Email this article Influence of correction of nutritive deficiency on the effectiveness of neoadjuvant chemotherapy in patients with locally advanced gastric cancer
- Authors: Brish N.A.1, Semiglazova T.Y.1,2, Karachun A.M.1, Shevkunov L.N.1, Ulyanchenko Y.A.1, Artemyeva A.S.1, Golovanova T.S.1, Tkachenko E.V.1, Alexeeva Y.V.1, Sharashenidze S.M.1, Strakh L.V.3, Protsenko S.A.1, Teletaeva G.M.1, Filatova L.V.1,2, Kasparov B.S.1, Semiglazov V.V.1,3, Belyaev A.M.1,2
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Affiliations:
- Petrov National Medical Research Center of Oncology
- Mechnikov North-Western State Medical University
- Pavlov First Saint Petersburg State Medical University
- Issue: Vol 23, No 3 (2021)
- Pages: 519-524
- Section: CLINICAL ONCOLOGY
- URL: https://journals.rcsi.science/1815-1434/article/view/75939
- DOI: https://doi.org/10.26442/18151434.2021.3.201075
- ID: 75939
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Abstract
Aim. To increase the effectiveness of neoadjuvant chemotherapy in patients with locally advanced gastric cancer by correcting nutritional deficiency.
Materials and methods. Of 200 patients with locally advanced gastric cancer (mean age 57.2 years (46.1–68.3), 100 patients received neoadjuvant chemotherapy with nutritional support from 2018 to 2020. One hundred patients received neoadjuvant chemotherapy without nutritional support from 2013 to 2018 (historical control). The incidence of nutritional deficiency before treatment in the “neoadjuvant chemotherapy + nutritional support” group was 54%, and in the “neoadjuvant chemotherapy only” group it was 47%. Nutritional status was assessed using anthropometry, questionnaires (NRS-2002, MUST, GLIM), dynamometry, blood tests, bioimpedance. Complications according to NCI CTCAE v5.0; оbjective response rate according to RECIST 1.1; pathomorphological regression according to the JGCA classification (2017); 2-year event-free survival were assessed.
Results. The frequency of nutritional deficiency before the start of treatment in the “neoadjuvant chemotherapy + nutritional support” group was 54%, in the “neoadjuvant chemotherapy only” group – 47%. After the completion of neoadjuvant chemotherapy in the group “neoadjuvant chemotherapy + nutritional support” the frequency of nutritional deficiency was 1%, in the group “neoadjuvant chemotherapy only” without nutritional support – 62%. In patients with nutritional deficiency in the “neoadjuvant chemotherapy + nutritional support” group, partial regression was registered in 51.9% of cases, in the “neoadjuvant chemotherapy only ”group it was 27.6% (p<0.05). There were no differences in the frequency of pathological response. 2-year event-free survival in patients without nutritional deficiency in the group “neoadjuvant chemotherapy + nutritional support” was 100%, in the “neoadjuvant chemotherapy only” group it was 68.5% (p<0.001); in patients with nutritional deficiency – 72,5 and 60.6% respectively (p<0.05).
Conclusion. Nutritional deficiency is an important predictive and prognostic marker of the efficacy of neoadjuvant chemotherapy in the treatment of locally advanced gastric cancer. Comprehensive diagnosis of nutritional status and nutritional support can improve the results of neoadjuvant chemotherapy in patients with locally advanced gastric cancer.
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##article.viewOnOriginalSite##About the authors
Nadezhda A. Brish
Petrov National Medical Research Center of Oncology
Email: nbrish@list.ru
ORCID iD: 0000-0001-6995-1048
D. Sci. (Med.)
Russian Federation, Saint PetersburgTatiana Yu. Semiglazova
Petrov National Medical Research Center of Oncology; Mechnikov North-Western State Medical University
Author for correspondence.
Email: tsemiglazova@mail.ru
ORCID iD: 0000-0002-4305-6691
D. Sci. (Med.)
Russian Federation, Saint PetersburgAleksei M. Karachun
Petrov National Medical Research Center of Oncology
Email: dr.a.karachun@gmail.ru
ORCID iD: 0000-0001-6641-7229
D. Sci. (Med.)
Russian Federation, Saint PetersburgLev N. Shevkunov
Petrov National Medical Research Center of Oncology
Email: levka1978@mail.ru
ORCID iD: 0000-0003-4533-1658
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgYana A. Ulyanchenko
Petrov National Medical Research Center of Oncology
Email: yanamischanchuk@mail.ru
ORCID iD: 0000-0002-9629-2065
radiologist
Russian Federation, Saint PetersburgAnna S. Artemyeva
Petrov National Medical Research Center of Oncology
Email: oinochoya@gmail.com
ORCID iD: 0000-0002-2948-397X
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgTatiana S. Golovanova
Petrov National Medical Research Center of Oncology
Email: tatsersem@gmail.com
ORCID iD: 0000-0001-8655-0377
pathologist
Russian Federation, Saint PetersburgElena V. Tkachenko
Petrov National Medical Research Center of Oncology
Email: elenatkachen@yandex.ru
ORCID iD: 0000-0001-6375-8335
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgYuliia V. Alexeeva
Petrov National Medical Research Center of Oncology
Email: dr.alekseevauv@gmail.com
ORCID iD: 0000-0001-5609-1237
Graduate Student
Russian Federation, Saint PetersburgSofiko M. Sharashenidze
Petrov National Medical Research Center of Oncology
Email: sofiko.sharashenidze@gmail.com
ORCID iD: 0000-0002-9842-2951
Clinical Resident
Russian Federation, Saint PetersburgLiubov V. Strakh
Pavlov First Saint Petersburg State Medical University
Email: lubovstrah@gmail.com
ORCID iD: 0000-0001-5943-1081
Clinical Resident
Russian Federation, Saint PetersburgSvetlana A. Protsenko
Petrov National Medical Research Center of Oncology
Email: s.protsenko@list.ru
ORCID iD: 0000-0001-8704-7669
D. Sci. (Med.)
Russian Federation, Saint PetersburgGulfiia M. Teletaeva
Petrov National Medical Research Center of Oncology
Email: drteletaeva@yahoo.com
ORCID iD: 0000-0001-9365-8554
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgLarisa V. Filatova
Petrov National Medical Research Center of Oncology; Mechnikov North-Western State Medical University
Email: larisa_filatova@list.ru
ORCID iD: 0000-0002-0728-4582
D. Sci. (Med.), Prof.
Russian Federation, Saint PetersburgBoris S. Kasparov
Petrov National Medical Research Center of Oncology
Email: boriankasparov@mail.ru
ORCID iD: 0000-0003-0341-3823
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgVladislav V. Semiglazov
Petrov National Medical Research Center of Oncology; Pavlov First Saint Petersburg State Medical University
Email: ssemiglazov@mail.ru
ORCID iD: 0000-0002-8825-5221
D. Sci. (Med.), Prof.
Russian Federation, Saint PetersburgAleksei M. Belyaev
Petrov National Medical Research Center of Oncology; Mechnikov North-Western State Medical University
Email: tsemiglazova@mail.ru
ORCID iD: 0000-0002-4636-4200
D. Sci. (Med.), Prof.
Russian Federation, Saint PetersburgReferences
- Rosania R, Chiapponi C, Malfertheiner P, Venerito M. Nutrition in Patients with Gastric Cancer: An Update. Gastrointest Tumors. 2016;2(4):178-87. doi: 10.1159/000445188
- Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36(3):623-50. doi: 10.1016/j.clnu.2017.02.013
- Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11-20.
- Ychou М, Boige V, Pignon JP, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011;29(13):1715-21. doi: 10.1200/JCO.2010.33.0597
- Al-Batran SE, Homann N, Schmalenberg H, et al. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): A multicenter, randomized phase 3 trial. J Clin Oncol. 2017;35(15):4004.
- Schuhmacher C, Gretschel S, Lordick F, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol. 2010;28:5210-8. doi: 10.1200/JCO.2009.26.6114
- Mirkin KA, Luke FE, Gangi A, et al. Sarcopenia related to neoadjuvant chemotherapy and perioperative outcomes in resected gastric cancer: a multi-institutional analysis. J Gastrointest Oncol. 2017;8(3):589-95. doi: 10.21037/jgo.2017.03.02
- Palmela C, Velho S, Agostinho L, et al. Body Composition as a Prognostic Factor of Neoadjuvant Chemotherapy Toxicity and Outcome in Patients with Locally Advanced Gastric Cancer. J Gastric Cancer. 2017;17(1):74-87. doi: 10.5230/jgc.2017.17.e8
- Kawamura T, Makuuchi R, Tokunaga M, et al. Long-Term Outcomes of Gastric Cancer Patients with Preoperative Sarcopenia. Ann Surg Oncol. 2018;25(6):1625-32. doi: 10.1245/s10434-018-6452-3
- Prado CM, Baracos VE, McCargar LJ, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007;13:3264-8. doi: 10.1158/1078-0432.CCR-06-3067
- Huang DD, Zhou CJ, Wang SL, et al. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer. Surgery. 2017;161:680-93. doi: 10.1016/j.surg.2016.08.030
- Chen FF, Zhang FY, Zhou XY, et al. Role of frailty and nutritional status in predicting complications following total gastrectomy with D2 lymphadenectomy in patients with gastric cancer: a prospective study. Langenbecks Arch Surg. 2016;401:813-22. doi: 10.1007/s00423-016-1490-4
- Zhuang CL, Huang DD, Pang WY, et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Medicine (Baltimore). 2016;95:e3164. doi: 10.1097/MD.0000000000003164
- Wang SL, Zhuang CL, Huang DD, et al. Sarcopenia adversely impacts postoperative clinical outcomes following gastrectomy in patients with gastric cancer: a prospective study. Ann Surg Oncol. 2016;23:556-64. doi: 10.1245/s10434-015-4887-3
- Fukuda Y, Yamamoto K, Hirao M, et al. Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy. Gastric Cancer. 2016;19:986-93. doi: 10.1007/s10120-015-0546-4
- Tamandl D, Paireder M, Asari R, et al. Markers of sarcopenia quantified by computedtomography predict adverse long-term outcome in patients withresected oesophageal or gastro-oesophageal junction cancer. Eur Radiol. 2016;26(5):1359-67. doi: 10.1007/s00330-015-3963-1
- Okumura S, Kaido T, Hamaguchi Y, et al. Impact of the preoperative quantity and quality of skeletal muscle on outcomes after resection of extrahepatic biliary malignancies. Surgery. 2016;159(3):821-33. doi: 10.1016/j.surg.2015.08.047
- Levolger S, van Vledder MG, Muslem R, et al. Sarcopenia impairs survival in patients with potentially curable hepatocellular carcinoma. J Surg Oncol. 2015;112(2):208-13. doi: 10.1002/jso.23976
- Huang DD, Chen XX, Chen XY, et al. Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study. J Cancer Res Clin Oncol. 2016;142:2347-56. doi: 10.1007/s00432-016-2230-4
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