Malnutrition Increases the Risk of Mortality in Hospitalized Lung Cancer Patients

Background The Global Leadership Initiative on Malnutrition(GLIM)recently developed a new set of diagnostic criteria for identifying patients with malnutrition.Because the GLIM criteria were only introduced a little over 3 years ago,additional validation and reliability testing are needed in a variety of populations.Methods We performed an observational,multicenter cohort study.From July 2013 to October 2018,lung cancer patients were recruited from the Daping Hospital of Army Medical University and the First Hospital of Jilin University as part of the INSCOC project.Previously-established cut-off values for the calf circumference(CC,male<30 cm,female<29.5 cm)were applied as the reduced muscal mass of phenotypic criteria to establish the GLIM diagnosis.Multivariate Cox regression analyses were performed to analyze the association between the GLIM criteria and survival.Results A total of 1219 patients with lung cancer were studied as subjects.Their age was 58.81±9.92 years old,and 820 were male and 399 were female.According to the GLIM diagnostic criteria using the CC as a muscle mass measurement,303 patients(24.9%)were categorized as malnourished,142 patients(23.1%)in the adult group(18≤age<60)and 161 patients(26.7%)in the older group(age≥60 years).The patients with malnutrition had a higher incidence of anemia than the nourished patients(P=0.012).The QLQ-C30 score and KPS score indicating that the malnourished patients had a consistently worse quality of life compared to the nourished group(all P<0.001).The median survival of the malnutrition group was 42(95%CI:34-50)months,which was much shorter than the 62(95%CI:57-66)months in the nourished group(P<0.001).In the adult group,the median survival decreased from 65(95%CI:55-72)months in nourished group to 34(95%CI:25-48)months in the patients with malnutrition(P<0.001).In the older group,it decreased from 61(95%CI:55-67)months to 48(95%CI:39-59)months(P=0.001).A Cox regression analysis showed that GLIM-diagnosed malnutrition was associated with an increased risk of death among adult group(HR=1.670,95%CI:1.29-2.16),older group(HR=1.332,95%CI:1.05-1.69)and overall(HR=1.453,95%CI:1.22-1.72).Conclusion All of these results demonstrate that GLIM-diagnosed malnutrition is associated with a poorer survival for all lung cancer patients,independent of age.

Sex differences in the scored Patient-Generated Subjective Global Assessment in 19,528 cancer patients

Background:The scored Patient-Generated Subjective Global Assessment(PG-SGA)has been widely used to assess the nutritional status of cancer patients.The purpose of this study is to compare the differences in PG-SGA scores and the 7 domain scores of the PG-SGA in male and female cancer patients.Methods:This study was conducted at 72 hospitals from July 2013 to December 2018,a part of the Investigation on Nutritional Status and its Clinical Outcomes of Common Cancers.The PG-SGA was recorded to evaluate the nutritional status of patients.A total of 19,528 patients with 13 common malignancies were included in this study.Student t test and the χ^(2) test were applied to analyze the sex diferences in the 7 domain scores.The Cancer Genome Atlas(TCGA)database was used to analyze the expression levels of symptom-related genes.Results:There were significant sex dfferences in the PG-SGA(P=0.032),notably in patients with gastric cancer(male vs female:9.09±4.86 vs 9.58±5.07,P=0.005)and esophageal cancer(9.64±4.90 vs 10.46±4.96,P=0.011)and the average total PG-SGA of female patients was slightly higher than that of male patients(7.64±4.98 vs 7.77±5.14).The differences were mainly related to the weight,eating,symptom,as well as activity and physical function scores in the stratified analysis.Possible causes of the sex differences were the rates of nausea,vomiting,dry mouth,and other symptoms,in both gastric and esophageal cancer patients.Analysis of the TCGA database suggested that most of the related genes were sex neutral,except for genes related to dysphagia in gastric cancer(VEGFC was higher in female patients,VEGFA and VEGFB higher in male patients).Conclusions:There are sex differences in the PG-SGA scores in patients with various tumor types(female patients generally had higher scores than male patients),with differences mainly in the weight,eating,symptom,as well as activity and physical function scores.The sex differences in PG-SGA scores might be due to the differences in the clinical manifestations of the disease,and further studies should be carried out to investigate other factors influencing the PG-SGA scores in cancer patients.This study provides basic data supporting the individualized nutritional treatment of cancer patients in clinical practice.

Associations of the Fat-age-infl ammation Index with Overall Survival in Patients with Metastatic Lung Cancer

Background Metastatic lung cancer(LC)is a threat to human health.We previously proposed a fat age-inflammation(FAIN)index which showed prognostic value in patients with certain cancers.However,whether a similar association exists in patients with metastatic LC remains unknown.Methods We performed a cohort study including 1360 patients with metastatic LC from January 2013 to April 2019.The FAIN index was defined as:(triceps skinfold thickness+albumin)/[age+5×(neutrophil count/lymphocyte count)]×100%.Sex-specific cutoffs of the FAIN were determined using an optimal stratification approach.The associations of the FAIN index with the nutrition related factors,short-term outcomes and overall survival(OS)of patients were comprehensively assessed.Results The study enrolled 865 males and 495 females with a median age of 59.9 years.The continuous FAIN was significantly associated with the OS in both genders(both P<0.05).The optimal stratification-defined FAIN cutoffs were 82 for women and 60 for men.A total of 623 patients(45.8%)were categorized as having a low FAIN.A low FAIN was associated with poorer nutrition-related factors and impaired short-term outcomes including the thirty-day mortality,length of hospital stay,intensive care unit stay and cost(all P<0.05).Multivariate Cox regression analysis revealed that a lower FAIN was also associated with an increased death hazard(HR=1.428,95%CI=1.209-1.686).Conclusion This study assessed the FAIN index,which might act as a feasible tool to monitor nutrition-related factors and help develop management strategies to optimize the clinical outcomes of patients with metastatic LC.

Validity of the Chinese Version of the Patient-Generated Subjective Global Assessment (PG-SGA) in Lung Cancer Patients

The prevalence of malnutrition is high among oncology patients in China. Although the Patient- Generated Subjective Global Assessment (PG-SGA) is widely recognized as an important nutritional assessment tool, it has not been validated for Chinese cancer patients. The purpose of this study was to conduct an analysis of nutrition screening and assessment data to validate the Chinese version of the PG-SGA in Chinese patients with lung cancer. This was an observational, cross-sectional study of 2,000 consecutive adult patients with lung cancer treated at several tertiary hospitals in China. Anthropometric and patient descriptive data were collected. The PG-SGA generated a score for the nutritional risk and a global rating for the nutritional status. The internal consistency, external consistency, and construct validity were evaluated, and a known-groups comparison and principal component analyses were conducted to evaluate the reliability and validity of the PG-SGA. The known-groups comparison demonstrated the ability of the PG-SGA to differentiate lung cancer patients of different nutritional and body mass index (BMI) groups. A confirmatory factor analysis supported the original four-factor structure of the PG-SGA. In terms of the internal and external consistency, the PG-SGA demonstrated intra-class correlation coefficients (ICC) up to 0.987. Alternative form validity was also demonstrated between Box 4 of the PG-SGA and the Karnofsky Performance Status score, with excellent external consistency (r = 0.972, P < 0.001). The construct validity was supported, and selected questionnaire dimensions were evident in the principal component analysis. Significant Spearman correlations (P < 0.001) were demonstrated. The Chinese version of the PG-SGA demonstrated significant reliability and sufficient exploratory properties to support its validity. It seems to be a valid tool that can be used to access the nutritional status of Chinese lung cancer patients. The validity of the PG-SGA in Chinese cancer patients warrants further investigation in other cancer types.

Validity of the Chinese Version of the Patient-Generated Subjective Global Assessment (PG-SGA) in Gastric Cancer Patients

Purpose Malnutrition is severe among gastric cancer patients in China. While the Patient-Generated Subjective Global Assessment (PG-SGA) is a widely used nutritional assessment tool, the validation for Chinese patients with gastric cancer has not been performed yet. The aim of this research is to validate the Chinese version of the PGSGA in Chinese gastric cancer patients by conducting analyses of nutrition screening and assessment data. Methods Two thousand consecutive adult patients with gastric cancer were included in this observational, cross-sectional study in several tertiary hospitals in China. A survey was made among those patients, which included several questionnaires and some anthropometric parameters. We calculated the parameters to validate the use of PG-SGA categorizing the nutritional status of gastric cancer patients. Then we performed statistical analysis to evaluate the internal consistency, external consistency, and construct validity. Results This study verified the ability of the PG-SGA to differentiate gastric cancer patients into different nutritional groups. The confirmatory factor analysis verified the original four-factor structure of the PG-SGA. The internal and external consistency was measured by a concordance analysis which showed an intraclass correlation coefficients (ICC) of 0.987. The correlations of the Box 4 score with the Karnofsky performance status score demonstrated alternative form validity with good external consistency (Pearson, r = 0.643, P < 0.001). All three anthropometric dimensions of the PG-SGA were supported by principal component analysis. Spearman correlations (P < 0.001) were significant in the majority of tests. Conclusion The Chinese version of the PG-SGA is a valid tool to access the patients’ nutritional status for Chinese gastric patients.

Extension Protocol for the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC)Study:2021 update

Background Malnutrition is common in patients with cancer,and this adversely affects the survival and quality of life of patients.Chinese Society for Nutritional Oncology issued a multi-center,large-scale,long-term follow-up prospective study,the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC study)since 2013.This is an extension to the previous 2013-2020 study protocol.This study still sought to:①address the prognostic impact of nutritional factors and quality of life on cancer patient survival;②describe the overall and cancer-specific incidence and/or distribution of malnutrition and different measurements of patient quality of life.Methods and study design This is an observational,multi-centered,hospital-based prospective cohort study.Data collection will be performed at baseline(within 48 hours after patient admission),during the hospital stay and 30 days after hospital admission.Follow-up will be conducted for 1-20 years after enrollment.The primary outcome will be the all-cause mortality/overall survival,and secondary outcomes will be the length of hospital stay and costs of hospitalization.Study factors will include demographic characteristics,tumor characteristics,information about chronic diseases,hematological measurements(e.g.,red blood cell count,total lymphocyte counts,hemoglobin,albumin,prealbumin,creatinine,C-reactive protein,IL-6),anthropometric measurements(e.g.,height,weight,arm circumference,arm muscle circumference,triceps skinfold thickness,and waist circumference),body composition parameters,PG-SGA scores,quality of life(as indicated by the QLQ-C30 questionnaire),muscle mass(as indicated by the calf circumference),muscle strength(as indicated by the handgrip strength),muscle function(as indicated by the six-meter walking speed test)and physical status assessments(as indicated by the Karnofsky Performance Status scores).This clinical study protocol was approved by local Ethics Committees of all the participating hospitals.Written informed consent is required for each subject included.Discussion This multi-center,large-scale,long-term follow up prospective study will help improve the diagnosis of malnutrition in cancer patients and identify the risk factors associated with adverse clinical outcomes.The anticipated results of this study will highlight the need for a truly scientific appraisal of nutrition therapy in Chinese oncology populations,and finally help treat the potentially reversible elements of malnutrition in cancer patients to improve their clinical outcomes in the future.

The Role of Neutrophils in Cancer Development

In recent years, the numerous roles of neutrophils have gained increasing attention. Beyond their traditional role in infection control, research on neutrophils has expanded to their roles in tumor regulation. It has been found that neutrophils present in the tumor microenvironment, tumor-associated neutrophils (TANs), exert complex and apparently opposing effects by reducing and promoting tumor growth and progression in response to various factors in the tumor microenvironment. In addition, recent studies have reported the heterogeneity and complex tumor regulation of circulating neutrophils. The present paper provides a summary of the related research progress.

Application of a Modified Distress Thermometer to Screen for Psychological Distress in 140 Patients with Malignancies,and an Analysis of Related Factors

Objective A modified Distress Thermometer(DT)was applied to explore the status of psychological distress in patients with malignant tumors and to analyze the related factors influencing psychological distress.Methods The modified DT was used to screen for psychological distress in 140 patients with malignant tumors in the Cancer Center of the First Hospital of Jilin University.Aχ2 test was used to analyze the effects of age and gender on psychological distress;risk factors associated with significant psychological distress(DT≥4)were further analyzed by Stepwise Logistics Regression.Spearman’s Correlation Analysis was used to determine the correlations among the items in the problems list(economic problems,fatigue,eating,pain,nausea,constipation,decreased memory/inattention,anxiety,tension,sleep).Results The results of the modified DT screening showed that the rate of significant psychological distress was 33.57%in patients with malignant tumors,and females and elderly patients were more likely to suffer significant psychological distress(P=0.048;P=0.002).A dry/congestive nose,depression,having to work/go to school,bathing/dressing,and nausea were significant factors or situations associated with psychological distress in patients with malignant tumors,and physical and emotional problems often appeared together in the problems list.Conclusion The modified DT reflected the degree of each symptom(to a certain extent),and could accurately and concretely identify the major cause(s)of the patients’psychological distress,so that the clinical medical care workers could target the problems and improve the patients’quality of life.

Nutritional Risk Screening with NRS2002 among Hospitalized Cancer Patients in China

Objective The Nutritional Risk Screening 2002(NRS 2002)was used to assess the nutritional risk of hospitalized oncology patients in China.This study explored the factors affecting the risk of nutrition to provide a scientific basis for the assessment and treatment of malnutrition in oncology patients.Methods We used the NRS 2002 to evaluate the nutritional risk in 48,831 hospitalized cancer patients.Descriptive statistical methods were used to describe the general patient information.A Chi-squared test was applied to analyze the relationship between NRS 2002 scores and different demographic characteristics,and the NRS 2002 scores of cancer patients with different characteristics were compared by one-way ANOVA.Results Among 48,831 patients,43.3%were women and 57.7%were men,and 36.5%(17,802)of patients were at risk of nutrition(score≥3).The NRS 2002 score was the highest in leukemia patients(2.93±1.28).A one-way ANOVA revealed that the differences in NRS 2002 scores among patients of different gender,ages,TNM stages,education levels,occupations and areas of residence were statistically significant(P<0.001).Male patients had slightly higher NRS 2002 scores than females(2.33 vs.2.17).The lowest NRS 2002 scores were in patients aged 45-59(2.00±1.26)years and the highest scores were in patients aged≥70(2.76±1.43)years.The NRS 2002 score of patients receiving surgery was the highest(2.45±1.41),and patients receiving surgery plus radiotherapy/chemotherapy was the lowest(2.00±1.26).The risk of nutrition was highest in patients who were farmers(2.34±1.37 scores)and lowest in office staff(2.15±1.32 scores).Patients living in rural areas had the highest risk of nutrition(2.32±1.37 scores).There were significant differences in the NRS 2002 scores for different cancer sub-types for different ethnic groups(P<0.05),except for Zhuang individuals(P=0.124).The risk of nutrition was highest in Uyghur patients(3.35±1.33 scores)and lowest in Mongolians(2.04±1.37 scores).Conclusion More attention should be paid to people at high risk of nutrition,such as elderly patients,patients with a high TNM stage,patients receiving surgical treatment,and patients living in rural areas.Active nutritional interventions should be carried out to improve the nutritional status of malnourished patients.

Malnutrition and Quality of Life in Chinese Cancer Patients: a Clinical Study of 23,994 Subjects

Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.

High Risk of Malnutrition in Uyghur Patients with Cancer in China

Background Patients with advanced cancer often present with malnutrition.Globally,minority populations frequently suffer from higher rates of malnutrition than the majority group.It was unknown whether the nutritional status of cancer patients is different between ethicality groups(i.e.Uyghur and Han)in China.Methods A total of 251 Uyghur cancer patients were enrolled from the Xinjiang Kashgar First People's Hospital in the INSCOC Program.The Han patients were 1∶1 matched to Uyghur patients by age,gender and type of cancer from 72 hospitals around China in INSCOC Program.The nutritional risk and nutritional status were assessed using the Nutrition Risk Screening 2002(NRS 2002)and Patient-Generated Subjective Global Assessment(PG-SGA),respectively.Then,the functional status of cancer patients was determined based on the Karnofsky Performance Status(KPS).Results The incidence of an abnormal NRS-2002(≥3),PG-SGA(≥4),and KPS(≤70)was significantly different(86.1%vs 59.0%,70.5%vs 27.5%,and 18.7%vs 4.0%,respectively P<0.05).The abnormal rate of laboratory indicators in Uyghur cancer patients was significantly higher than that in Han cancer patients,including total protein,albumin,serum total bilirubin,direct bilirubin,HDL-C,white blood cell,lymphocyte,red blood cell,and platelet(all P<0.05).The abnormal rates of TSF,HGS and CC were significantly higher than that of Han nationality patients(17.5%vs 9.7%,39.6%vs 19.6%,29.1%vs 15.2%,P<0.001).The nutritional support rate of Uyghur patients was lower than that of Han patients(0%vs 16.3%).After adjusting for potential risk factors,malnutrition was associated with gender(female,OR=0.35,95%CI=0.13-0.92,P=0.034),age(>60 years,OR=5.32,95%CI=1.46-19.41,P=0.011),cancer type(gastroesophageal tumor,OR=33.62,95%CI=3.42-330.67,P=0.003),and treatment methods(received radical tumor resection,OR=5.78,95%CI=1.45-23.08,P=0.008;received radiotherapy or chemotherapy:OR=7.69,95%CI=2.27-26.04,P<0.001).Conclusions The nutritional status of Uyghur cancer patients is worse than that of Han patients and the Uyghur patients with poor nutritional status lack the necessary nutritional support.

Nutritional Assessment of Gynecological Cancer Patients in China

Background Malnutrition is common among cancer patients,but few studies have evaluated the nutritional status among gynecological cancer patients in China.This study aimed to assess the nutritional status of women with gynecological cancer using the patient-generated subjective global assessment(PG-SGA).Methods Data for gynecological cancer patients treated at 44 tertiary hospitals were retrieved from a multicenter study on tumor nutrition.The R Software was used for statistical analyses.Univariate analyses of PG-SGA scores were performed using the Chi-squared test for categorical variables and the Wilcoxon-rank sum test or Kruskal-Wallis test for continuous variables,as appropriate.The significance level was 0.05.Results Data for 1962 women with three types of gynecological cancer(cervical,uterine and ovarian cancer)were used for the data analysis.The median PG-SGA score was 4(interquartile range,IQR:1,8),the median participants’age was 51(IQR:46,59)years old,and the patients had a median BMI of 22.9(IQR:20.7,25.4).The percentages of women who had a medical co-morbidity,or had undergone any radical resection,chemotherapy,or radiotherapy were approximately 27.7%,55.4%,52.5%,and 30.2%,respectively.The levels of serum albumin and high density lipoprotein cholesterol(HDL-C)were 40.1g/L(IQR:36.8,43.1)and 1.2mmol/L(IQR:1.0,1.5),respectively.The identified risk factors for malnutrition based on the PG-SGA score were age(0.05±0.01,p=0.002),BMI(-0.34±0.04,p<0.001),having a medical co-morbidity(0.95±0.33,p=0.004),receiving radiotherapy(1.52±0.31,p<0.001),the serum albumin level(-0.18±0.03,p<0.001),and the HDL-C(-1.12±0.35,p=0.001)as indicated by a linear regression analysis.Conclusions A higher PG-SGA score is positively associated with the age of the patient,having a medical co-morbidity,and receiving radiotherapy,and is negatively related to the patients’BMI and serum albumin and HDL-C levels.

First-line atezolizumab plus chemotherapy in treatment of extensive small cell lung cancer:a cost-effectiveness analysis from China

Background:IMpower 133 trial first confirmed the efficacy and safety of adding atezolizumab or placebo to first-line treatment with chemotherapy in patients with extensive-stage small-cell lung cancer(SCLC).While,overprice limited its broad use in clinical.The aim of this study was to evaluate the cost-effectiveness of atezolizumab plus chemotherapy in treatment of extensive SCLC as first line in China.Methods:A Markov model was established by extracting data from the IMpower 133 trial with untreated extensive SCLC patients.Utility values were obtained from published studies,and the costs were acquired from real world and literature.Additionally,sensitivity analyses based on a willingness-to-pay(WTP)threshold were performed to identify the uncertain parameters of Markov model.Results:Total costs of atezolizumab group were$48,129,while cost of chemotherapy alone was just$12,920 in placebo group.The quality-adjusted life-years(QALYs)in atezolizumab group was just 0.072 higher than that in placebo group(0.858 QALYs vs.0.786 QALYs).The cost-effectiveness ratio between atezolizumab combination with chemotherapy and chemotherapy alone was$489,013/QALY in China.The net benefit of placebo group was significantly higher than atezolizumab group.One-way sensitivity analyses highlighted that utilities of the progression-free survival(PFS)and progression disease state in placebo group were the most influential parameter.Conclusions:Atezolizumab combination therapy was not more cost-effective than chemotherapy alone at a WTP threshold of$25,929/QALY in China.

Impact of Real-Time Contrast-Enhanced Ultrasound-Guided Radiofrequency Ablation on Progression-Free Survival in Patients with Hepatocellular Carcinoma:a Retrospective Case-Control Study

Objective To compare the value of contrast-enhanced ultrasound(CEUS)and conventional ultrasound(US)during radiofrequency ablation(RFA)for the treatment of hepatocellular carcinoma(HCC)≥3.0 cm in diameter.Methods A total of 149 HCC patients treated with RFA guided by either CEUS or conventional US between January 2012 and June 2013 were retrospectively analyzed.Patients were divided into different groups based on the type of ultrasound guidance(CEUS or conventional US)and tumor volume(diameter<3.0 or≥3.0 cm).The progressionfree survival(PFS)and complete ablation rates were compared between groups,and risk factors for the PFS were investigated.Results Seventy four patients received CEUS-guided RFA,and conventional US was performed in 75 patients.Among patients with a tumor<3.0 cm,the PFS and complete ablation rates were similar.However,for patients with a tumor≥3.0 cm,those treated with CEUS had a significantly longer PFS(17.3 vs.3.1 months,HR=2.73;95%CI,1.28~5.81;P=0.007)and higher complete ablation rates at 6-and 12-month post-treatment(87.5%vs.57.7%,P=0.042;75.0%vs.38.5%,P=0.009,respectively)than those treated with conventional US-guided RFA.The type of treatment(P=0.024)and maximum tumour size(P=0.011)were both found to be independent factors associated with the PFS.Conclusion Compared with conventional US,CEUS is more effective for guiding RFA in patients with HCC≥3.0 cm.CEUS-guided RFA could target HCC more accurately,and its ability to immediately detect any residual tumor during RFA might contribute to an increase in complete ablation rates and reduced progression.

AIWW:a new nutrition-screening tool for the oncologic population

Malnutrition is a common comorbidity among patients with cancer.However,no nutrition-screening tool has been recognized in this population.A quick and easy screening tool for nutrition with high sensitivity and easy-to-use is needed.Based on the previous 25 nutrition-screening tools,the Delphi method was made by the members of the Chinese Society of Nutritional Oncology to choose the most useful item from each category.According to these results,we built a nutrition-screening tool named age,intake,weight,and walking(AIWW).Malnutrition was defined based on the scored patient-generated subjective global assessment(PG-SGA).Concurrent validity was evaluated using the Kendall tau coefficient and kappa consistency between the malnutrition risks of AIWW,nutritional risk screening 2002(NRS-2002),and malnutrition screening tool(MST).Clinical benefit was calculated by the decision curve analysis(DCA),integrated discrimination improvement(IDI),and continuous net reclassification improvement(c NRI).A total of 11,360 patients(male,n=6,024(53.0%)were included in the final study cohort,and 6,363 patients had malnutrition based on PG-SGA.Based on AIWW,NRS-2002,and MST,7,545,3,469,and1,840 patients were at risk of malnutrition,respectively.The sensitivities of AIWW,NRS-2002,and MST risks were 0.910,0.531,and 0.285,and the specificities were 0.768,0.946,and 0.975.The Kendall tau coefficients of AIWW,NRS-2002,and MST risks were 0.588,0.501,and 0.326,respectively.The area under the curve of AIWW,NRS-2002,and MST risks were0.785,0.739,and 0.630,respectively.The IDI,c NRI,and DCA showed that AIWW is non-inferior to NRS-2002(IDI:0.002(-0.009,0.013),c NRI:-0.015(-0.049,0.020)).AIWW scores can also predict the survival of patients with cancer.The missed diagnosis rates of AIWW,NRS-2002,and MST were 0.09%,49.0%,and 73.2%,respectively.AIWW showed a better nutritionscreening effect than NRS-2002 and MST for patients with cancer and could be recommended as an alternative nutritionscreening tool for this population.

Adipose Tissue and Cachexia: White or Brown

The adipose tissue of the body is classified into two types: white adipose tissue and brown adipose tissue;the former is mainly responsible for storing energy and the latter is to produce heat and dissipate energy. Recent research has shown that there is a third type of adipose tissue, namely white adipose tissue browning, i.e., brown adipose tissue existing inside the white adipose tissue. Brown adipose tissue, which is converted from white adipose tissue, is similar to brown adipocytes in function. Browning is one of the important features of lipid metabolism of cancer cachexia. On the one hand, white adipose tissue affects metabolism through increasing the amount of heat consumption after browning, resulting in a decrease in fat;on the other hand, the browning process participates in the process of the occurrence and development of cancer cachexia. Two driving factors, interleukin-6 and parathyroid hormone related protein, play an important role in this browning process. They are secreted by tumor tissue, mainly through the exciting sympathetic nervous system to release norepinephrine, and act on β3 adrenergic receptor of the adipocytes and further activate the the transcription factors which corresponded heat-production gene expression such as uncoupling protein 1 (UCP1), leading to white adipose tissue browning. The browning process is the early event of the occurrence of cancer cachexia and continues throughout the entire process of cancer cachexia. Therefore, early detection of the browning process will facilitate the development of intervention approach, improving the clinical outcome of diagnosis, prevention, and treatment for cancer cachexia.

Intestinal Microbiota:Potential Tumor Biomarkers

Intestinal microecology is closely related to human health and plays an important role in metabolism,digestion,absorption and immunity.Disorders of the intestinal microbiota may lead to abnormalities of the immune system,and may be involved in the development of malignancy.This review summarizes the evidence supporting the use of intestinal microorganisms as tumor markers.In addition,this paper also summarizes the current perspectives regarding the involvement of intestinal microecology in the pathogenesis of cancer,providing a reference for potential biomarkers that could be used for the clinical diagnosis and response to treatment of tumors.