Early nutritional risk assessment by NRS 2002 to predict survival in patients with advanced biliary tract cancer.

Abstract

505 Background: Biliary tract cancer (BTC) has heterogenous disease with dismal prognosis. We investigated the predictors of overall survival (OS) among Korean patients with advanced BTC according to their baseline nutritional risks estimated by Nutritional Risk Screening (NRS) 2002 score. Methods: From September 2006 to July 2017, we retrospectively reviewed the data of 601 patients with BTC. Data on demographic and clinical parameters were collected from electronic medical records, and overall survival (OS) and progression-free survival (PFS) was estimated using the Kaplan–Meier method. Stepwise Cox regression analysis was used to determine the factors associated with survival. Patients with a NRS 2002 score ≤2 were classified as “no-risk; ” those with a score of 3 were classified as “moderate-risk; ” and those with a score of ≥4 were classified as “high-risk.” Results: Following nutritional screening at baseline, 333 patients (55%) were classified as the “no risk” group; 109 patients (18%), as the “moderate risk” group; and 159 patients (27%) as the “high risk” group. Survival analysis showed significant differences in the median OS according to the NRS 2002 groups: “no risk” group: 12.6 months (95% CI: 11.5–13.7); “moderate risk” group: 6.1 months (95% CI: 4.3–8.0); and “high risk” group: 3.9 months (95% CI: 3.2 – 4.6) (p<0.001). On the Cox’s regression analysis, NRS 2002 score came out as the most independent factor for OS (for “moderate-risk” HR 1.610, 95% CI 1.288-2.027, p<0.001; for “high-risk”, HR 2.121, 95% CI 1.728-2.612, p<0.001), compared with other prognostic factors including liver metastasis, peritoneal seeding, white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, cholesterol, CEA, and CA19-9. Conclusions: Our study demonstrated OS of advanced BTC was strongly related to their baseline nutritional status assessed by NRS 2002. Constitutional nutritional assessment can help to improve patient prognosis through proactive and individualized nutritional intervention. Baseline nutritional status should be integrated for implementing prognostic scoring system, which can provide more sophisticated risk stratification of patients with metastatic BTC.