Objective To explore the relationship between body mass index, hemoglobin, serum albumin, and prognosis in advanced colorectal cancer patients undergoing chemotherapy. Methods From January 2013 to January 2018, 97 patients with stage Ⅲ-Ⅳ colorectal cancer who underwent palliative operation and postoperative chemotherapy in Hunan cancer hospital were analyzed retrospectively. To collect the clinical pathological data and the results of nutritional indicator pre-and post-chemotherapy, analyze the changes and the effects of nutritional indicator pre-and post-chemotherapy, on the survival time of patients according to the follow-up data. Results ①Before chemotherapy, there was a statistically significant difference in age between overweight group and normal weight group, and overweight group and low weight group (P<0.001）. The difference in Hb levels between different tumor sites was statistically significant (P=0.029). ②After chemotherapy, patients with low weight and low Hb increased significantly, while patients with normal weight and high Hb decreased, the difference was statistically significant (P=0.017, 0.007). ③Gender、the levels of post-chemotherapy Hb and ALB on the prognosis of patients were statistically significant (P<0.05）. Tumor differentiation and post-chemotherapy BMI are independent risk factors that affect the prognosis of patients with colorectal cancer (P<0.05）.Conclusion ①Advanced colorectal cancer over 60 years of age is more prone to low weight, and patients with colorectal cancer were more prone to have anemia. ②The proportion of patients with low weight and anemia increased after chemotherapy, and the incidence of malnutrition was higher in patients with advanced colorectal cancer after chemotherapy. ③Gender、the levels of post-chemotherapy ALB and Hb are the risk factors for the prognosis of patients with advanced colorectal cancer, but cannot independently predict the prognosis. Tumor differentiation and post-chemotherapy BMI are independent risk factor for the prognosis of patients with advanced colorectal cancer after chemotherapy.
1.中华人民共和国卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2017年版)［J］.中华外科杂志,2018,56(4):241-258.
2.CHEN W, ZHENG R, BAADE P D, et al.Cancer statistics in China, 2015［J］.CA Cancer J Clinc, 2016, 66(2):115-132.
3.OCONNELL J B, MAGGARD M A, KO C Y. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging［J］.J Natl Cancer Inst, 2004, 96(19):1420-1425.
4.陈晓秋.消化道恶性肿瘤患者营养风险、营养状况与炎症因子的相关性及其对临床结局的影响［J］.广东医学, 2015, 36(10):1505-1508.
5.HEBUTERNE X, LEMARIE E, MICHALLET M, et al.Prevalence of malnutrition and current use of nutrition support in patients with cancer［J］.JPEN J Parenter Enteral Nutr, 2014, 38(2):196-204.
6.BARACOS V E. Cancer-associated malnutrition［J］.Eur J Clin Nutr, 2018, 72(9):1255-1259.
7.THANIKACHALAM K, KHAN G. Colorectal cancer and nutrition［J］.Nutrients, 2019, 11(1):164.
8.VASHI P G, GORSUCH K, WAN L, et al.Sarcopenia supersedes subjective global assessment as a predictor of survival in colorectal cancer［J］.PLoS One, 2019, 14(6):e0218761.
9.OKADA S, YAMAZAKI S, KAIGA T, et al.Impact of nutritional status in the era of FOLFOX/FIRI-based chemotherapy［J］.World J Surg Oncol, 2017, 15(1):162.
10.LIN J, PENG J, QDAISAT A, et al.Severe weight loss during preoperative chemoradiotherapy compromises survival outcome for patients with locally advanced rectal cancer［J］.J Cancer Res Clin Oncol, 2016, 142(12):2551-2560.
11.LEE J, MEYERHARDT J A, GIOVANNUCCI E, et al.Association between body mass index and prognosis of colorectal cancer: a meta-analysis of prospective cohort studies［J］.PloS one, 2015, 10(3):e0120706.
12.DIGNAM J J, POLITE B N, YOTHERS G, et al.Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer［J］.J Natl Cancer Inst, 2006, 98(22):1647-1654.
13.SINICROPE F A, FOSTER N R, YOTHERS G, et al.Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy［J］.Cancer, 2013, 119(8):1528-1536.
14.LEE D W, HAN S W, CHA Y, et al.Prognostic influence of body mass index and body weight gain during adjuvant FOLFOX chemotherapy in Korean colorectal cancer patients［J］.BMC cancer, 2015, 15:690.
15.SHAHJEHAN F, MERCHEA A, COCHUYT J J, et al.Body mass index and long-term outcomes in patients with colorectal cancer［J］.Front Oncol, 2018, 8:620.
16.VANDEWOUDE M. Nutritional assessment in geriatric cancer patients［J］.Support Care Cancer, 2010, 18 Suppl 2(S51-56).
17.CAILLET P, LIUU E, RAYNAUD SIMON A, et al.Association between cachexia, chemotherapy and outcomes in older cancer patients: A systematic review［J］.Clin Nutr, 2017, 36(6):1473-1482.
18.VAYRYNEN J P, TUOMISTO A, VAYRYNEN S A, et al.Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival［J］.Sci Rep, 2018, 8(1):1126.
19.MAKINEN M J. Colorectal serrated adenocarcinoma［J］.Histopathology, 2007, 50(1):131-150.
20.EDNA T H, KARLSEN V, JULLUMSTRO E, et al.Prevalence of anaemia at diagnosis of colorectal cancer: assessment of associated risk factors［J］.Hepato-gastroenterology, 2012, 59(115):713-716.
21.KNIGHT K, WADE S, BALDUCCI L.Prevalence and outcomes of anemia in cancer: a systematic review of the literature［J］.Am J Med, 2004, 116 Suppl 7A(11s-26s).
22.TAMPELLINI M, SAINI A, ALABISO I, et al.The role of haemoglobin level in predicting the response to first-line chemotherapy in advanced colorectal cancer patients［J］.Br J Cancer, 2006, 95(1):13-20.
23.WEI Y S, ZHOU Y G, WANG G Y, et al.The impact of chemotherapy-associated hemoglobin on prognosis of colorectal cancer patients receiving adjuvant chemotherapy［J］.Cancer Biomark, 2017, 20(4):627-635.
24.KIM J H, CHOI P R, PARK S J, et al.Prognostic factors for metastatic colorectal cancer after first-line chemotherapy with FOLFOX-4 or FOLFIRI regimen［J］.Korean J Gastroenterol, 2014, 63(4):209-215.
25.魏宜胜, 洪楚原,赵楚雄.结直肠癌患者合并癌性贫血的临床病理特征及预后分析［J］.中华胃肠外科杂志,2012,15(4):385-387.
26.张瑜.血清CRP、白蛋白及GCS预后评分联合检测对结肠癌化疗疗效的预测意义［J］.中国老年学杂志, 2015, 35(18):5176-5178.
27.蒋志强,李亚兰,韩广森.术前血清白蛋白水平与结肠癌临床病理特征及生存预后的关系［J］.中华胃肠外科杂,2016,19(1):80-83.
28.杨焕丽, 贾泽博, 刘振社.结肠癌患者化疗前后血清白蛋白水平与临床病理特征及预后的关系研究［J］.结直肠肛门外科, 2018, 24(4):321-327.
29.FUCHS-TARLOVSKY V, ALVAREZ-ALTAMIRANO K, TURQUIE-SACAL D, et al.Nutritional status and body composition are already affected before oncology treatment in ovarian cancer［J］.Asia Pac J Clin Nutr, 2013, 22(3):426-430.
30.DANIELE A, DIVELLA R, ABBATE I, et al.Assessment of nutritional and inflammatory status to determine the prevalence of malnutrition in patients undergoing surgery for colorectal carcinoma［J］.Anticancer Res, 2017, 37(3):1281-1287.
31.QUINTANA PACHECO D A, SOOKTHAI D, GRAF M E, et al.Iron status in relation to cancer risk and mortality: Findings from a population-based prospective study［J］.Int J Cancer, 2018, 143(3):561-569.
32.GOMME P T, MCCANN K B, BERTOLINI J.Transferrin: structure, function and potential therapeutic actions［J］.Drug Discov Today, 2005, 10(4):267-273.
