Nutrition impact symptoms: Noteworthy prognostic indicators for lung cancer

Chen-An Liu; Tong Liu; Hui-Chen Li; Meng-Meng Song; Yi-Zhong Ge; Guo-Tian Ruan; Li Deng; Qi Zhang; Hai-Lun Xie; Shi-Qi Lin; Jin-Yu Shi; Han-Ping Shi

doi:10.1016/j.clnu.2023.02.021

Nutrition impact symptoms: Noteworthy prognostic indicators for lung cancer

Clin Nutr. 2023 Apr;42(4):550-558. doi: 10.1016/j.clnu.2023.02.021. Epub 2023 Feb 24.

Authors

Chen-An Liu¹, Tong Liu¹, Hui-Chen Li², Meng-Meng Song¹, Yi-Zhong Ge¹, Guo-Tian Ruan¹, Li Deng¹, Qi Zhang³, Hai-Lun Xie¹, Shi-Qi Lin¹, Jin-Yu Shi¹, Han-Ping Shi⁴

Affiliations

¹ Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China.
² Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China; Tianjin Institute of Coloproctology, Tianjin, 300121, China.
³ Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310022, China.
⁴ Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China. Electronic address: shihp@ccmu.edu.cn.

PMID: 36863291
DOI: 10.1016/j.clnu.2023.02.021

Abstract

Background: Nutrition impact symptoms (NIS) in head and neck cancer are well-studied and are found to be heavy contributors of poor outcome. However, the prevalence and role of NIS in other cancer are less addressed. In this study, we investigated the incidence and prognostic role of NIS in patients with lung cancer.

Methods: NIS, evaluated by patient-generated subjective global assessment (PG-SGA) in a multicenter real-world prospective study, included loss of appetite, nausea, vomiting, mouth ulcer, constipation, diarrhea, dry mouth, taste change, altered smell, dysphagia, early satiety, and pain. The endpoints were the patients' overall survival (OS) and quality of life (QoL). The COX analysis was used to investigate the relationship between NIS and OS. Interaction analysis and mediation analysis were performed to determine the modifiers and mediator.

Results: 3634 patients with lung cancer were enrolled in this study, of which 1533 patients had NIS. During the average follow-up of 22.65 months, 1875 deaths occurred. The OS of patients with lung cancer with NIS was lower than that of patients without NIS. NIS (HR, 1.181, 95% CI, 1.073-1.748), loss of appetite (HR, 1.266, 95% CI, 1.137-1.409), vomiting (HR, 1.282, 95% CI, 1.053-1.561), and dysphagia (HR, 1.401, 95% CI, 1.079-1.819) were independent prognostic factors in patients with lung cancer. There were interactions between chemotherapy and primary tumor on NIS . In the relationship between different types of NIS (NIS, loss of appetite, vomiting, dysphagia) and prognosis, the mediating effects of inflammation accounted for 15.76%, 16.49%, 26.32%, and 18.13%, respectively. Meanwhile, these three NIS were closely associated with the occurrence of severe malnutrition and cancer cachexia.

Conclusions: 42% patients with lung cancer experienced different types of NIS. NIS were independent indicators of malnutrition, cancer cachexia and shorter OS, and closely related to QoL. NIS management is of clinical significance.

Keywords: Cachexia; Inflammation; Lung cancer; Malnutrition; Nutrition impact symptoms; Prognosis.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cachexia / complications
Deglutition Disorders* / epidemiology
Deglutition Disorders* / etiology
Humans
Lung Neoplasms* / complications
Malnutrition* / diagnosis
Nutrition Assessment
Nutritional Status
Prognosis
Prospective Studies
Quality of Life
Vomiting / complications
Vomiting / etiology