Dataset Information

Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy.

ABSTRACT: BACKGROUND:Patients with esophageal cancer (EC) have high rates of malnutrition due to tumor location and treatment-related toxicity. Various strategies are used to improve nutritional status in patients with EC including oral and enteral support. METHODS:We conducted a retrospective analysis to determine the impact of malnutrition and prophylactic feeding jejunostomy tube (FJT) placement on toxicity and outcomes in patients with localized EC who were treated with neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy. RESULTS:We identified 125 patients who were treated with nCRT between 2002 and 2014. Weight loss and hypoalbuminemia occurred frequently during nCRT and were associated with multiple adverse toxicity outcomes including hematologic toxicity, nonhematologic toxicity, grade ?3 toxicity, and hospitalizations. After adjusting for relevant covariates including the specific nCRT chemotherapy regimen received and the onset of toxicity, there were no significant associations between hypoalbuminemia, weight loss, or FJT placement and relapse-free survival (RFS) or overall survival (OS). FJT placement was associated with less weight loss during nCRT (p = 0.003) but was not associated with reduced toxicity or improved survival. CONCLUSIONS:Weight and albumin loss during nCRT for EC are important factors relating to treatment toxicity but not RFS or OS. While pretreatment FJT placement may reduce weight loss, it may not impact treatment tolerance or survival.

SUBMITTER: Jain R

PROVIDER: S-EPMC7602938 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy.

Jain Rishi R Shaikh Talha T Yee Jia-Llon JL Au Cherry C Denlinger Crystal S CS Handorf Elizabeth E Meyer Joshua E JE Dotan Efrat E

Nutrients 20201017 10

<h4>Background</h4>Patients with esophageal cancer (EC) have high rates of malnutrition due to tumor location and treatment-related toxicity. Various strategies are used to improve nutritional status in patients with EC including oral and enteral support.<h4>Methods</h4>We conducted a retrospective analysis to determine the impact of malnutrition and prophylactic feeding jejunostomy tube (FJT) placement on toxicity and outcomes in patients with localized EC who were treated with neoadjuvant chem ...[more]

PMID: 33080840

Similar Datasets

Project description:BackgroundThere are multiple choices for the nutritional management mode after esophageal cancer surgery. Currently, there is still controversy regarding which nutritional management mode has an impact on the postoperative recovery and overall survival (OS) of patients. This study aims to compare the differences between two commonly used clinical nutritional management modes: jejunostomy feeding plus oral intake (JF plus OI) and intravenous nutrition plus oral intake (IN plus OI), in terms of short-term efficacy and 3-year OS, in order to further explore the optimal mode of enteral nutrition management after esophageal cancer surgery.MethodsWe evaluated esophageal cancer patients who underwent radical surgery at Union Hospital of Fujian Medical University between January 1, 2010 and January 1, 2020. The purpose of this analysis was to compare the perioperative complications, Nutritional Risk Screening 2002 (NRS2002) nutritional scores at 1 week, 2 weeks, 1 month, and 3 months after surgery, as well as the 3-year OS rates, between two different nutritional management approaches: JF plus OI and IN plus OI following esophageal cancer surgery.ResultsAmong the 822 patients included, 668 and 154 patients belonged to JF plus OI and IN plus OI groups, respectively. After propensity score matching, 149 patients per group were evaluated. The amount of gastric drainage fluid was higher in the IN plus OI group (P<0.05), and the incidence of postoperative gastrointestinal emptying disorder and intestinal obstruction was significantly higher in the JF plus OI group (P<0.05). The IN plus OI group had a higher incidence of perioperative hypoproteinemia (P<0.05), and a higher risk of malnutrition in 2 weeks after surgery (P<0.05). The 3-year OS was not significantly different (P>0.05).ConclusionsJF plus OI may be the preferable nutritional management approach after esophageal cancer resection as it can potentially reduce perioperative nutritional deficiency. However, attention should be paid to the risk of gastrointestinal emptying and intestinal obstruction associated with JF.

Project description:BackgroundThe controlling nutritional status (CONUT) score, as an immune-nutritional index, has been reported to be related to prognosis in several cancers. Neoadjuvant immunochemotherapy (nICT) is an emerging pattern for cancer treatment in recent years. However, the usefulness of CONUT in esophageal squamous cell carcinoma (ESCC) with nICT has not been reported so far. This study attempted to clarify the usefulness of CONUT in predicting disease-free survival (DFS) in ESCC with nICT.MethodsTwo hundred sixteen ESCC patients receiving nICT between 2019 and 2021 were retrospectively enrolled. Based on CONUT, the patients were divided into two groups: low groups (score ≤ 2) and high (score ≥ 3) groups. The relationships between CONUT and clinical characteristics were estimated. Cox regression analyses with hazard ratios (HRs) and 95% confidence intervals (CIs) were also performed to evaluate the prognostic factors of DFS.ResultsFifty-nine (27.3%) patients achieved pathologic complete response (pCR), and 30 (13.9%) cases had a recurrence. There were 150 cases (69.4%) in low CONUT group and 66 cases (30.6%) in high CONUT group, respectively. The results revealed that vessel invasion (P = 0.037), postoperative pneumonia (P = 0.001), advanced ypT stage (P = 0.011), cTNM stage (P = 0.007), and ypTNM stage (P < 0.001) were significantly related to patients with a high CONUT score. A high pCR rate was found in patients with a low CONUT score (33.3% vs. 13.6%, P = 0.003), and a high recurrence rate was found in patients with a high CONUT score (24.2% vs. 9.3%, P = 0.004), respectively. Patients with a low CONUT score had a better 1-year DFS than those with a high CONUT score (90.7% vs. 75.8%, P = 0.004). Multivariate analyses indicated that the pretreatment CONUT score was an independent predictor regarding DFS (HR = 2.221, 95% CI: 1.067-4.625, P = 0.033).ConclusionA better response and a lower recurrence were found in ESCC patients with a lower pretreatment CONUT. As a useful index for immune-nutritional status, the CONUT might be a reliable prognostic indicator in ESCC patients with nICT.

Project description:Enteral nutrition (EN) is superior to parenteral nutrition (PN) in improving the nutritional status of esophageal cancer (EC) patients and accelerating postoperative recovery. Therefore, feeding via jejunostomy (FJ) is currently placed during esophagectomy to maintain the postoperative nutrition supply. However, FJ have some serve complications. The aim of this study was to explore the value of feeding via duodenostomy (FD) in reducing the complications associated with FJ. In this retrospective cohort study, the clinical data of 154 patients with EC who underwent surgical treatment in our center from January 1, 2020, to June 30, 2020 were collected. A concurrent, nonrandomized control group of 154 patients underwent thoraco-laparoscopic esophagectomy (TLE) was enrolled consisting of 82 males and 72 females. These patients were randomly divided into two groups according to the different ostomy method applied, including 80 cases in the FD group and 74 cases in the FJ group. The ostomy-related complications during the 180-day follow-up and indicators including perioperative nutritional markers, length of stay (LoS), and operative time were recorded. After 1 week, the albumin level in the FD group was noninferior to that in the FJ group (36.8 vs. 36.3 g/L; P=0.792), and the prealbumin level also showed no significant difference (178 vs. 176 g/L; P=0.347). Four weeks later, there was significant difference in levels of albumin (42 vs. 41 g/L; P=0.018) but no significant difference prealbumin (225 vs. 222.89 g/L; P=0.493). The LoS was similar between the 2 groups (7 vs. 7.21 days; P=0.697). In terms of the time of stoma creation, it was significantly longer in the FD group than in the FJ group (20 vs. 12 minutes; P<0.001); however, it did not bring a significant impact on the overall procedure length (240 vs. 230.69 minutes; P=0.057). The incidence of postoperative complications (e.g., intestinal obstruction) was significantly lower in the FD group than in the FJ group (P=0.017). The method of FD is safe, effective and acceptable. It is worthwhile to use in clinic practice.

Dataset Information

Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy.

Publications

Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets