Desnutrición y Baja Masa Muscular en Pacientes con Cáncer Gastrointestinal Sometidos a Cirugía: ¿Existe Asociación con la Ubicación del Tumor?
DOI:
https://doi.org/10.32635/2176-9745.RBC.2024v70n2.4630Palabras clave:
Neoplasias Gastrointestinales/cirugía, Neoplasias Colorrectales/ cirugía, Sarcopenia/cirugía, Estado Nutricional, Composición CorporalResumen
Introducción: La depleción del estado nutricional y la reducción de la masa muscular son características frecuentes en pacientes con cáncer. Objetivo: Comparar el estado nutricional, la masa y la fuerza muscular en pacientes con cáncer del tracto gastrointestinal superior y cáncer colorrectal. Método: Submuestra de un estudio de cohorte prospectivo con pacientes con cáncer del tracto gastrointestinal sometidos a cirugía. Para la evaluación nutricional se utilizaron la valoración global subjetiva generada por el paciente (VGS-GP) y el índice de masa corporal (IMC). La composición corporal se evaluó mediante tomografía computarizada y la medición de la fuerza de prensión manual se realizó mediante dinamometría. La sarcopenia se estableció por la reducción de la fuerza y del índice de masa muscular esquelética o la reducción de la fuerza y la radiodensidad muscular esquelética. Resultados: El estudio se llevó a cabo con 52 pacientes, de los cuales el 54% eran hombres, el 56% eran ancianos, el 67% tenía cáncer colorrectal y el 68% se encontraba en las etapas 3 y 4 de la enfermedad. Aunque la mayoría de los individuos (42%) fue clasificado como peso normal/eutrófico según el IMC en la primera consulta, el 56% estaba en riesgo nutricional o desnutrido según la VGS-GP. Solo tres pacientes presentaban sarcopenia. Se observó una mayor incidencia de pacientes con bajo peso/desnutrición y reducción de la masa muscular esquelética en el grupo de tumores del tracto gastrointestinal superior en comparación con el grupo de pacientes con tumor colorrectal (58% y 42%, p = 0,031; 60% y 40%, p = 0,018, respectivamente). Conclusión: El análisis reveló una mayor incidencia de reducción de la masa muscular esquelética y bajo peso/desnutrición en pacientes con cáncer de tracto gastrointestinal superior.
Descargas
Citas
Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63. doi: https://doi.org/10.3322/caac.21834 DOI: https://doi.org/10.3322/caac.21834
Santos MO, Lima FCS, Martins LFL, et al. Estimativa de incidência de câncer no Brasil, 2023-2025. Rev Bras Cancerol. 2023;69(1):e-213700. doi: https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3700 DOI: https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3700
Arens J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin nutr. 2017;36(5):1187-96. DOI: https://doi.org/10.1016/j.clnu.2017.06.017
Pinho NB, Martucci RB, Rodrigues VD, et al. High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: results of Brazilian multicenter study. Cancer. 2020;126(1):156-64. DOI: https://doi.org/10.1002/cncr.32437
Scislo L, Bodys-Cu´pak I, Walewska E, et al. Nutritional status indicators as predictors of postoperative complications in the elderly with gastrointestinal cancer. Int J Environ Res Public Health. 2022;19(20):1-14. DOI: https://doi.org/10.3390/ijerph192013453
Sathianathen NJ, Kwaan M, Lawrentschuk N, et al. Adverse impact of malnutrition markers on major abdominopelvic cancer surgery. ANZ J Surg. 2019;89(5):509-14. DOI: https://doi.org/10.1111/ans.15129
Cruz-Jentoft AJ, Gonzalez MC, Prado CM. Sarcopenia ≠ low muscle mass. Eur Geriatr Med. 2023;14(2):225-8. doi: https://doi.org/10.1007/s41999-023-00760-7 DOI: https://doi.org/10.1007/s41999-023-00760-7
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised european consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi: https://doi.org/10.1093/ageing/afy169 DOI: https://doi.org/10.1093/ageing/afz046
Knoedler S, Schliermann R, Knoedler L, et al. Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis. Int J Surg. 2023;109(12):4238-62. doi: https://doi.org/10.1097/JS9.0000000000000688 DOI: https://doi.org/10.1097/JS9.0000000000000688
Zhang S, Tan S, Jiang Y, et al. Sarcopenia as a predictor of poor surgical and oncologic outcomes after abdominal surgery for digestive tract cancer: a prospective cohort study. Clin Nutr. 2019;38(6):2881-8. doi: https://doi.org/10.1016/j.clnu.2018.12.025 DOI: https://doi.org/10.1016/j.clnu.2018.12.025
Alnimri F, Sivakumar J, Sutherland T, et al. Pre-operative low muscle mass is associated with major complications and lower recurrence-free survival after gastric cancer surgery. ANZ J Surg. 2021;91(3):316-22. DOI: https://doi.org/10.1111/ans.16590
Sakurai K, Kubo N, Tamura T, et al. Adverse Effects of low preoperative skeletal muscle mass in patients undergoing gastrectomy for gastric cancer. Ann Surg Oncol. 2017;24(9):2712-9. DOI: https://doi.org/10.1245/s10434-017-5875-6
Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-55. DOI: https://doi.org/10.1097/00000421-198212000-00014
Ottery FD. Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition. 1996;12(Suppl.1):15-9. DOI: https://doi.org/10.1016/0899-9007(95)00067-4
Huang DD, Cai Hy, Wang WB, et al. Measurement of muscle quantity/quality has additional predictive value for postoperative complications and long-term survival after gastrectomy for gastric cancer in patients with probable sarcopenia as defined by the nem EWGSOP2 consensus: analysis from a large scale prospective study. Nutrition. 2021;86:111156. doi: https://doi.org/10.1016/j.nut.2021.111156 DOI: https://doi.org/10.1016/j.nut.2021.111156
Zhuang CL, Shen X, Zou HB, et al. EWGSOP2 versus EWGSOP1 for sarcopenia to predict prognosis in patients with gastric cancer after radical gastrectomy: analysis from a large-scale prospective study. Clin Nutr. 2020;39(7):2301-10. DOI: https://doi.org/10.1016/j.clnu.2019.10.024
Bossi P, Delrio P, Mascheroni A, et al. The spectrum of malnutrition/cachexia/sarcopenia in oncology according to different cancer types and settings: a narrative review. Nutrients. 2021;13(6):1-16. DOI: https://doi.org/10.3390/nu13061980
Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF. 2013 jun 13; Seção I:59.
Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of the Patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care. 2017;20(5):322-9.
World Health Organization. Physical status the use and interpretation of anthopometry. Geneva: WHO Library Cataloguing; 1995.
Organización Panamericana de la Salud. Encuesta Multicéntrica Salud Bienestar y Envejecimiento (SABE) en América Latina y el Caribe: informe preliminar. 36ª Reunión del Comité Asesor de Investigaciones en Salud; 9 -11 jul 2001; Kingston; Washington, D.C: OPAS: 2001.
Mourtzakis M, Prado CMM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997-1006. DOI: https://doi.org/10.1139/H08-075
sliceOmatic [Internet]. Versão 5. Magog: TomoVision; 2021. [acesso 2024 jan 20]. Disponível em: https://www.tomovision.com/download/download_sliceo.html
Leotti VB, Birck AR, Riboldi J. Comparação dos Testes de Aderência à Normalidade Kolmogorov-smirnov, Anderson-Darling, Cramer–Von Mises e Shapiro-Wilk por Simulação. In: 11º Simpósio de Estatística Aplicada à Experimentação Agronômica; 2005 jul 4-8; Londrina (PR). Florianópolis (SC): UFSC; 2005. p. 192.
Silva TGB. Prevalência de Sarcopenia em Idosos nãoinstitucionalizados de uma cidade brasileira de médio porte [dissertação]. Pelotas: Universidade Federal de Pelotas; 2014. 163 p.
Mulazzani GEG, Corti F, Valle S Della, et al. Nutritional support indications in gastroesophageal cancer patients: from perioperative to palliative systemic therapy. a comprehensive review of the last decade. Nutrients. 2021;13(8):2766. doi: https://doi.org/10.3390/nu13082766 DOI: https://doi.org/10.3390/nu13082766
Klassen D, Strauch C, Alteheld B, et al. Assessing the effects of a perioperative nutritional support and counseling in gastrointestinal cancer patients: a retrospective comparative study with historical controls. Biomedicines. 2023;11(2):609. doi: https://doi.org/10.3390/biomedicines11020609 DOI: https://doi.org/10.3390/biomedicines11020609
McGovern J, Dolan RD, Horgan PG, et al. Computed tomography-defined low skeletal muscle index and density in cancer patients: observations from a systematic review. J Cachexia Sarcopenia Muscle. 2021;12(6):1408-17. DOI: https://doi.org/10.1002/jcsm.12831
Murnane LC, Forsyth AK, Koukounaras J, et al. Myosteatosis predicts higher complications and reduced overall survival following radical oesophageal and gastric cancer surgery. Eur J Surg Oncol. 2021;47(9):2295-303. doi: https://doi.org/10.1016/j.ejso.2021.02.008 DOI: https://doi.org/10.1016/j.ejso.2021.02.008
Carvalho ALM, Gonzalez MC, Sousa IM, et al. Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: a cohort study. PLoS One. 2021;16(2):0247322. DOI: https://doi.org/10.1371/journal.pone.0247322
Ryan AM, Prado CM, Sullivan ES, et al. Effects of weight loss and sarcopenia on response to chemotherapy, quality of life, and survival. Nutrition. 2019;67-68:110539. doi: https://doi.org/10.1016/j.nut.2019.06.020 DOI: https://doi.org/10.1016/j.nut.2019.06.020
Daly LE, Ní Bhuachalla ÉB, Power DG, et al. Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer. J Cachexia Sarcopenia Muscle. 2018;9(2):315-25. doi: https://doi.org/10.1002/jcsm.12267 DOI: https://doi.org/10.1002/jcsm.12267
Malietzis G, Johns N, Al-Hassi HO, et al. Low muscularity and myosteatosis is related to the host systemic inflammator y response in patients undergoing surger y for colorectal cancer. Ann Surg. 2016;263(2):320-5. DOI: https://doi.org/10.1097/SLA.0000000000001113
Okugawa Y, Kitajima T, Yamamoto A, et al. Clinical relevance of myopenia and myosteatosis in colorectal cancer. J Clin Med. 2022;11(9):2617. DOI: https://doi.org/10.3390/jcm11092617
Aro R, Meriläinen S, Sirniö P, et al. Sarcopenia and myosteatosis are associated with neutrophil to lymphocyte ratio but not glasgow prognostic score in colorectal cancer patients. J Clin Med. 2022;11(2656):1-16. DOI: https://doi.org/10.3390/jcm11092656
McGregor RA, Cameron-Smith D, Poppitt SD. It is not just muscle mass: a review of muscle quality, composition and metabolism during ageing as determinants of muscle function and mobility in later life. Longev Heal. 2014;3(1):1-8. doi: http://dx.doi.org/10.1186/2046-2395-3-9. DOI: https://doi.org/10.1186/2046-2395-3-9
Stretch C, Aubin JM, Mickiewicz B, et al. Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas. PLoS One. 2018;13(5):1-17. DOI: https://doi.org/10.1371/journal.pone.0196235
Martin L, Birdsell L, MacDonald N, et al. Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47. DOI: https://doi.org/10.1200/JCO.2012.45.2722
Tian J, Yuan X, Xiao J, et al. Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020;21(7):893-903. doi: https://doi.org/10.3390/biomedicines11020609 DOI: https://doi.org/10.1016/S1470-2045(20)30309-0
Ishida T, Makino T, Yamasaki M, et al. Quantity and quality of skeletal muscle as an important predictor of clinical outcomes in patients with esophageal cancer undergoing esophagectomy after neoadjuvant chemotherapy. Ann Surg Oncol. 2021;28(12):7185-95. doi: https://doi.org/10.1245/s10434-021-10025-x DOI: https://doi.org/10.1245/s10434-021-10025-x
Shibutani M, Kashiwagi S, Fukuoka T, et al. Impact of preoperative nutritional status on long-term survival in patients with stage i-iii colorectal cancer. In Vivo. 2023;37(4):1765-74. DOI: https://doi.org/10.21873/invivo.13265
Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of the patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care. 2017;20(5):322-9. DOI: https://doi.org/10.1097/MCO.0000000000000389
Holmes CJ, Racette SB. The utility of body composition assessment in nutrition and clinical practice: an overview of current methodology. Nutrients. 2021;13(8):1-16. DOI: https://doi.org/10.3390/nu13082493
Gharagozlian S, Mala T, Brekke HK, et al. Nutritional status, sarcopenia, gastrointestinal symptoms and quality of life after gastrectomy for cancer – a cross-sectional pilot study. Clin Nutr ESPEN. 2020;37:195-201. doi: https://doi.org/10.1016/j.clnesp.2020.03.001 DOI: https://doi.org/10.1016/j.clnesp.2020.03.001
Xia L, Zhao R, Wan Q, et al. Sarcopenia and adverse health-related outcomes: An umbrella review of meta-analyses of observational studies. Cancer Med. 2020;9(21):7964-78. DOI: https://doi.org/10.1002/cam4.3428
Shirdel M, Andersson F, Myte R, et al. Body composition measured by computed tomography is associated with colorectal cancer survival, also in early-stage disease. Acta Oncol (Madr). 2020;59(7):799-808. doi: https://doi.org/10.1080/0284186X.2020.1744716 DOI: https://doi.org/10.1080/0284186X.2020.1744716
Nunes GD, Cardenas LZ, Miola TM, et al. Preoperative evaluation of sarcopenia in patients with colorectal cancer: a prospective study. Rev Assoc Med Bras. 2023;69(2):222-7. DOI: https://doi.org/10.1590/1806-9282.20220339
Jiang X, Xu X, Ding L, et al. Preoperative low absolute and relative handgrip strength as predictors of postoperative short-term outcomes: a prospective study based on patients aged 60 years and older with gastric cancer. Eur Geriatr Med. 2023;14(2):251-62. doi: https://doi.org/10.1007/s41999-023-00768-z DOI: https://doi.org/10.1007/s41999-023-00768-z
Publicado
Cómo citar
Número
Sección
Licencia
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
