Determinantes de la Pérdida de Peso y del Deterioro de la Fuerza Muscular en Pacientes con Cáncer Gastrointestinal durante el Tratamiento Quimioterapéutico
DOI:
https://doi.org/10.32635/2176-9745.RBC.2026v72n1.5465Palabras clave:
Estado Nutricional/efectos de los fármacos, Pérdida de Peso/efectos de los fármacos, Fuerza Muscular/efectos de los fármacos, Neoplasias Gastrointestinales/tratamiento farmacológico, Terapia Neoadyuvante/efectos adversosResumen
Introducción: Los cánceres gastrointestinales están estrechamente asociados con la desnutrición. Además, la pérdida de peso y la disminución de la fuerza muscular inducidas por la quimioterapia se asocian significativamente con desenlaces clínicos adversos. Objetivo: Evaluar los factores asociados con la pérdida de peso y la disminución de la fuerza muscular en pacientes con cáncer gastrointestinal sometidos a quimioterapia. Método: Estudio de cohorte prospectivo y observacional con pacientes sometidos a quimioterapia neoadyuvante o exclusiva, con evaluaciones antes y después del final del tratamiento. Se evaluaron la Valoración Global Subjetiva Generada por el Paciente (VGS-GP), el peso corporal y la fuerza de prensión manual (FPM) en ambos momentos. Resultados: De los 51 pacientes, el 53% presentaba tumor colorrectal, el 53% estaba en estadio III, el 76 % presentaba desnutrición o sospecha de desnutrición y el 84% se sometió a quimioterapia neoadyuvante, con una mediana de 101 días entre la consulta pretratamiento y la consulta próxima al término de la quimioterapia (intervalo intercuartílico de 58 a 158 días). Se observó una reducción significativa tanto del peso como de la FPM en los hombres, mientras que la disminución en los puntajes de la VGS-GP se registró en ambos sexos. La localización tumoral y el intervalo entre evaluaciones se asociaron de forma independiente con la pérdida de peso. Los pacientes con tumores colorrectales o del conducto anal tuvieron casi tres veces más probabilidades de mantener o ganar peso en comparación con aquellos con tumores esofágicos y gástricos. El sexo y la duración del tratamiento se asociaron significativamente con los cambios en la FPM. El sexo femenino presentó 2,3 veces más probabilidades de mantener o ganar FPM en comparación con el sexo masculino. Conclusión: Este estudio destaca la importancia del monitoreo nutricional y la evaluación de los factores relacionados con la pérdida de peso y la fuerza muscular para permitir la identificación temprana de pacientes en riesgo nutricional.
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
Santos MO, Lima FCS, Martins LFL, et al. Estimated cancer incidence in Brazil, 2023-2025. Rev Bras Cancerol. 2023;69(1):e213700. doi: https://doi.org/10.32635/2176-9745.RBC.2023v69n1.1700
Pinho NB, Martucci RB, Rodrigues VD, et al. High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: results of a brazilian multicenter study. Cancer. 2020;126(1):156-64. doi: https://doi.org/10.1002/cncr.32437
Setiawan T, Sari IN, Wijaya YT, et al. Cancer cachexia: molecular mechanisms and treatment strategies. J Hematol Oncol. 2023;16(1):54.
doi: https://doi.org/10.1186/s13045-023-01454-0
Mizukami T, Hamaji K, Onuki R, et al. Impact of body weight loss on survival in patients with advanced gastric cancer receiving second-line treatment. Nutr Cancer. 2022;74(2):539-45. doi: https://doi.org/10.1080/01635581.2021.1902542
Fukahori M, Shibata M, Hamauchi S, et al. A retrospective cohort study to investigate the incidence of cancer-related weight loss during chemotherapy in gastric cancer patients. Support Care Cancer. 2021;29(1):341-8. doi: https://doi.org/10.1007/s00520-020-05479-w
Gabrielson DK, Brezden-Masley C, Keith M, et al. Evaluation of nutritional, inflammatory, and fatty acid status in patients with gastric and colorectal cancer receiving chemotherapy. Nutr Cancer. 2021;73(3):420-32. doi: https://doi.org/10.1080/01635581.2020.1756351
Yamano T, Tomita N, Sato T, et al. Influence of chemoradiotherapy on nutritional status in locally advanced rectal cancer: prospective multicenter study. Nutrition. 2020;77:110807. doi: https://doi.org/10.1016/j.nut.2020.110807
Pinho NB, Martucci RB, Rodrigues VD, et al. Malnutrition associated with nutrition impact symptoms and localization of the disease: results of a multicentric research on oncological nutrition. Clin Nutr. 2019;38(3):1274-9. doi: https://doi.org/10.1016/j.clnu.2018.05.010
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):1980. doi: https://doi.org/10.3390/nu13061980
Song C, Cao J, Zhang F, et al. Nutritional risk assessment by scored patient-generated subjective global assessment associated with demographic characteristics in 23,904 common malignant tumors patients. Nutr Cancer. 2019;71(1):50-60. doi: https://doi.org/10.1080/01635581.2019.1566478
Schneider SM, Correia MITD. Epidemiology of weight loss, malnutrition and sarcopenia: a transatlantic view. Nutrition. 2020;69:110581. doi: https://doi.org/10.1016/j.nut.2019.110581
Aprile G, Basile D, Giaretta R, et al. The clinical value of nutritional care before and during active cancer treatment. Nutrients. 2021;13(4):1196. doi: https://doi.org/10.3390/nu13041196
Al-Bayyari N, Hailat M, Baylin A. Gender-specific malnutrition and muscle depletion in gastric and colorectal cancer: role of dietary intake in a Jordanian cohort. Nutrients. 2024;16(23):4000. doi: https://doi.org/10.3390/nu16234000
Xie H, Zhang H, Ruan G, et al. Individualized threshold of the involuntary weight loss in prognostic assessment of cancer. J Cachexia Sarcopenia Muscle. 2023;14(6):2948-58. doi: https://doi.org/10.1002/jcsm.13368
Hadzibegovic S, Porthun J, Lena A, et al. Hand grip strength in patients with advanced cancer: a prospective study. J Cachexia Sarcopenia Muscle. 2023;14(4):1682-94. doi: https://doi.org/10.1002/jcsm.13248
Marques VA, Ferreira Junior JB, Lemos TV, et al. Effects of chemotherapy treatment on muscle strength, quality of life, fatigue, and anxiety in women with breast cancer. Int J Environ Res Public Health. 2020;17(19):7289. doi: https://doi.org/10.3390/ijerph17197289
Bicakli DH, Ozveren A, Uslu R, et al. The effect of chemotherapy on nutritional status and weakness in geriatric gastrointestinal system cancer patients. Nutrition. 2018;47:39-42. doi: https://doi.org/10.1016/j.nut.2017.09.013
Hagens ERC, Feenstra ML, van Egmond MA, et al. Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment. J Cachexia Sarcopenia Muscle. 2020;11(3):756-67. doi: https://doi.org/10.1002/jcsm.12540
Colcord ME, Benbow JH, Trufan S, et al. Preoperative muscle strength is a predictor of outcomes after esophagectomy. J Gastrointest Surg. 2021;25(12):3040-8. doi: https://doi.org/10.1007/s11605-021-05183-y
Martin P, Botsen D, Brugel M, et al. Association of low handgrip strength with chemotherapy toxicity in digestive cancer patients: a comprehensive observational cohort study (FIGHTDIGOTOX). Nutrients. 2022;14(21):4448. doi: https://doi.org/10.3390/nu14214448
Botsen D, Ordan MA, Barbe C, et al. Dynapenia could predict chemotherapy-induced dose-limiting neurotoxicity in digestive cancer patients. BMC Cancer. 2018;18(1):955. doi: https://doi.org/10.1186/s12885-018-4860-1
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.
Instituto Nacional de Câncer. Consenso nacional de nutrição oncológica. 2. ed. rev ampl atual. Rio de Janeiro: INCA, 2015. (volume 1). 182 p.
Instituto Nacional de Câncer. Consenso nacional de nutrição oncológica. 2. ed. rev ampl atual. Rio de Janeiro: INCA; 2016. (volume 2). 114 p.
Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr. 2021;40(5):2898-913. doi: https://doi.org/10.1016/j.clnu.2021.02.005
Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48. doi: https://doi.org/10.1016/j.clnu.2016.07.015
World Health Organization. Physical status: the use and interpretation of anthropometry. Geneva: Technical Report; 1995. (Series, n. 854).
Pan American Health Organization. Multicenter survey on health, well-being, and aging (SABE) in Latin America: preliminary report. Washington, D.C.: PAHO; 2001.
Ottery FD. Definition of f standardized nutritional assessment and interventional pathways in oncology. Nutrition. 1996;12(1 Supl):S15-9. doi: https://doi.org/10.1016/0899-9007(96)90011-8
Silva SCG, Pinho JP. Cross-cultural adaptation and validation of the Portuguese version of the Score Patient-Generated Subjective Global Assessment (PG-SGA). Clin Nutr. 2015;34(S1):S194-5. doi: https://doi.org/10.1016/s0261-5614(15)30611-7
Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010: características gerais da população, religião e pessoas com deficiência. Rio de Janeiro: IBGE; 2012.
Brierley JD, Gospodarowicz MK, Wittekind C, editores. TNM classification of malignant tumours. 8. ed. Oxford: Wiley-Blackwell; 2017.
SPSS®: Statistical Package for Social Science [Internet]. Versão 21.0. [Nova York]. International Business Machines Corporation. [acesso 2025 mar 9]. Disponível em: https://www.ibm.com/br-pt/spss?utm_content=SRCWW&p1=Search&p4=43700077515785492&p5=p&gclid=CjwKCAjwgZCoBhBnEiwAz35Rwiltb7s14pOSLocnooMOQh9qAL59IHVc9WP4ixhNTVMjenRp3-aEgxoCubsQAvD_BwE&gclsrc=aw.ds
Wilcoxon F. Individual comparisons by ranking methods. Biometrics Bull. 1945;1(6):80-3. doi: https://doi.org/10.2307/3001968
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.
Horie LM, Barrére APN, Castro MG, et al. Diretriz BRASPEN de terapia nutricional no paciente com câncer. Braspen J. 2019;34(1):2-32.
Freitas JS, Oliveira Pedron ÉL, Aliprandi JLS et al. The effect of chemotherapy on dietary intake and nutritional status in patients with colorectal neoplasms and the importance of nutritional counseling. Support Care Cancer. 2022;30(5):3885-91. doi: https://doi.org/10.1007/s00520-022-06794-0
Norman K, Stobäus N, Reiß J, et al. Effect of sexual dimorphism on muscle strength in cachexia. J Cachexia Sarcopenia Muscle. 2012;3(2):111-6. doi: https://doi.org/10.1007/s13539-012-0060-z
Zohri R, Hahn L, Seyedi N, et al. Nutritional gender-specific differences in head and neck cancer patients treated with (chemo)radiotherapy: results from a prospective trial cancers. 2024;16(23):4080. doi: https://doi.org/10.3390/cancers16234080
Rubin JB, Lagas JS, Broestl L, et al. Sex differences in cancer mechanisms. Biol Sex Differ. 2020;11(1):17. doi: https://doi.org/10.3390/cancers16234080
Zhong X, Zimmers TA. Sex Zimmers TA. Sex differences in cancer cachexia. Curr Osteoporos Rep. 2020;18(6):646-54. doi: https://doi.org/10.1007/s11914-020-00628-w
Anderson LJ, Liu H, Garcia JM. Sex differences in muscle wasting. Adv Exp Med Biol. 2017;1043:153-97. doi: https://doi.org/10.1007/978-3-319-70178-3_9
Carriço M, Guerreiro CS, Parreira A. The validity of the patient-generated subjective global assessment short-form© in cancer patients undergoing chemotherapy. Clin Nutr Espen. 2021;43:296-301. doi: https://doi.org/10.1016/j.clnesp.2021.03.037
Descargas
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.
