Impact of perioperative high-protein nutritional support on postoperative outcomes in the treatment of primary lung cancer: Russian prospective multicenter comparative study (NUTRILUNC-study)

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BACKGROUND: Up to 60% of lung cancer pts experience weight loss. Prevalence of sarcopenia in patients (pts) with non-small cell lung cancer (NSCLC) is about 43% and is an independent predictor of worse overall survival. It was shown that nutritional support improves outcomes in pts with cancer.

AIM: To evaluate impact of perioperative nutritional support on surgical treatment outcomes of patients with NSCLC.

MATERIALS AND METHODS: Patients with primary NSCLC (n=112, 69 males), aged 57,2±8,2, awaiting lung surgery and being at risk of malnutrition (Nutritional Risk Screening Assessment 2002 score ≥3) were randomized into 2 groups. Study group (n=55) received oral nutritional support (Nutridrink Compact Protein, Nutricia LLC), 250 ml/d (36 g of protein, 612 kcal) for 14 d before and 14 d after surgery in addition to standard diet. Control group (n=57) had a standard diet. The number of respiratory complications after surgery, length of hospitalization, anthropometric, functional, laboratory parameters, quality of life (according to Quality of Life Questionnaire Core-30) were assessed. Results were presented as mean ± standard deviation. Differences were considered significant at p ≤0.05.

RESULTS: In the study group there were fewer respiratory complications (p <0.01), and a shorter length of hospitalization (p=0.03). Body weight in the study group did not change significantly, while in the control group it decreased (0.15±3.7 kg versus loss of 3.47±3.6 kg). Results of six-minute walk test and hand grip dynamometry were higher in the study group then in the control group (411.8±56.0 m versus 383.2±52.1 m; 33.5±8.4 kg versus 27.1±6.8 kg). Quality of life was better in the study group, p <0.05. The total protein and albumin levels were higher in the study group (70.9±5.6 g/l versus 63.1±4.0 g/l; 38.5±5.8 g/l versus 33.2±3.0 g/l). One patient in study group experienced 1st grade diarrhea.

CONCLUSION: In patients with NSCLC at risk of malnutrition perioperative nutritional support with high protein oral nutritional support has a positive effect on surgical treatment outcomes.

About the authors

Olga A. Obukhova

N.N. Blokhin National Medical Research Center of Oncology

Author for correspondence.
Email: obukhova0404@yandex.ru
ORCID iD: 0000-0003-0197-7721
SPIN-code: 6876-7701

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Ildar A. Kurmukov

N.N. Blokhin National Medical Research Center of Oncology

Email: kurmukovia@gmail.com
ORCID iD: 0000-0001-8463-2600
SPIN-code: 3692-5202

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Nail M. Egofarov

Nutricia LLC

Email: nail.egofarov@danone.com
ORCID iD: 0000-0001-5013-0231
Russian Federation, Moscow

Mariya G. Kolesnichenko

Medical Center “Verax-Med” LLC; North-Western State Medical University named after I.I. Mechnikov

Email: maria_2182@mail.ru

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

Yuriy V. Kirillov

Medical Center “Verax-Med” LLC; North-Western State Medical University named after I.I. Mechnikov

Email: Yura-1992@mail.ru
SPIN-code: 1186-9704
Russian Federation, Saint Petersburg; Saint Petersburg

Svetlana S. Povaga

Smolensk Regional Clinical Oncology Dispensary

Email: povaga1980@mail.ru
ORCID iD: 0000-0001-6606-606X
Russian Federation, Smolensk

Natal’ya A. Belyaeva

Clinical hospital “Russian Railways-Medicine”

Email: n.makar1973@mail.ru
ORCID iD: 0000-0001-9616-0030
Russian Federation, Smolensk

Ekaterina V. Gordeeva

Moscow Multidisciplinary Center for Palliative Care

Email: simmetria0@mail.ru
SPIN-code: 9814-3379
Russian Federation, Moscow

Yuriy V. Perminov

Saint Petersburg State Research Institute of Phthisiopulmonology

Email: iuriiperminov88@gmail.com
Russian Federation, Saint Petersburg

Andrey A. Skorokhod

Saint Petersburg State Research Institute of Phthisiopulmonology

Email: dr.skorokhod@mail.ru
ORCID iD: 0000-0002-1819-7206
SPIN-code: 6609-6890

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Andrey O. Nefedov

Saint Petersburg State Research Institute of Phthisiopulmonology

Email: herurg78@mail.ru
ORCID iD: 0000-0001-6228-182X
SPIN-code: 2365-9458

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Dmitriy N. Novitsky

Clinical Oncology Dispensary

Email: dnn1978@gmail.com
Russian Federation, Omsk

Timur N. Egofarov

Medical University REAVIZ

Email: tim7903@gmail.com
ORCID iD: 0009-0007-3620-7811
Russian Federation, Samara

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Supplementary files

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1. JATS XML
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2. Fig. 1. Study design: GI — study group; CG — control group; NSCLC — non-small cell lung cancer; EN — enteral nutrition.

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3. Fig. 2. Dynamics body weight at the stages of the study (В1–В4).

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4. Fig. 3. Dynamics of total protein concentration during the study stages (В1–В4).

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5. Fig. 4. Dynamics of serum albumin concentration at the stages of the study (В1–В4).

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6. Fig. 5. Lung infections, frequency in groups (% of the group size).

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7. Fig. 6. Duration of antibiotic therapy.

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8. Fig. 7. Proportion of patients with the need for postoperative sanitation bronchoscopy (% of the group size).

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9. Fig. 8. Blood saturation (SpO2) dynamics at the stages of the study (В1–В4).

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10. Fig. 9. Length of hospital stay by group (days).

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11. Fig. 10. Six-minute walk test results at the B1, B2 and B4 stages of the study.

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12. Fig. 11. Hand grip dynamometry at the stages of the study (B1–B4).

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13. Fig. 12. General health status dynamics at the B1, B2, B4 and B5 stages of the study, according to the Quality of Life Questionnaire Core-30 (scores).

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