Comparative clinical outcomes of home parenteral nutrition in adults with gastrointestinal or gynecologic cancers versus non-cancer patients: a prospective cohort study using propensity score matching from the Canadian HPN registry.

IF 3.3 3区医学 Q2 NUTRITION & DIETETICS

European Journal of Clinical Nutrition Pub Date : 2025-07-11 DOI:10.1038/s41430-025-01640-y

Chanita Unhapipatpong, Katherine J P Schwenger, David Armstrong, Barbara Bielawska, Brian Jurewitsch, J D McHattie, Donald R Duerksen, Yidan Lu, Dane Christina Daoud, Anabelle Cloutier, Matreyi Raman, Leah Gramlich, George Ou, Johane P Allard

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引用次数: 0

Abstract

Background: Home parenteral nutrition (HPN) is indicated for patients with intestinal failure, but its use in cancer patients requires careful consideration due to the unique challenges and complexities involved.

Methods: This prospective cohort study analyzed data from cancer patients receiving HPN, recorded in the Canadian HPN Registry from 2003 to 2022. Patients were divided into two groups: those with gastrointestinal or gynecologic cancer and a propensity score-matched cohort of non-cancer patients. The objective was to assess survival rates by performance status and prescription decade in both groups. Secondary objectives were to compare complications between the groups.

Results: A total of 400 HPN patients were enrolled: 200 cancer patients (128 gastrointestinal, 72 gynecologic) and 200 matched non-cancer patients. Median age (interquartile range) was 58 (16) years for cancer and 56 (19) for non-cancer groups, with 71.5% and 66.5% female, respectively. Median survival was 1.71 years (95% confidence interval (CI), 0.81-2.61) for gastrointestinal cancer, 0.99 years (95% CI, 0.36-1.6) for gynecologic cancer, and 3.89 years (95% CI, 2.72-5.06) for non-cancer patients (p-value < 0.001). Survival showed no improvement over two decades. Patients with Karnofsky Performance Scale (KPS) ≤ 50 had shorter survival. Catheter complications and HPN-related hospitalizations were similar, but HPN-related liver disease was more common in non-cancer patients (16.5% vs. 9%, p-value = 0.025).

Conclusion: Survival for patients with gastrointestinal and gynecologic cancer and co-existing intestinal failure has not improved over the past two decades, with poorer outcomes observed in those with low KPS. Complication rates were similar in both groups. Graphical abstract: Created in BioRender. Unhapipatpong, C. (2025) https://BioRender.com/l25d998 .

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比较胃肠或妇科癌症患者与非癌症患者家庭肠外营养的临床结果：一项使用加拿大HPN登记处倾向评分匹配的前瞻性队列研究。

背景：家庭肠外营养（HPN）适用于肠衰竭患者，但由于其独特的挑战和复杂性，在癌症患者中的应用需要仔细考虑。方法：这项前瞻性队列研究分析了2003年至2022年加拿大HPN登记处记录的接受HPN治疗的癌症患者的数据。患者被分为两组：胃肠道或妇科癌症患者和倾向评分匹配的非癌症患者。目的是评估两组患者的表现状态和处方年限的生存率。次要目的是比较两组之间的并发症。结果：共纳入400例HPN患者：200例肿瘤患者（128例胃肠道患者，72例妇科患者）和200例匹配的非肿瘤患者。癌症组的中位年龄（四分位数范围）为58（16）岁，非癌症组为56（19）岁，分别为71.5%和66.5%的女性。胃肠道肿瘤患者的中位生存期为1.71年（95%可信区间（CI） 0.81-2.61），妇科肿瘤患者的中位生存期为0.99年（95% CI, 0.36-1.6），非癌症患者的中位生存期为3.89年（95% CI, 2.72-5.06） (p值结论：胃肠道和妇科肿瘤合并肠道衰竭患者的生存期在过去20年没有改善，低KPS患者的预后更差。两组的并发症发生率相似。图形摘要：在BioRender中创建。Unhapipatpong， C. (2025) https://BioRender.com/l25d998。

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来源期刊

European Journal of Clinical Nutrition 医学-营养学

CiteScore

10.60

自引率

2.10%

发文量

189

审稿时长

3-6 weeks

期刊介绍： The European Journal of Clinical Nutrition (EJCN) is an international, peer-reviewed journal covering all aspects of human and clinical nutrition. The journal welcomes original research, reviews, case reports and brief communications based on clinical, metabolic and epidemiological studies that describe methodologies, mechanisms, associations and benefits of nutritional interventions for clinical disease and health promotion. Topics of interest include but are not limited to: Nutrition and Health (including climate and ecological aspects) Metabolism & Metabolomics Genomics and personalized strategies in nutrition Nutrition during the early life cycle Health issues and nutrition in the elderly Phenotyping in clinical nutrition Nutrition in acute and chronic diseases The double burden of ''malnutrition'': Under-nutrition and Obesity Prevention of Non Communicable Diseases (NCD)