胃癌根治术后肌肉减少症患病率及肠内营养支持的作用

The prevalence rate of sarcopenia and clinical effects of enteral nutrition support on gastric cancer patients after radical gastrectomy

目的:探讨胃癌病人根治术后肌肉减少症的患病率,明确肠内营养支持联合抗阻力锻炼对营养状态改善、辅助化疗耐受性及病人预后的影响。方法:将胃癌根治术后病人按有无肌肉减少症分为患病(SA)组和未患病(NSA)组,所有病人术后行6 周期化疗(奥沙利铂+卡培他滨)。术后辅助化疗期间,SA组病人正常饮食配合口服肠内营养(安素)并联合抗阻力锻炼,NSA组病人正常普通饮食。分析营养支持及抗阻力锻炼对病人营养指标改善、化疗耐受性及预后的影响。结果:2013 年1 月至2016 年1 月共纳入295 名病人(SA组116 名,NSA组129 名)。两组性别、年龄、鲍曼分型、病理类型、病理分期均无统计学差异(P > 0.05)。SA 组肿瘤直径大于NSA组[(3.23 ±0.89)cm vs (2.72 ± 0.99)cm,P = 0.001]。化疗前SA组病人BMI和骨骼肌百分比显著低于NSA组(P < 0.05);治疗后SA组BMI、骨骼肌百分比较化疗前改善(P < 0.05),NSA组BMI、骨骼肌百分比较化疗前下降(P < 0.05),治疗后两组BMI、骨骼肌百分比无统计学差异(P < 0.05)。SA组有72(43.37%)名病人营养状态得到明显改善,转化为NSA病人。两组化疗严重毒副反应无统计学差异(P > 0.05)。SA组与NSA组病人,1、3 年生存率无统计学差异(91.0%vs 97.6%,55.1% vs 66.9%,P = 0.101);营养干预后改善的SA组病人较未改善病人中位数生存时间明显延长(32 个月vs 29 个月,P = 0.033)。结论:56.27%胃癌病人行根治术后出现肌肉减少症;肠内营养支持治疗结合抗阻力锻炼能够改善该类病人营养状态,减少化疗相关不良反应并改善病人预后。

Objective: This study aimed to investigate the prevalence rate of sarcopenia and clear the clinical effects of enteral nutrition support (ENS) combined with resistance training on improvement of nutritional status, tolerance of adjuvant chemotherapy (AC) and the prognosis in gastric cancer patients after radical gastrectomy.Methods: After radical gastrectomy, patients with sarcopenia were enrolled into SA group, while the others without sarcopenia were included into NSA group. All patients were given six courses of adjuvant chemotherapy (i.e., oxaliplatin plus capecitabine). During chemotherapy, SA patients received normal diet and ENS, combined with resistance training, and NSA patients received adequate diet. The effects of nutritional support and resistance training on nutritional status, chemotherapeutic tolerance and the prognosis (overall survival, OS) were analyzed. Results: From January 2013 to January 2016, 295 patients were enrolled (SA, n = 116, NSA, n = 129). There were no significant differences between the two groups in gender, age, Borrmman type, pathological type and pathological stage, while tumor size in SA group was significantly larger ([3.23 ± 0.89]cm vs [2.72 ± 0.99])cm,P = 0.001 than the size in NSA patients. Before AC,patients in SA group had significantly less BMI and skeletal mass index than that in NSA group (P < 0.05), whereas no statistical differences were observed at the end of AC. After AC, seventy-two cases in SA group achieved the amelioration of nutritional status and were in accord with the diagnosis criteria of NSA. Chemotherapy-related adverse events were similar in the two groups, and there were no significant differences between SA and NSA group in 1, 3-year survival rates (91.0% vs 97.6%,55.1% vs 66.9%,P = 0.101). The patients who achieved the improvement after nutrition intervene in SA group undergone significant longer median survival time compared with the time in NSA patients.Conclusion: The prevalence rate of sarcopenia in gastric cancer patients after radical gastrectomy is 56.27%. ENS combined with resistance training can improve nutritional status, reduce the rate of chemotherapy-related adverse events and thereby improve the prognosis.