Letter to the Editor: Dynamic Deterioration of Nutritional Status During the Preoperative Period in Gastric Cancer

Objective To investigate the nutritional status and quality of life (QOL) of patients with gastric cancer in perioperative period and to analyze the relationship between nutritional status and QOL. Methods A prospective study was performed. One hundred and thirty-five patients with gastric cancer were enrolled in this study. The nutritional status and quality of life, 1 day before operation and 10 days after operation, were assessed by the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Quality of Life Questionnaire of Stomach 22 (QLQ-STO22). Statistical analysis was performed using SPSS13.0 software. Results In preoperative period, the PG-SGA score was (6.71±3.05), which belonged to moderate malnutrition. PG-SGA score in postoperative period was (12.82±2.85), which belonged to severe malnutrition. PG-SGA score in postoperative period was significantly higher than that in preoperative period (t=-21.91, P=0.000). QOL score in postoperative period (19.69±7.59) was significantly higher than that in preoperative period (14.32±5.97) (t=8.21, P=0.000). The total scores of QOL showed statistically significant differences in patients with different nutritional statuses (F=29.29, P=0.000). Conclusions Gastric cancer patients' nutritional status and QOL are impaired in perioperative period. Compared with preoperative period, the nutritional status and QOL of postoperative period are obviously poorer. The QOL of malnourished patients is worse than well-nourished patients. Therefore, nutritional status is independently and negatively associated with QOL in gastric cancer and improving the status of nutritional should be viewed as an important part in the management of gastric cancer. Key words: Gastric cancer; Perioperative; Nutritional status; Quality of life

IntroductionHelicobacter pylori is the most common bacterial infection in humans. H. pylori is now known to be responsible for chronic gastritis, peptic ulcer, B-cell gastric lymphoma, and gastric adenocarcinoma. Laparoscopic sleeve gastrectomy (LSG) is increasingly preferred among surgical treatment methods in obese patients.AimTo discuss the detection and treatment of H. pylori in patients undergoing LSG surgery.Material and methodsPatients who underwent biopsy with upper gastrointestinal endoscopy in the preoperative and postoperative period of LSG between 2014 and 2019 were included in the study, resulting in a sample of 162 patients who underwent preoperative and postoperative endoscopy. Endoscopic biopsies of these patients were collected in accordance with the preoperative Sydney protocol. The patients did not receive H. pylori-related eradication treatment. Endoscopy was performed to investigate dyspeptic complaints in the postoperative period. The biopsy results obtained in the endoscopy in the postoperative period were compared to those obtained in the preoperative period.ResultsOf the 162 patients in our study, 39 were male and 123 were female. All patients were assigned to one of two groups in the preoperative period: H. pylori (+) and H. pylori (–). H. pylori was found to be positive in 99 patients in the preoperative period. H. pylori was negative in 62 patients in the biopsy results of these patients after the LSG. H. pylori was found to be negative in 63 patients in the preoperative period, and 51 patients were H. pylori-negative in the biopsy results of these patients following LSG. These changes were found to be statistically significant when the preoperative and postoperative pathology results were evaluated (p < 0.01).ConclusionsThis study showed that LSG reduced the presence of H. pylori.

INTRODUCTION. In the Russian Federation, among all malignant diseases in the male population, gastric cancer ranks the 4th, in women – 5th place, and in terms of mortality in both sexes from malignant diseases – 2nd place. During surgical treatment of patients with gastric cancer, anemia is detected in more than 1/4 of patients, who significantly worsens the prognosis due to postoperative complications. Timely correction of anemia can reduce the risk of complications during surgical treatment and improve the course of the postoperative period.OBJECTIVE is to evaluate the effectiveness of correction of anemia in the preoperative period and the results of radical surgical treatment in patients with gastric cancerMETHODS AND MATERIALS. The article presents the analysis of medical records of 30 patients aged 56–75 years with a diagnosis of gastric cancer complicated by anemia (hemoglobin level &lt; 80 g/l). All patients in the preoperative period for the correction of anemia were prescribed iron (III) hydroxide oligoisomaltose intravenously at the dose of 20 mg/kg 21 days before surgery, due to the detection of iron deficiency in them.RESULTS. The target blood hemoglobin level was more than 95 g/l. In the absence of the desired effect, erythrocyte transfusion was performed. The use of iron preparations made it possible to correct anemia in 14 (46.7 %) patients without resorting to transfusions, in 16 (53.3 %) patients, it was required to additionally transfuse 1 dose of erythrocytes, while earlier in the preoperative anemia was corrected using transfusions of 2–3 doses of erythrocytes. All patients underwent radical surgery with D2 lymph node dissection. Operations were accompanied by blood loss of 201.0±94.4 ml (120–475 ml). It was revealed that radical surgeries for gastric cancer in patients who received anemia correction in the preoperative period are accompanied by a low number of purulent-inflammatory (in 27.3 % of patients) and cardiovascular complications (in 20 % of patients).CONCLUSION. Correction of anemia is a mandatory part of therapy in the preoperative period and allows to perform a full range of radical surgical intervention, improve the safety of surgical treatment and improve the course of the postoperative period.

IntroductionImmunonutrition is a part of nutritional interventions in gastrointestinal cancer patients. It seems to be especially important in the preoperative period to reduce, among others, surgery-related complications. The relation between the immune system and gut microbiota has been previously analyzed. However, the influence of immunonutrients on the composition of gut microbiota is still unclear. Therefore, the aim of this study was to assess the impact of enteral immunonutrition on gut microbiota in gastric/colorectal cancer patients in the preoperative period.Patients and methodsThis study included 14 patients (n = 9 colorectal cancer, n = 5 gastric cancer) allocated to receive immunonutrition or standard products by 7 days prior to the surgery. Randomization was performed using a random number generator. The stool samples were collected at day 0 and after 7 days of consuming the study products. Therefore, gut microbiota analysis was conducted at the beginning and after 7 days (follow-up). The analysis consists of alpha diversity analysis, taxonomic data processing, beta diversity analysis, and differential abundance analysis.ResultsStatistical analysis did not indicate any significant differences (p > 0.05) between the two dietary groups for any of the alpha diversity indices. Microbial community compositions were largely similar between the immunodiet and standard nutridrink groups. Differential abundance analysis (DAA) using the Wilcoxon test identified several taxa with nominal p-values <0.05, suggesting potential differences in abundance between groups. However, none of these findings remained statistically significant. The taxa with nominal significance included Bilophila, CAG-56, Clostridium sensu stricto 1, Coprobacter, Holdemania, Fusicatenibacter, Ruminococcus, and [Eubacterium] eligens group.ConclusionsThe analysis of gut microbiota in the context of immunonutrition is a new area in oncology. In the current study, despite some initial microbial alterations, it was not finally confirmed that immunonutrition has a beneficial effect on gut microbiota in gastric and colorectal cancer patients in the preoperative period. However, the small sample size is one of the study’s limitations.

Introdução: O câncer de esôfago (CE) afeta mais de 450 mil pessoas no mundo por ano, enquanto o câncer de estômago é a segunda causa de morte por câncer no mundo. Objetivo: Avaliar e comparar o perfil sociodemográfico e clínico de pacientes com neoplasia de esôfago e estômago. Método: Foram avaliados 24 indivíduos internados em um hospital escola em período pré-operatório. Esses responderam a um questionário com dados sociodemográficos e passaram por uma avaliação clínica. Foi considerado o grau de independência, de acordo com a escala Performance Status. Foi aplicada estatística descritiva e inferencial com teste t de Student não pareado para comparar as variáveis sociodemográficas e físicas dos pacientes, sendo considerada diferença estatisticamente significativa, valores de p≤0,05. Resultados: Dos pacientes com neoplasia de esôfago, 100,00% (n=8) eram homens e, na neoplasia de estômago, 68,75% (n=11) eram homens. Quanto à escolaridade e renda, a maioria dos pacientes em ambas as doenças possuía ensino fundamental e renda de um salário mínimo. Na escala Performance Status, o escore mais elevado foi II para neoplasia de esôfago e 0 para neoplasia de estômago. Em relação às características físicas, verificou-se diferença significativa (p=0,01) na comparação do índice de massa corpórea entre homens (21,68±2,62 kg/m2) e mulheres (27,91±5,97 kg/m2). Já na força muscular, a maioria apresentou grau 5 para membros superiores e inferiores. Conclusão: O perfil desses pacientes se caracteriza pela prevalência de homens brancos e pardos, idosos, com baixa escolaridade, baixa renda e independentes para as atividades de vida diária.

Gastric cancer (GC) has a high mortality rate, and robust diagnostic biomarkers are currently lacking. However, the clinical relevance of circular RNAs (circRNAs) as GC biomarkers remains largely unexplored. To evaluate the potential of novel circRNA circ_0004592 in the early screening and prognosis of GC. High-throughput sequencing of circRNAs was performed to screen for potential target molecules. Circ_0004592 expression was examined in GC tissues, cells, and plasma. Plasma samples were collected from healthy subjects' patients, as well as from patients with benign lesions, precancerous lesions, and GC, whereafter the diagnostic accuracy of circ_0004592 was evaluated. The correlation between circ_0004592 levels in plasma and clinicopathological data of patients with GC was further analyzed. Circ_0004592 was upregulated in both the tissue and plasma of patients with GC. Further, circ_0004592 expression was higher in patients with precancerous lesions than in healthy controls while being highest in patients with GC. In the same patient, the postoperative plasma level of circ_0004592 was lower than that in the preoperative period. Moreover, circ_0004592 level was significantly correlated with tumor differentiation, tumor depth, and lymph node metastasis. The area under the curve (AUC) of plasma circ_0004592 exhibited high sensitivity and specificity for differentiating patients with GC from healthy donors. Diagnosis based on circ_0004592, carcinoembryonic antigen, and cancer antigen 199 achieved a superior AUC and was highly sensitive. Plasma circ_0004592 may represent a potential non-invasive auxiliary diagnostic biomarker for patients with GC.

Objective. Gastric cancer is the fifth most common malignancy and the third leading cause of the cancer mortality worldwide. It is most often diagnosed at a locally advanced or metastatic stage. Angiogenesis has become an important target in the treatment of solid tumors, and antiangiogenic agents are a promising approach to cancer therapy. In this review, we summarize the current literature on the treatment of gastric and gastroesophageal cancer with ramucirumab, an antiangiogenic agent specifically targeting vascular endothelial growth factor receptor-2 (VEGFR-2). Material and methods. We conducted a systematic search in May 2016 of PubMed and relevant congress proceedings including the American Society of Clinical Oncology, the European Society for Medical Oncology, and the European Cancer Congress. Included studies were aimed to prospectively evaluate the efficacy and safety of ramucirumab in advanced gastric or gastroesophageal cancer. Results. Our search yielded 91 publications including 5 manuscripts and 6 congress abstracts meeting the predefined inclusion criteria. Included studies reported outcomes were related to ramucirumab in gastric cancer, published within the past 5 years. Conclusion. Second-line treatment with ramucirumab, either as monotherapy or in combination with paclitaxel, significantly improves the survival of patients with advanced gastric cancer. Ramucirumab is well tolerated and has an acceptable safety profile. Furthermore, the patient quality of life is maintained with delayed both symptom worsening and deterioration of the functional status. Studies are required to identify potential predictive biomarkers of ramucirumab efficacy.

Gastric cancer (GC) patients are vulnerable to malnutrition due to abdominal discomfort, nausea, vomiting, and anorexia. The Prognostic Nutritional Index (PNI), which combines serum albumin and total lymphocyte count (TLC), has prognostic value for numerous malignancies including GC. GC patients who are malnourished have a higher incidence of surgical complications and worse long-term prognosis. Although the link between PNI and prognosis is well established, whether the PNI decreases while GC patients await surgery is unknown. The primary objective of this study of 124 GC patients was to determine whether the nutritional and immune status decreased during the preoperative period. Here we demonstrate that the PNI decreased due to reductions in both serum albumin and TLC (P < 0.001); the effects were greater in advanced vs. early-stage GC. Corresponding decreases in BMI were found (P < 0.001). Significant reductions in PNI occurred over time regardless of tumor location. Tumor diameter was positively associated with the magnitude of PNI decline (P < 0.01). Reductions in preoperative PNI/day were associated with worsening of progression-free survival (PFS) and overall survival (OS). Collectively, these results provide a strong rationale for future nutritional support studies that aim to attenuate the preoperative decline in PNI and improve outcomes of GC patients.

Malnutrition in children with cystic fibrosis: the energy-balance equation.

Gastric cancer is the sixth most common malignancy in the world. However, its mortality has been decreasing in the last years thanks to improvement in diagnostics and therapeutics. Nevertheless, the high rate of malnutrition in patients with gastric cancer still has a major impact on the overall survival and quality of life of patients. The narrative review presents the most recent data on nutritional support in the resectable stages of gastric cancer, with a particular focus on perioperative strategies, and discusses malnutrition in gastric cancer, nutritional support before and after surgery, and the relationship between nutritional support and chemotherapy. Despite the predominantly methodological limitations related to the difficulty of performing randomized controlled trials on nutritional support in cancer patients, this review highlights important points. Nutritional counselling is essential starting from diagnosis. In limited or locally advanced forms (about 40% of cases), the therapeutic cornerstone is represented by gastric surgery. In most of these cases, perioperative chemotherapy is also indicated. Of note, nutritional support varies before and after surgery. In the preoperative period, the goal is to prepare the body for surgery, with available evidence recommending the prescription of immunonutrition (both oral and artificial, as appropriate). In the postoperative period, on the other hand, the objective is to facilitate recovery and adaptation to the new anatomy; an early and combined strategy (oral and enteral) seems to be the most suitable to pursue this. Unfortunately, rigorous data on the relationship between nutritional support and chemotherapy treatments used in resectable gastric cancer are not available. In the absence of strong scientific evidence, it may be useful to adopt a personalized multidisciplinary strategy for each patient wherein the chemotherapy programme is modulated based on nutritional status.

ABSTRACTBackgroundThe association between changes in nutritional status over time and the risk of sarcopenia in older adults is unclear. This study investigated the impact of baseline nutritional status and its 4‐year changes on the development of sarcopenia and severe sarcopenia.MethodsWe conducted a prospective, multicentre longitudinal cohort study and 1661 community‐dwelling adults aged 70–84 years without baseline sarcopenia were included for analysis. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), categorized as normal, at risk of malnutrition or malnutrition (24–30, 17–23.5 and < 17 points, respectively). Changes in nutritional status were classified as improved, unchanged or deteriorated. Primary outcomes were new‐onset sarcopenia and severe sarcopenia. Sarcopenia was defined by the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Cox regression models using changes in nutritional status as a time‐varying covariate were used to estimate hazard ratios (HRs), adjusted for age, sex, body mass index, smoking, alcohol use, fall history, education, comorbidities and activities of daily living. In sensitivity analyses, the Fine and Gray subdistribution hazard model was performed to estimate subdistribution HRs (sHRs), which accounts for death as a competing risk.ResultsThe mean age of participants was 76.3 ± 3.6 years, and 46.9% were male. At baseline, 77.3% had normal nutritional status, 21.8% were at risk of malnutrition, and 0.9% were malnourished. After mean follow‐up of 6.8 years, deterioration in nutritional status was associated with increased risk of sarcopenia (HR 1.77 [95% confidence interval, 1.25–2.51], p = 0.001) and severe sarcopenia (HR 1.97 [1.23–3.16], p = 0.005) compared to those with unchanged nutritional status among total participants. Among those with normal nutritional status at baseline, deterioration in nutritional status was also associated with increased risk of sarcopenia (HR 2.07 [95% confidence interval, 1.37–3.12], p = 0.001) and severe sarcopenia (HR 1.95 [1.08–3.53], p = 0.028). Prevalence of low muscle mass differed significantly by measurement device (Hologic 64.8%, GE Lunar 37.2%, BIA 24.2%, p < 0.001); however, the longitudinal association between nutritional status and sarcopenia risk remained consistent in sensitivity analysis.ConclusionBaseline nutritional risk and deterioration in nutritional status are robust predictors of future sarcopenia and severe sarcopenia in community‐dwelling older adults. Improving nutritional status over time may significantly reduce the risk of progressing to severe sarcopenia. Clinical strategies to monitor and enhance nutrition are essential for preventing sarcopenia.

Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition

Introduction: In cancer patients, the reduced food intake causes weight loss and promotes protein-calorie malnutrition. This results in loss of lean body mass, which affects both skeletal muscles and respiratory muscles. Objective: Evaluate and compare the respiratory muscle strength of patients with esophageal and stomach neoplasia during the preoperative period. Methods: This is a cross-sectional study carried out with 24 patients of both genders hospitalized in a teaching hospital. They underwent a physical therapy evaluation composed of anthropometric data and measurement of respiratory muscle strength through manovacuometry. Paired and unpaired t-tests were used to compare the values obtained with the predicted equations. Results: Regarding the disease prevalence, 66.66%(16) of the individuals had stomach neoplasm and 33.33%(8) esophageal neoplasm. Of the patients with esophageal neoplasm, 100% were men with a mean age of 63 ± 9.16 years. Of those with stomach neoplasm, 68.75% were men with a mean age of 69.36 ± 10.92 years. Female patients with stomach neoplasm had significantly higher BMI (p = 0.01) than male patients, and they were classified as overweight. Both neoplasms had significantly lower real values (p ≤ 0.05) than predicted values at the maximal expiratory pressure. Conclusion: Patients with esophageal and stomach neoplasms in the preoperative period present reduction in the expiratory muscle strength. There were no statistically significant differences, when we compared the maximum respiratory pressures between the two types of neoplasms investigated.

Introduction: Gastric cancer has a high incidence. His clinical symptons and signals are silent and his malignancy is high, which makes his prognosis reserved. Inflammation plays a key role in the development and progression of neoplastic disease, induced by inflammatory cytokines produced by the tumor and/or released by the immune system. In recent years, the variability in the gene expression of inflammatory cytokines in neoplastic disease has been documented. Objectives: To assess in peripheral blood samples from patients with gastric neoplasia the concentration of tumor necrosis factor alpha (TNF-), soluble type 1A and 1B receptors of tumor necrosis factor (TNFR1A and TNFR1B), interleukin-6 (IL-6), interleukin-1 (IL-1), interleukin 1 (IL-1R), interferon-gamma (INF) and interleukin-10 (IL-10), and the gene expression of these cytokines, of zinc-alpha-2-glycoprotein (ZAG) and gamma peroxisome proliferator-activated receptor (PPAR-) Casuistic: The cross-sectional study was conducted with 25 patients with gastric adenocarcinoma (Cancer Group). At a later stage, these subjects were subdivided into Subgroups, Without Chemotherapy (n = 15) and Chemotherapy (n = 10). All volunteers were in the preoperative period. The study also included 15 patients in the immediate preoperative period of elective herniorrhaphy (Control Group). Methods: Intake evaluation, clinical and nutritional status, as well as the dosages of TNF-, IL-6, IL-1, INF-, IL-10, soluble receptor of TNF1A, TNF1B and IL-1R cytokines . The mRNA expression of TNF-, IL-6, INF-, IL-10, soluble receptors TNFR1A, TNFR1B and IL-1R; ZAG and PPAR- were determined in whole blood. The Mann-Whitney test was used to compare groups and subgroups of patients. Results: Patients in the Cancer Group had lower intakes of proteins, vitamin B12, iron and zinc than control subjects, as well as lower values of fat-free mass. Weight loss greater than 10% was documented in 32% of patients with gastric cancer. In relation to the Control Group, the Cancer Group presented lower serum levels of total proteins, iron, zinc, vitamin A and E, in addition to higher levels of C-reactive protein. Serum concentrations of TNF-, TNFR1A, TNFR1B, IL-6, IL-1 and IL-10 were higher in the Cancer Group than in controls. The comparison between subgroups showed that the serum concentration of IL-1 was higher in the Chemotherapy Subgroup. The mRNA expression of TNFR1A, INF-, IL-10 and PPAR- in whole blood was higher in the Cancer Group than in the Control Group. No changes were observed in serum concentration of IL-1R, as well as in the mRNA expression of IL-1R and ZAG in whole blood in the groups and subgroups studied. Conclusions: Changes in dietary intake, body composition and biochemical markers of systemic inflammatory response were evident in patients with gastric cancer, in addition, the increased serum levels of TNF-, TNFR1A, TNFR1B, IL-6, IL-1 and IL-10; and the higher mRNA expression of TNFR1A, INF-, IL-10 and PPAR- in whole blood. The mRNA expression of ZAG in whole blood was similar across all study groups. Except for the higher serum IL-1 values, chemotherapy did not result in changes in serum concentration and mRNA expression of the inflammatory cytokines evaluated.

Nutritional status of esophageal cancer patients who undergo esophagectomy is significantly exacerbated postoperatively. The aim of this study is to investigate changes in nutritional status and muscle function between preoperative period and the time of hospital discharge in cancer patients undergoing esophagectomy. The study sample consisted of 70 patients with esophageal (n = 13) and gastroesophageal junction cancer (n = 57) who were admitted for surgery in our Department between September 2015 and February 2020. Out of them, 52 patients underwent Ivor-Lewis esophagectomy, while 18 patients underwent McKewon esophagectomy. The preoperative evaluation of nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA), while the preoperative assessment of muscle function was based on Handgrip Strength (HG). Weight loss and anthropometric measurements were also recorded. Patients’ follow-up was done at the time of hospital discharge. Patients’ mean length of stay was 17.7 ± 12.5 days. Mean postoperative involuntary weight loss was 6% ± 3%. HG dominant hand was significantly lower at the time of discharge (−3.02 ± 3.80 kg, p &amp;lt; 0.001) compared to preoperative levels. Moreover, a significant change was observed for PG-SGA score (+2.61 ± 1.73) indicating greater rates of impaired nutritional status. There was a significant reduction in BMI (−3.7 ± 2.47 kg/m2, p &amp;lt; 0.001) and in arm circumference values (−0.8 ± 0.03 cm, p &amp;lt; 0.05), whereas no statistically significant alterations were observed in triceps skinfold measurements postoperatively (−0.007 ± 0.49, p = 0.368). Esophageal cancer patients who undergo esophagectomy exhibit overt deterioration of nutritional and functional status during the postoperative course. Timely nutritional interventions are of great significance in order to avoid patients underfeeding and improve patients’ postoperative outcome.