早期营养和炎症评估可预测肿瘤起源和转移状态患者的预后

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-08-05 DOI:10.1016/j.clnu.2025.07.029

Juliette Renard , Jean-Philippe Durand , Sixtine De Percin , Jennifer Arrondeau , Johanna Noel , Audrey Thomas-Schoemann , Manuela Tiako Meyo , Clémentine Villeminey , Jérôme Alexandre , Pascaline Boudou-Rouquette , François Goldwasser , Guillaume Beinse

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引用次数: 0

摘要

背景与目的癌症患者的临床复杂性是实施个体化临床管理策略的一大挑战。尽管它们对患者预后有影响，但癌症相关恶病质和炎症的负担仍然被癌症医生低估。我们的目的是评估早期多维患者评估的性能，整合全面的营养和炎症评估，用于患者分类和预后，独立于肿瘤特征。方法采用系统的、结构化的临床评价方法对门诊肿瘤患者进行肿瘤治疗前评估[科钦医院，2017-2023]。对常规临床和生物学数据进行回顾性分析，包括全面的营养和炎症评估。数据在结构化记录中前瞻性地实现，并在事后自动提取。无监督聚类使用混合数据（N = 53个特征）的析因分析确定的主成分。采用Cox回归分析与总生存期（OS）的相关性。结果1370例患者中，28%为局部肿瘤。主要肿瘤来源为肺部（25%）、消化道（18%）、肉瘤（17%）、妇科/乳腺（15%）、前列腺（9%）和泌尿道（8%）。中位生存期为28个月[25-31]（N = 833例死亡）（中位随访= 52个月）。根据贡献特征确定了五类患者：“健康”（47%）、“老年合并症”（26%）、“代谢异常”（10%）、“消化/肝脏损伤”（2%）和“严重受损/炎症”（15%）患者。在调整肿瘤起源和转移情况后，第2-5组（参考：“适合”患者）的OS风险比分别为1.84[1.55-2.19]、1.71[1.34-2.16]、2.07[1.28-3.31]和2.96[2.43-3.61]。结论早期，对肿瘤患者进行肿瘤不可知论、以宿主为中心的评估，确定了癌症患者的五个主要类型，其中营养和炎症特征是独立于肿瘤起源或转移状态的预后关键决定因素。需要进一步的调查来评估每组患者早期个性化干预的益处。

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Early nutritional and inflammation assessment predicts prognosis in patients with cancer across tumor origin and metastaticc status

Background and aims

Clinical complexity of patients with cancer represents a challenge when aiming to implement individualized clinical management strategies. Despite their impact on patient outcomes, the burden of cancer-associated cachexia and inflammation remains underestimated by cancer physicians. We aimed to evaluate the performances of an early multi-dimensional patient assessment, integrating a comprehensive nutritional and inflammatory evaluation, for patient categorization and prognostication, independently of tumor features.

Methods

Oncology outpatients evaluated in the setting of a systematic, structured clinical evaluation before anti-cancer treatment [Cochin Hospital, 2017–2023] were included. Retrospective analyses were conducted on routine-practice clinical and biological data, including a comprehensive nutritional and inflammatory assessment. Data were prospectively implemented in structured records, and automatically extracted post-hoc. Unsupervised clustering used principal components identified by factorial analysis of mixed data (N = 53 features). Associations with overall survival (OS) were analyzed using Cox regression.

Results

Among 1370 patients included, 28 % had localized tumors. Main tumor origins were lung (25 %), digestive (18 %), sarcoma (17 %), gynecological/breast (15 %), prostate (9 %), and urinary tract (8 %). Median OS was 28 months [25–31] (N = 833 deaths) (median follow-up = 52 months). Five clusters were identified, described based on contributing features: “fit” (47 %), “older comorbid” (26 %), “dysmetabolic” (10 %), “digestive/liver injured” (2 %), and “critically impaired/inflamed” (15 %) patients. Hazard ratio for OS were 1.84 [1.55–2.19], 1.71 [1.34–2.16], 2.07 [1.28–3.31], and 2.96 [2.43–3.61] for cluster 2–5 respectively (reference: “fit” patients), after adjustment on tumor origin and metastatic status.

Conclusions

Early, cancer-agnostic, host-centered evaluation of oncology patients identified five main clusters outlining the complexity of patients with cancer, where nutritional and inflammatory features are among key determinants of prognosis independently of tumor origin or metastatic status. Further investigations are warranted to evaluate the benefit of early personalized intervention in each cluster of patients.

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.