, нутриционный статус
________________________________________________
Materials and methods. One hundred fifty eight patients with primary diagnosed locally advanced and metastatic PC were included in the retrospective study. We used the calculation of the odds ratio with 95% CI with an assessment of the p value using the Pearson χ2 test to compare the incidence of clinical and laboratory parameters of nutritional status with values below the lower limit of normal (LLN) depending on the location of the tumor in the pancreas.
Results. Fecal elastase test was performed in only 19 (12%) patients. In this group, the incidence of EPI was 73.6%. Pancreatic enzyme replacement therapy in the minimal sufficient dose was prescribed in 17.1% of the general cohort. The level of hemoglobin, erythrocytes and albumin below the LLN was found in patients with the tumor in the pancreatic head, respectively, 2.742 (95% CI 1.27–5.92), 3.788 (95% CI 1.554–9.232) and 9.767 (95% CI 1.255–76.027) times more often than in patients with cancer in the body-tail of the pancreas. In patients with the tumor in the pancreatic head, the lower levels of hemoglobin (median 125 g/l vs 132 g/l, respectively), erythrocytes (4.19 mil/μl vs 4.51 mil/μl), total protein (69.6 g/l vs 71.5 g/l), and albumin (40.1 g/l vs 42 g/l), as well as the values of nutritional indices: prognostic nutritional index, nutritional risk index, hemoglobin, albumin, lymphocyte and platelet ratio index, and prognostic immune nutritional index were observed.
Conclusion. Diagnosis and treatment of EPI remains inadequately attended. The values of nutritional status parameters in patients with PC in the head are lower than in patients with a tumor in the body-tail of the pancreas, which reflects the contribution of EPI.
Keywords: advanced pancreatic cancer, exocrine pancreatic insufficiency, nutritional status
Полный текст
Список литературы
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3. Roxburgh CSD, McMillan DC. Cancer and systemic inflammation: Treat the tumour and treat the host. Br J Cancer. 2014;110(6):1409-12. DOI:10.1038/bjc.2014.90
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5. Hendifar AE, Chang JI, Huang BZ, et al. Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy. J Gastrointest Oncol. 2018;9(1):17-23. DOI:10.21037/jgo.2017.11.10
6. Carnie L, Abraham M, McNamara MG, et al. Impact on prognosis of early weight loss during palliative chemotherapy in patients diagnosed with advanced pancreatic cancer. Pancreatology. 2020;20(8):1682-8. DOI:10.1016/J.PAN.2020.09.012
7. Kurita Y, Kobayashi N, Tokuhisa M, et al. Sarcopenia is a reliable prognostic factor in patients with advanced pancreatic cancer receiving FOLFIRINOX chemotherapy. Pancreatology. 2019;19(1):127-35. DOI:10.1016/j.pan.2018.11.001
8. Uemura S, Iwashita T, Ichikawa H, et al. The impact of sarcopenia and decrease in skeletal muscle mass in patients with advanced pancreatic cancer during FOLFIRINOX therapy. Br J Nutr. 2021;125(10):1140-7. DOI:10.1017/S0007114520003463
9. Domínguez-Muñoz JE, Nieto-Garcia L, López-Díaz J, et al. Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: A retrospective analysis. BMC Cancer. 2018;18(1):1-8. DOI:10.1186/s12885-018-4439-x
10. Forsmark CE, Tang G, Xu H, et al. The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent. Aliment Pharmacol Ther. 2020;51(10):958-67. DOI:10.1111/APT.15698
11. Landers A, Muircroft W, Brown H. Pancreatic enzyme replacement therapy (PERT) for malabsorption in patients with metastatic pancreatic cancer. BMJ Support Palliat Care. 2016;6(1):75-9. DOI:10.1136/bmjspcare-2014-000694
12. Harvey PR, McKay SC, Wilkin RJW, et al. Pancreatic enzyme replacement therapy in patients with pancreatic cancer: A national prospective study. Pancreatology. 2021;21(6):1127-34. DOI:10.1016/j.pan.2021.05.299
13. Saito T, Nakai Y, Isayama H, et al. A Multicenter Open-Label Randomized Controlled Trial of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer. Pancreas. 2018;47(7):800-6. DOI:10.1097/MPA.0000000000001079
14. Giordano G, Cincione RI, Losavio F, et al. Pancreatic Enzyme Replacement and Nutritional Support With nab-Paclitaxel-based First-Line Chemotherapy Regimens in Metastatic Pancreatic Cancer. Oncologist. 2023:1-8. DOI:10.1093/ONCOLO/OYAD101
15. Trestini I, Carbognin L, Peretti U, et al. Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma. Front Oncol. 2021;11:688889. DOI:10.3389/fonc.2021.688889
16. Carnie LE, Shah D, Vaughan K, et al. Prospective Observational Study of Prevalence, Assessment and Treatment of Pancreatic Exocrine Insufficiency in Patients with Inoperable Pancreatic Malignancy (PANcreatic Cancer Dietary Assessment-PanDA). Cancers. 2023;15(8). DOI:10.3390/CANCERS15082277
17. Iglesia D de la, Avci B, Kiriukova M, et al. Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis. United European Gastroenterol J. 2020;8(9):1115-25. DOI:10.1177/2050640620938987
18. Aquilani R, Brugnatelli S, Maestri R, et al. Peripheral Blood Lymphocyte Percentage May Predict Chemotolerance and Survival in Patients with Advanced Pancreatic Cancer. Association between Adaptive Immunity and Nutritional State. Curr Oncol. 2021;28(5):3280-96. DOI:10.3390/CURRONCOL28050285
19. Ulíbarri JID, González-Madroño A, Villar NGPD, et al. CONUT: A tool for Controlling Nutritional Status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38-45. DOI:10.3305/nutr
20. Uemura S, Iwashita T, Ichikawa H, et al. Impact of Controlling nutritional status (CONUT) in patients with unresectable advanced pancreatic cancer receiving multi-agent chemotherapy: A single center, retrospective cohort study. Pancreatology. 2022;22(2):304-10. DOI:10.1016/J.PAN.2022.01.010
21. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001-5.
22. Geng Y, Qi Q, Sun M, et al. Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer. Eur J Surg Oncol. 2015;41(11):1508-14. DOI:10.1016/J.EJSO.2015.07.022
23. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. DOI:10.1016/0021-9681(87)90171-8
24. Hasselmann M, Alix E. Outils et procédures de dépistage de la dénutrition et de son risque en milieu hospitalier. Nutr Clin Métab. 2003;17(4):218-26. DOI:10.1016/J.NUPAR.2003.09.004
25. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-82. DOI:10.18632/ONCOTARGET.5629
26. Jung SH, Hao J, Shivakumar M, et al. Development and validation of a novel strong prognostic index for colon cancer through a robust combination of laboratory features for systemic inflammation: a prognostic immune nutritional index. Br J Cancer. 2022;126(11):1539. DOI:10.1038/S41416-022-01767-W
27. Roberts KJ, Bannister CA, Schrem H. Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study. Pancreatology. 2019;19(1):114-21. DOI:10.1016/j.pan.2018.10.010
28. Kanda M, Fujii T, Kodera Y, N et al. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268-74. DOI:10.1002/bjs.7305
29. Li S, Tian G, Chen Z, et al. Prognostic Role of the Prognostic Nutritional Index in Pancreatic Cancer: A Meta-analysis. Nutr Cancer. 2019;71(2):207-13. DOI:10.1080/01635581.2018.1559930
2. White JV, Guenter P, Jensen G, et al. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). J Acad Nutr Diet. 2012;112(5):730-8. DOI:10.1016/j.jand.2012.03.012
3. Roxburgh CSD, McMillan DC. Cancer and systemic inflammation: Treat the tumour and treat the host. Br J Cancer. 2014;110(6):1409-12. DOI:10.1038/bjc.2014.90
4. Mitchell T, Clarke L, Goldberg A, Bishop KS. Pancreatic Cancer Cachexia: The Role of Nutritional Interventions. Healthcare. 2019;7(3):89. DOI:10.3390/healthcare7030089
5. Hendifar AE, Chang JI, Huang BZ, et al. Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy. J Gastrointest Oncol. 2018;9(1):17-23. DOI:10.21037/jgo.2017.11.10
6. Carnie L, Abraham M, McNamara MG, et al. Impact on prognosis of early weight loss during palliative chemotherapy in patients diagnosed with advanced pancreatic cancer. Pancreatology. 2020;20(8):1682-8. DOI:10.1016/J.PAN.2020.09.012
7. Kurita Y, Kobayashi N, Tokuhisa M, et al. Sarcopenia is a reliable prognostic factor in patients with advanced pancreatic cancer receiving FOLFIRINOX chemotherapy. Pancreatology. 2019;19(1):127-35. DOI:10.1016/j.pan.2018.11.001
8. Uemura S, Iwashita T, Ichikawa H, et al. The impact of sarcopenia and decrease in skeletal muscle mass in patients with advanced pancreatic cancer during FOLFIRINOX therapy. Br J Nutr. 2021;125(10):1140-7. DOI:10.1017/S0007114520003463
9. Domínguez-Muñoz JE, Nieto-Garcia L, López-Díaz J, et al. Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: A retrospective analysis. BMC Cancer. 2018;18(1):1-8. DOI:10.1186/s12885-018-4439-x
10. Forsmark CE, Tang G, Xu H, et al. The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent. Aliment Pharmacol Ther. 2020;51(10):958-67. DOI:10.1111/APT.15698
11. Landers A, Muircroft W, Brown H. Pancreatic enzyme replacement therapy (PERT) for malabsorption in patients with metastatic pancreatic cancer. BMJ Support Palliat Care. 2016;6(1):75-9. DOI:10.1136/bmjspcare-2014-000694
12. Harvey PR, McKay SC, Wilkin RJW, et al. Pancreatic enzyme replacement therapy in patients with pancreatic cancer: A national prospective study. Pancreatology. 2021;21(6):1127-34. DOI:10.1016/j.pan.2021.05.299
13. Saito T, Nakai Y, Isayama H, et al. A Multicenter Open-Label Randomized Controlled Trial of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer. Pancreas. 2018;47(7):800-6. DOI:10.1097/MPA.0000000000001079
14. Giordano G, Cincione RI, Losavio F, et al. Pancreatic Enzyme Replacement and Nutritional Support With nab-Paclitaxel-based First-Line Chemotherapy Regimens in Metastatic Pancreatic Cancer. Oncologist. 2023:1-8. DOI:10.1093/ONCOLO/OYAD101
15. Trestini I, Carbognin L, Peretti U, et al. Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma. Front Oncol. 2021;11:688889. DOI:10.3389/fonc.2021.688889
16. Carnie LE, Shah D, Vaughan K, et al. Prospective Observational Study of Prevalence, Assessment and Treatment of Pancreatic Exocrine Insufficiency in Patients with Inoperable Pancreatic Malignancy (PANcreatic Cancer Dietary Assessment-PanDA). Cancers. 2023;15(8). DOI:10.3390/CANCERS15082277
17. Iglesia D de la, Avci B, Kiriukova M, et al. Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis. United European Gastroenterol J. 2020;8(9):1115-25. DOI:10.1177/2050640620938987
18. Aquilani R, Brugnatelli S, Maestri R, et al. Peripheral Blood Lymphocyte Percentage May Predict Chemotolerance and Survival in Patients with Advanced Pancreatic Cancer. Association between Adaptive Immunity and Nutritional State. Curr Oncol. 2021;28(5):3280-96. DOI:10.3390/CURRONCOL28050285
19. Ulíbarri JID, González-Madroño A, Villar NGPD, et al. CONUT: A tool for Controlling Nutritional Status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38-45. DOI:10.3305/nutr
20. Uemura S, Iwashita T, Ichikawa H, et al. Impact of Controlling nutritional status (CONUT) in patients with unresectable advanced pancreatic cancer receiving multi-agent chemotherapy: A single center, retrospective cohort study. Pancreatology. 2022;22(2):304-10. DOI:10.1016/J.PAN.2022.01.010
21. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001-5.
22. Geng Y, Qi Q, Sun M, et al. Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer. Eur J Surg Oncol. 2015;41(11):1508-14. DOI:10.1016/J.EJSO.2015.07.022
23. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. DOI:10.1016/0021-9681(87)90171-8
24. Hasselmann M, Alix E. Outils et procédures de dépistage de la dénutrition et de son risque en milieu hospitalier. Nutr Clin Métab. 2003;17(4):218-26. DOI:10.1016/J.NUPAR.2003.09.004
25. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-82. DOI:10.18632/ONCOTARGET.5629
26. Jung SH, Hao J, Shivakumar M, et al. Development and validation of a novel strong prognostic index for colon cancer through a robust combination of laboratory features for systemic inflammation: a prognostic immune nutritional index. Br J Cancer. 2022;126(11):1539. DOI:10.1038/S41416-022-01767-W
27. Roberts KJ, Bannister CA, Schrem H. Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study. Pancreatology. 2019;19(1):114-21. DOI:10.1016/j.pan.2018.10.010
28. Kanda M, Fujii T, Kodera Y, N et al. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268-74. DOI:10.1002/bjs.7305
29. Li S, Tian G, Chen Z, et al. Prognostic Role of the Prognostic Nutritional Index in Pancreatic Cancer: A Meta-analysis. Nutr Cancer. 2019;71(2):207-13. DOI:10.1080/01635581.2018.1559930
2. White JV, Guenter P, Jensen G, et al. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). J Acad Nutr Diet. 2012;112(5):730-8. DOI:10.1016/j.jand.2012.03.012
3. Roxburgh CSD, McMillan DC. Cancer and systemic inflammation: Treat the tumour and treat the host. Br J Cancer. 2014;110(6):1409-12. DOI:10.1038/bjc.2014.90
4. Mitchell T, Clarke L, Goldberg A, Bishop KS. Pancreatic Cancer Cachexia: The Role of Nutritional Interventions. Healthcare. 2019;7(3):89. DOI:10.3390/healthcare7030089
5. Hendifar AE, Chang JI, Huang BZ, et al. Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy. J Gastrointest Oncol. 2018;9(1):17-23. DOI:10.21037/jgo.2017.11.10
6. Carnie L, Abraham M, McNamara MG, et al. Impact on prognosis of early weight loss during palliative chemotherapy in patients diagnosed with advanced pancreatic cancer. Pancreatology. 2020;20(8):1682-8. DOI:10.1016/J.PAN.2020.09.012
7. Kurita Y, Kobayashi N, Tokuhisa M, et al. Sarcopenia is a reliable prognostic factor in patients with advanced pancreatic cancer receiving FOLFIRINOX chemotherapy. Pancreatology. 2019;19(1):127-35. DOI:10.1016/j.pan.2018.11.001
8. Uemura S, Iwashita T, Ichikawa H, et al. The impact of sarcopenia and decrease in skeletal muscle mass in patients with advanced pancreatic cancer during FOLFIRINOX therapy. Br J Nutr. 2021;125(10):1140-7. DOI:10.1017/S0007114520003463
9. Domínguez-Muñoz JE, Nieto-Garcia L, López-Díaz J, et al. Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: A retrospective analysis. BMC Cancer. 2018;18(1):1-8. DOI:10.1186/s12885-018-4439-x
10. Forsmark CE, Tang G, Xu H, et al. The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent. Aliment Pharmacol Ther. 2020;51(10):958-67. DOI:10.1111/APT.15698
11. Landers A, Muircroft W, Brown H. Pancreatic enzyme replacement therapy (PERT) for malabsorption in patients with metastatic pancreatic cancer. BMJ Support Palliat Care. 2016;6(1):75-9. DOI:10.1136/bmjspcare-2014-000694
12. Harvey PR, McKay SC, Wilkin RJW, et al. Pancreatic enzyme replacement therapy in patients with pancreatic cancer: A national prospective study. Pancreatology. 2021;21(6):1127-34. DOI:10.1016/j.pan.2021.05.299
13. Saito T, Nakai Y, Isayama H, et al. A Multicenter Open-Label Randomized Controlled Trial of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer. Pancreas. 2018;47(7):800-6. DOI:10.1097/MPA.0000000000001079
14. Giordano G, Cincione RI, Losavio F, et al. Pancreatic Enzyme Replacement and Nutritional Support With nab-Paclitaxel-based First-Line Chemotherapy Regimens in Metastatic Pancreatic Cancer. Oncologist. 2023:1-8. DOI:10.1093/ONCOLO/OYAD101
15. Trestini I, Carbognin L, Peretti U, et al. Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma. Front Oncol. 2021;11:688889. DOI:10.3389/fonc.2021.688889
16. Carnie LE, Shah D, Vaughan K, et al. Prospective Observational Study of Prevalence, Assessment and Treatment of Pancreatic Exocrine Insufficiency in Patients with Inoperable Pancreatic Malignancy (PANcreatic Cancer Dietary Assessment-PanDA). Cancers. 2023;15(8). DOI:10.3390/CANCERS15082277
17. Iglesia D de la, Avci B, Kiriukova M, et al. Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis. United European Gastroenterol J. 2020;8(9):1115-25. DOI:10.1177/2050640620938987
18. Aquilani R, Brugnatelli S, Maestri R, et al. Peripheral Blood Lymphocyte Percentage May Predict Chemotolerance and Survival in Patients with Advanced Pancreatic Cancer. Association between Adaptive Immunity and Nutritional State. Curr Oncol. 2021;28(5):3280-96. DOI:10.3390/CURRONCOL28050285
19. Ulíbarri JID, González-Madroño A, Villar NGPD, et al. CONUT: A tool for Controlling Nutritional Status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38-45. DOI:10.3305/nutr
20. Uemura S, Iwashita T, Ichikawa H, et al. Impact of Controlling nutritional status (CONUT) in patients with unresectable advanced pancreatic cancer receiving multi-agent chemotherapy: A single center, retrospective cohort study. Pancreatology. 2022;22(2):304-10. DOI:10.1016/J.PAN.2022.01.010
21. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001-5.
22. Geng Y, Qi Q, Sun M, et al. Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer. Eur J Surg Oncol. 2015;41(11):1508-14. DOI:10.1016/J.EJSO.2015.07.022
23. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. DOI:10.1016/0021-9681(87)90171-8
24. Hasselmann M, Alix E. Outils et procédures de dépistage de la dénutrition et de son risque en milieu hospitalier. Nutr Clin Métab. 2003;17(4):218-26. DOI:10.1016/J.NUPAR.2003.09.004
25. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-82. DOI:10.18632/ONCOTARGET.5629
26. Jung SH, Hao J, Shivakumar M, et al. Development and validation of a novel strong prognostic index for colon cancer through a robust combination of laboratory features for systemic inflammation: a prognostic immune nutritional index. Br J Cancer. 2022;126(11):1539. DOI:10.1038/S41416-022-01767-W
27. Roberts KJ, Bannister CA, Schrem H. Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study. Pancreatology. 2019;19(1):114-21. DOI:10.1016/j.pan.2018.10.010
28. Kanda M, Fujii T, Kodera Y, N et al. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268-74. DOI:10.1002/bjs.7305
29. Li S, Tian G, Chen Z, et al. Prognostic Role of the Prognostic Nutritional Index in Pancreatic Cancer: A Meta-analysis. Nutr Cancer. 2019;71(2):207-13. DOI:10.1080/01635581.2018.1559930
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2. White JV, Guenter P, Jensen G, et al. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). J Acad Nutr Diet. 2012;112(5):730-8. DOI:10.1016/j.jand.2012.03.012
3. Roxburgh CSD, McMillan DC. Cancer and systemic inflammation: Treat the tumour and treat the host. Br J Cancer. 2014;110(6):1409-12. DOI:10.1038/bjc.2014.90
4. Mitchell T, Clarke L, Goldberg A, Bishop KS. Pancreatic Cancer Cachexia: The Role of Nutritional Interventions. Healthcare. 2019;7(3):89. DOI:10.3390/healthcare7030089
5. Hendifar AE, Chang JI, Huang BZ, et al. Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy. J Gastrointest Oncol. 2018;9(1):17-23. DOI:10.21037/jgo.2017.11.10
6. Carnie L, Abraham M, McNamara MG, et al. Impact on prognosis of early weight loss during palliative chemotherapy in patients diagnosed with advanced pancreatic cancer. Pancreatology. 2020;20(8):1682-8. DOI:10.1016/J.PAN.2020.09.012
7. Kurita Y, Kobayashi N, Tokuhisa M, et al. Sarcopenia is a reliable prognostic factor in patients with advanced pancreatic cancer receiving FOLFIRINOX chemotherapy. Pancreatology. 2019;19(1):127-35. DOI:10.1016/j.pan.2018.11.001
8. Uemura S, Iwashita T, Ichikawa H, et al. The impact of sarcopenia and decrease in skeletal muscle mass in patients with advanced pancreatic cancer during FOLFIRINOX therapy. Br J Nutr. 2021;125(10):1140-7. DOI:10.1017/S0007114520003463
9. Domínguez-Muñoz JE, Nieto-Garcia L, López-Díaz J, et al. Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: A retrospective analysis. BMC Cancer. 2018;18(1):1-8. DOI:10.1186/s12885-018-4439-x
10. Forsmark CE, Tang G, Xu H, et al. The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent. Aliment Pharmacol Ther. 2020;51(10):958-67. DOI:10.1111/APT.15698
11. Landers A, Muircroft W, Brown H. Pancreatic enzyme replacement therapy (PERT) for malabsorption in patients with metastatic pancreatic cancer. BMJ Support Palliat Care. 2016;6(1):75-9. DOI:10.1136/bmjspcare-2014-000694
12. Harvey PR, McKay SC, Wilkin RJW, et al. Pancreatic enzyme replacement therapy in patients with pancreatic cancer: A national prospective study. Pancreatology. 2021;21(6):1127-34. DOI:10.1016/j.pan.2021.05.299
13. Saito T, Nakai Y, Isayama H, et al. A Multicenter Open-Label Randomized Controlled Trial of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer. Pancreas. 2018;47(7):800-6. DOI:10.1097/MPA.0000000000001079
14. Giordano G, Cincione RI, Losavio F, et al. Pancreatic Enzyme Replacement and Nutritional Support With nab-Paclitaxel-based First-Line Chemotherapy Regimens in Metastatic Pancreatic Cancer. Oncologist. 2023:1-8. DOI:10.1093/ONCOLO/OYAD101
15. Trestini I, Carbognin L, Peretti U, et al. Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma. Front Oncol. 2021;11:688889. DOI:10.3389/fonc.2021.688889
16. Carnie LE, Shah D, Vaughan K, et al. Prospective Observational Study of Prevalence, Assessment and Treatment of Pancreatic Exocrine Insufficiency in Patients with Inoperable Pancreatic Malignancy (PANcreatic Cancer Dietary Assessment-PanDA). Cancers. 2023;15(8). DOI:10.3390/CANCERS15082277
17. Iglesia D de la, Avci B, Kiriukova M, et al. Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis. United European Gastroenterol J. 2020;8(9):1115-25. DOI:10.1177/2050640620938987
18. Aquilani R, Brugnatelli S, Maestri R, et al. Peripheral Blood Lymphocyte Percentage May Predict Chemotolerance and Survival in Patients with Advanced Pancreatic Cancer. Association between Adaptive Immunity and Nutritional State. Curr Oncol. 2021;28(5):3280-96. DOI:10.3390/CURRONCOL28050285
19. Ulíbarri JID, González-Madroño A, Villar NGPD, et al. CONUT: A tool for Controlling Nutritional Status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38-45. DOI:10.3305/nutr
20. Uemura S, Iwashita T, Ichikawa H, et al. Impact of Controlling nutritional status (CONUT) in patients with unresectable advanced pancreatic cancer receiving multi-agent chemotherapy: A single center, retrospective cohort study. Pancreatology. 2022;22(2):304-10. DOI:10.1016/J.PAN.2022.01.010
21. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001-5.
22. Geng Y, Qi Q, Sun M, et al. Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer. Eur J Surg Oncol. 2015;41(11):1508-14. DOI:10.1016/J.EJSO.2015.07.022
23. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. DOI:10.1016/0021-9681(87)90171-8
24. Hasselmann M, Alix E. Outils et procédures de dépistage de la dénutrition et de son risque en milieu hospitalier. Nutr Clin Métab. 2003;17(4):218-26. DOI:10.1016/J.NUPAR.2003.09.004
25. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-82. DOI:10.18632/ONCOTARGET.5629
26. Jung SH, Hao J, Shivakumar M, et al. Development and validation of a novel strong prognostic index for colon cancer through a robust combination of laboratory features for systemic inflammation: a prognostic immune nutritional index. Br J Cancer. 2022;126(11):1539. DOI:10.1038/S41416-022-01767-W
27. Roberts KJ, Bannister CA, Schrem H. Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study. Pancreatology. 2019;19(1):114-21. DOI:10.1016/j.pan.2018.10.010
28. Kanda M, Fujii T, Kodera Y, N et al. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268-74. DOI:10.1002/bjs.7305
29. Li S, Tian G, Chen Z, et al. Prognostic Role of the Prognostic Nutritional Index in Pancreatic Cancer: A Meta-analysis. Nutr Cancer. 2019;71(2):207-13. DOI:10.1080/01635581.2018.1559930
Авторы
М.А. Кирюкова*1, Д.С. Бордин1–3, Л.Г. Жукова1, Е.А. Дубцова1, И.Е. Хатьков1,2
1ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия;
3ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России, Тверь, Россия
*m.kirukova@mknc.ru
1Loginov Moscow Clinical Scientific Center, Moscow, Russia;
2Russian University of Medicine, Moscow, Russia;
3Tver State Medical University, Tver, Russia
*m.kirukova@mknc.ru
1ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия;
3ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России, Тверь, Россия
*m.kirukova@mknc.ru
________________________________________________
1Loginov Moscow Clinical Scientific Center, Moscow, Russia;
2Russian University of Medicine, Moscow, Russia;
3Tver State Medical University, Tver, Russia
*m.kirukova@mknc.ru
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