食管癌患者营养治疗指南

1李涛; 2李宝生; 1吕家华; 3陈俊强; 4陈克能; 5陈媛媛; 6丛明华; 7傅剑华; 8韩泳涛; 9李杰; 10李薇; 11李增宁; 12廖正凯; 13刘明; 14庞青松; 15曲宝

doi:10.16689/j.cnki.cn11-9349/r.2020.01.007

肿瘤代谢与营养电子杂志 >

2020 , Vol. 7 >Issue 1: 32 - 42

DOI: https://doi.org/10.16689/j.cnki.cn11-9349/r.2020.01.007

共识、指南与标准

食管癌患者营养治疗指南

1李涛 ,
2李宝生 ,
1吕家华 ,
3陈俊强 ,
4陈克能 ,
5陈媛媛 ,
6丛明华 ,
7傅剑华 ,
8韩泳涛 ,
9李杰 ,
10李薇 ,
11李增宁 ,
12廖正凯 ,
13刘明 ,
14庞青松 ,
15曲宝

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1四川省肿瘤医院放疗中心，成都 610041；2山东省肿瘤医院放疗科，济南 250117；3 广西医科大学第一附属医院胃肠腺体外科，南宁 530021；4 北京大学肿瘤医院胸外科，北京 100142；5浙江省肿瘤医院放疗科，杭州 310022；6中国医学科学院肿瘤医院综合科，北京 100021；7中山大学肿瘤防治中心胸外科，广州 510060；8四川省肿瘤医院胸外科，成都 610041；9山西省肿瘤医院放疗科，太原 030013；10吉林大学第一医院肿瘤中心，长春 130021；11河北医科大学第一医院临床营养科，石家庄 050030；12武汉大学中南医院肿瘤放化疗科，武汉 430071；13哈尔滨医科大学附属第四医院普外科，哈尔滨 150001；14天津医科大学肿瘤医院放疗科，天津 300060；15中国人民解放军总医院放疗科，北京 100036；16南京医科大学第一附属医院放疗科，南京 210029；17陆军特色医学中心大坪医院临床营养科，重庆 400042；18宁夏医科大学总医院放疗科，银川 750003；19首都医科大学附属北京世纪坛医院胃肠外科/临床营养科，肿瘤代谢与营养北京市国际科技合作基地，首都医科大学肿瘤学系，北京 1000388

网络出版日期: 2021-04-12

基金资助

国家重点研发计划项目（2017YFC1309200）

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Guidelines for nutritional treatment of esophageal cancer patients

1Li Tao ,
2Li Baosheng ,
1Lyu Jiahua ,
3Chen Junqiang ,
4Chen Keneng ,
5Chen Yuanyuan ,
6Cong Minghua ,
7Fu Jian hua ,
8Han Yongtao ,
9Li Jie ,
10Li Wei ,
11Li Zengning ,
12Liao Zhengkai ,
13Liu Ming ,
14Pang Qingsong ,
15Qu Baoli

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1 Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu 610041, Sichuan, China； 2 Department of Radiation Oncology, Shandong Cancer Hospital, Jinan 250117, Shandong, China； 3 Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China； 4 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China；5 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang, China；6 Department of General Diseases, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China；7 Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou 510060, Guangdong, China；8 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, Sichuan, China；9 Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Taiyuan 030013, Shanxi, China；10Cancer Center, The First Hospital of Jilin University, Changchun 130021, Jilin, China；11 Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang 050030, Hebei, China；12Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China；13Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China；14Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China；15Department of Radiation Oncology, Chinese PLA General Hospital, Beijing 100036, China；16Department of Radiation Oncology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, China；17Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing 400042, China；18Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750003, Ningxia, China；19Department of Gastrointestinal Surgery-Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Department of Oncology, Capital Medical University, Beijing 100038, China

Online published: 2021-04-12

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摘要

食管癌是营养不良发病率最高的恶性肿瘤。营养不良会降低食管癌细胞对放化疗的敏感性，增加治疗不良反应，延长住院时间，延缓身体康复，增加医疗费用，降低患者治疗疗效和生活质量。因此，开展规范化的营养治疗对食管癌患者具有重要的意义。然而，迄今为止，国内外均没有专门针对食管癌患者的营养治疗指南。因此，中国抗癌协会肿瘤营养专业委员会、中华医学会肠外肠内营养学分会，中国医师协会放射肿瘤治疗医师分会营养与支持治疗学组的肿瘤营养专家，通过对食管癌营养治疗最新国内国外文献的全面检索与分析，并经过反复讨论与修改，制定了本指南。指南从食管癌患者的营养诊断、营养治疗适应证、治疗途径、治疗通路、营养素和疗效评价六个方面分别进行了证据论述和意见推荐。

关键词： 食管癌; 营养治疗; 指南

本文引用格式

1李涛 , 2李宝生 , 1吕家华 , 3陈俊强 , 4陈克能 , 5陈媛媛 , 6丛明华 , 7傅剑华 , 8韩泳涛 , 9李杰 , 10李薇 , 11李增宁 , 12廖正凯 , 13刘明 , 14庞青松 , 15曲宝 . 食管癌患者营养治疗指南[J]. 肿瘤代谢与营养电子杂志, 2020 , 7(1) : 32 -42 . DOI: 10.16689/j.cnki.cn11-9349/r.2020.01.007

Abstract

Esophageal cancer patients are at the highest incidence of malnutrition. Malnutrition will reduce the sensitivity of esophageal cancer cells to chemoradiotherapy, increase adverse reactions to treatment, prolong hospital stays, delay physical rehabilitation, increase medical costs, and reduce treatment efficacy and quality of life. Therefore, the standardized nutrition therapy is of great significance to patients with esophageal cancer. However, to date, there are no guidelines for nutritional treatment for esophageal cancer patients. Therefore, the tumor nutrition experts from China Society for Nutritional Oncology, Chinese Society for Parenteral and Enteral Nutrition and the Nutrition and Support Therapy Group of Chinese Association for Therapeutic Radiation Oncologists searched and analyzed the latest literature on nutritional treatment of esophageal cancer. After repeated discussions and modifications, they developed this guideline. The guideline discussed the evidence and recommendations from the six aspects of nutrition diagnosis, nutritional treatment indications, treatment access, treatment pathways, nutrients, and efficacy evaluations for patients with esophageal cancer.

Key words： Esophageal cancer; Nutritional treatment; Guidelines

参考文献

1.Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018： GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca-Cancer J Clin. 2018；68(6)：394-424.
2.郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志. 2019；41(1)：19-28.
3.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.
4.王东洲, 王铁君, 李涛. 肿瘤患者营养状况对放射敏感性的影响. 肿瘤代谢与营养电子杂志. 2016；3(4)：207-210.
5.Clavier JB, Antoni D, Atlani D, et al. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus. 2014；27(6)：560-567.
6.Matsumoto Y, Zhou Q, Kamimura K, et al. The prognostic nutrition index predicts the development of hematological toxicities in and the prognosis of esophageal cancer patients treated with cisplatin plus 5-fluorouracil chemotherapy. Nutr Cancer. 2018；70(3)：447-452.
7.Sagar RC, Kumar K, Ramachandra C, et al. Perioperative artificial enteral nutrition in malnourished esophageal and stomach cancer patients and its impact on postoperative complications. Indian J Surg Oncol. 2019；10(3)：460-464.
8.Steenhagen E, Vulpen JK, Hillegersberg R, et al. Nutrition in peri-operative esophageal cancer management. Expert Rev Gastroenterol Hepatol. 2017；11(7)：663-672.
9.Takesue T, Takeuchi H, Ogura M, et al. A prospective randomized trial of enteral nutrition after thoracoscopic esophagectomy for esophageal cancer. Ann Surg Oncol. 2015；22(3)：S802-S809.
10.Han H, Pan M, Tao Y, et al. Early enteral nutrition is associated with faster post-esophagectomy recovery in chinese esophageal cancer patients： a retrospective cohort study. Nutr Cancer. 2018；70(2)：221-228.
11.Cong MH, Li SL, Cheng GW, et al. An interdisciplinary nutrition support team improves clinical and hospitalized outcomes of esophageal cancer patients with concurrent chemoradiotherapy. Chin Med J. 2015；128(22)：3003-3007.
12.Mak M, Bell K, Ng W, et al. Nutritional status, management and clinical outcomes in patients with esophageal and gastro-oesophageal cancers： a descriptive study. J Nutr Diet. 2017；74(3)：229-235.
13.吕家华, 李涛, 朱广迎, 等. 肠内营养对食管癌同步放化疗患者营养状况、不良反应和近期疗效影响—前瞻性、多中心、随机对照临床研究(NCT02399306). 中华放射肿瘤学杂志. 2018；27(1)：44-48.
14.Lyu JH, Li T, Xie CH, et al. Enteral nutrition in esophageal cancer patients treated with radiotherapy： a Chinese expert consensus 2018. Future Oncol. 2019；15(5)：517-531.
15.Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017；36(1)：11-48.
16.Chen MJ, Wu IC, Chen YJ, et al. Nutrition therapy in esophageal cancer—Consensus statement of the Gastroenterological Society of Taiwan. Dis Esophagus. 2018；31(8)：1-9.
17.Quyen TC, Angkatavanich J, Thuan TV, et al. Nutrition assessment and its relationship with performance and Glasgow prognostic scores in Vietnamese patients with esophageal cancer. Asia Pac J Clin Nutr. 2017；26(1)：49-58.
18.杨家君, 黄学军, 邓俊晖, 等. PG-SGA 在常见消化道恶性肿瘤患者中的应用研究. 肿瘤代谢与营养电子杂志. 2017；4(2)：189-193.
19.石汉平, 李薇, 齐玉梅, 等. 营养筛查与评估. 北京：人民卫生出版社, 2014.
20.石汉平, 李薇, 王昆华. PG-SGA 肿瘤患者营养状况评估操作手册. 北京：人民卫生出版社, 2013.
21.石汉平, 赵青川, 王昆华, 等. 营养不良的三级诊断.肿瘤代谢与营养电子杂志. 2015；2(2)：31-36.
22.Jensen GL, Mirtallo J, Compher C, et al. International Consensus Guideline Committee. Adult starvation and disease-related malnutrition： a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr. 2010；34(2)：156-159.
23.Weimann A, Braga M, Carli F, et al. ESPEN guideline： Clinical nutrition in surgery. Clin Nutr. 2017；36(3)：623-650.
24.于振涛. 食管癌围手术期营养治疗. 肿瘤代谢与营养电子杂志. 2015；2(2)：19-22.
25.马兴好, 杨惠, 王家家, 等. 食管癌患者围术期不同时期营养状态与相关分析. 肿瘤代谢与营养电子杂志. 2018；5(3)：274-278.
26.Baker ML, Halliday V, Robinson P, et al. Nutrient intake and contribution of home enteral nutrition to meeting nutritional requirements after oesophagectomy and total gastrectomy. Eur J Clin Nutr. 2017；71(9)：1121-1128.
27.Donohoe CL, Healy LA, Fanning M, et al. Impact of supplemental home enteral feeding postesophagectomy on nutrition, body composition, quality of life, and patient satisfaction. Dis Esophagus. 2017；30(9)：1-9.
28.李涛, 吕家华, 郎锦义, 等. 恶性肿瘤放疗患者营养治疗专家共识. 肿瘤代谢与营养电子杂志. 2018；4(3)：358-365.
29.李涛, 吕家华, 郎锦义, 等. 恶性肿瘤放射治疗患者肠内营养专家共识. 肿瘤代谢与营养电子杂志. 2017；4(3)：272-279.
30.Yu HM, Tang CW, Feng WM, et al. Early enteral nutrition versus parenteral nutrition after resection of esophageal cancer： a retrospective analysis. Indian J Surg. 2017；79(1)：13-18.
31.Wang G, Chen H, Liu J, et al. A comparison of postoperative early enteral nutrition with delayed enteral nutrition in patients with esophageal cancer. Nutrients. 2015；7(6)：4308-4317.
32.Furuta M, Yokota T, Tsushima T, et al. Comparison of enteral nutrition with total parenteral nutrition for patients with locally advanced unresectable esophageal cancer harboring dysphagia in definitive chemoradiotherapy. JPAN J Clin Oncol. 2019；49(6).
33.Arends J, Bodoky G, Bozzetti F, et al. ESPEN guidelines on enteral nutrition： non-surgical oncology. Clin Nutr. 2006；25(2)：245-259.
34.程国威, 孙莉, 陈平, 等. 鼻空肠营养治疗对食管癌放疗患者疗效和不良反应的影响. 肿瘤代谢与营养电子杂志. 2019；6(3)：332-336.
35.蒋朱明. 临床诊疗指南：肠外肠内营养学分册(2008 版). 北京：人民卫生出版社, 2009.
36.Lser C, Aschl G, Hébuterne X, et al. ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin Nutr. 2005；24(5)：848-861.
37.杨志勇, 魏晶晶, 庄则豪. 中国恶性肿瘤营养治疗通路专家共识解读：非外科空肠造口. 肿瘤代谢与营养电子杂志. 2018；5(2)：139-143.
38.Yu FJ, Shih H Y, Wu CY, et al. Enteral nutrition and quality of life in patients undergoing chemoradiotherapy for esophageal carcinoma： a comparison of nasogastric tube, esophageal stent, and ostomy. Gastrointest Endosc. 2018；88(1)：21-31.
39.刘明, 石汉平. 中国恶性肿瘤营养治疗通路专家共识(2018). 北京：人民卫生出版社, 2018.
40.石汉平, 许红霞, 李薇. 临床能量需求的估算. 肿瘤代谢与营养电子杂志, 2015(1)：7-10.
41.Okamoto H, Sasaki M, Johtatsu T, et al. Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer. J Clin Biochem Nutr. 2011；49(3)：169-173.
42.Wu J, Huang C, Xiao H, et al. Weight loss and resting energy expenditure in male patients with newly diagnosed esophageal cancer. Nutrition. 2013；29(11/12)：1310-1314.
43.高纯, 李梦, 韦军民, 等. 复方氨基酸注射液临床应用专家共识. 肿瘤代谢与营养电子杂志, 2019(2)：183-189.
44.崔久嵬, 卓文磊, 黄岚, 等.肿瘤免疫营养治疗指南［J］.肿瘤代谢与营养杂志,2016；3(4)：224-228.
45.Aiko S, Yoshizumi Y, Tsuwano S, et al. The effects of immediate enteral feeding with a formula containing high levels of ωfatty acids in patients after surgery for esophageal cancer. JPAN J Parenter Enteral Nutr. 2005；29(3)：141-147.
46.Ryan AM, Reynolds JV, Healy L, et al. Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery： results of a doubleblinded randomized controlled trial. Ann Surg. 2009；249(3)：355-363.
47.Abe T, Hosoi T, Kawai R, et al. Perioperative enteral supplementation with glutamine, fiber, and oligosaccharide reduces early postoperative surgical stress following esophagectomy for esophageal cancer. Esophagus. 2019；16(1)：63-70.
48.Miyata H, Yano M, Yasuda T, et al. Randomized study of the clinical effects of omega-3 fatty acid-containing enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer. Nutrition. 2017；33(1)：204-210.
49.Fietkau R, Lewitzki V, Kuhnt T, et al. A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy： results of a randomized, controlled, multicenter trial. Cancer. 2013；119(18)：3343-3353.

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