多模式康复改善老年体弱胃癌患者的功能能力和减少慢性炎症反应：一项前瞻性队列研究

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2024-12-24 DOI:10.1016/j.ejso.2024.109563

Yuqi Sun , Yulong Tian , Zequn Li , Shougen Cao , Xiaodong Liu , Hongding Han , Lei Han , Lingxin Kong , Xu Zhang , Fang Liu , Cheng Meng , Gen Liu , Hao Zhong , Yanbing Zhou

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引用次数: 0

摘要

背景：人口老龄化和癌症负担是重要的全球公共卫生问题，对全球卫生系统构成前所未有的威胁。虚弱是老年癌症患者常见的健康问题。近年来，利用康复来改善虚弱受到了广泛的关注。很少有研究涉及手术患者康复的具体生理效应。方法：将2022年9月至2023年10月期间接受择期胃癌原发性手术的体弱老年患者（65岁以上）纳入本单中心前瞻性队列研究，并分为多模式预康复组或ERAS标准护理组。在胃切除术前至少两周提供康复治疗，包括身体和呼吸训练、营养支持和社会心理治疗。主要结果是功能状态。次要结局包括脂质代谢、氧化应激和慢性炎症指标的变化。结果：在13个月的时间里，137名参与者被评估为合格，110名患者（康复前55名，ERAS 55名）被分析。与基线相比，康复组患者在手术前表现出更高的体能(平均6分钟步行测试变化+28米；结论：多模式康复可通过减少慢性炎症、改善脂质代谢、减轻氧化应激等方式提高机体功能。

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Multimodal prehabilitation to improve functional abilities and reduce the chronic inflammatory response of frail elderly patients with gastric cancer: A prospective cohort study

Background

Population ageing and cancer burden are important global public health problems that pose unprecedented threats to health systems worldwide. Frailty is a common health problem among elderly patients with cancer. In recent years, the use of prehabilitation to improve frailty has received widespread attention. Few studies have addressed the specific physiologic effects of prehabilitation on patients undergoing surgery.

Methods

Frail elderly patients (aged at least 65 years) who underwent elective primary surgery for gastric cancer between September 2022 and October 2023 were included in this single-centre prospective cohort study and were categorized into multimodal prehabilitation or ERAS standard care groups. Prehabilitation, including physical and respiratory training, nutritional support and psychosocial treatment, was provided at least two weeks before gastrectomy. The primary outcome was functional status. Secondary outcomes included changes in indices of lipid metabolism, oxidative stress and chronic inflammation.

Results

Over a 13-month period, 137 participants were assessed for eligibility, and 110 patients (prehabilitation 55, ERAS 55) were analysed. Compared with the baseline, patients in the prehabilitation group exhibited increased physical capacity before the operation (mean 6-min walk test change +28 m; P < 0.001). After prehabilitation intervention, inflammation-related indicators (NLR, PLR, SII and CRP) improved, and proinflammatory cytokine production (IL-5, IL-6, IL-1β, IL-10 and TNF-α) decreased. After surgery, the increase in IL-6 was reduced in the prehabilitation group (P = 0.036). Moreover, prehabilitation was associated with alleviating oxidative stress as determined by the levels of MDA (P = 0.005).

Conclusion

Multimodal prehabilitation can play a beneficial role in improving functional abilities by reducing chronic inflammation, improving lipid metabolism, and attenuating oxidative stress.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.