口服营养补充对胃癌根治术后存在营养风险的老年出院患者影响的前瞻性研究

doi:10.19401/j.cnki.1007-3639.2025.10.001

摘要/Abstract

摘要：

背景与目的：营养不良和营养状况恶化在胃癌术后患者中较为常见，老年患者尤甚，严重影响患者的预后。研究显示，口服营养补充（oral nutritional supplements，ONS）可改善存在营养风险的胃癌术后出院患者的营养状况、改善患者的临床结局。本研究通过对前期随机对照临床试验中接受胃癌根治术的老年出院患者进行分析，探讨ONS对存在营养风险的老年胃癌术后出院患者的影响。方法：选取2017年1月—2018年12月在复旦大学附属中山医院就诊，存在营养风险并行接受胃癌根治术的出院患者，根据纳入和排除标准分为ONS组和对照组。对照组出院后3个月接受饮食建议，ONS组出院后3个月在饮食建议基础上联合ONS。出院后3个月比较两组患者的体重、体重指数（body mass index，BMI）、血红蛋白、血浆白蛋白及化疗耐受性。本研究的病例资料基于前期的1项随机对照临床试验（ChiCTR2000029708），获复旦大学附属中山医院伦理委员会批准（B2019-257R2）。结果：最终筛选出125例符合入组条件的患者，其中ONS组69例，对照组56例。通过3个月干预，两组患者体重、BMI、血红蛋白和血浆白蛋白水平差异均无统计学意义。然而，相比于对照组，ONS组在干预期间体重变化的下降幅度显著更小[（2.50±1.60）kg vs（4.24±1.80）kg，P<0.05]。相比于对照组，ONS组患者的化疗耐受性得到显著改善，总体化疗改变率下降（15.9% vs 41.1%，P=0.002），且化疗延迟，药物剂量减少及停止化疗的患者均少于对照组。多因素分析显示，体重、血浆白蛋白、血红蛋白、NRS2002、BMI对化疗正常进行的影响均不显著（P>0.05）；只有ONS是显著的保护性因素，可显著降低化疗改变的发生风险（OR=0.227，P=0.001）。结论：ONS有助于提高老年胃癌术后出院患者的化疗耐受性并在一定程度上改善患者营养结局。对于存在营养风险的老年胃癌术后患者，出院后给予营养干预对改善患者的临床结局有积极意义。

关键词: 胃癌, 口服营养补充, 老年, 出院患者, 化疗耐受性

Abstract:

Background and purpose: Malnutrition and deterioration of nutritional status are common in patients after surgery for gastric cancer, especially in the elderly, and severely affect patient prognosis. Studies have shown that oral nutritional supplements (ONS) can improve the nutritional status and clinical outcomes of patients after surgery for gastric cancer with nutritional risk. This study analyzed elderly patients who underwent radical surgery for gastric cancer in a previous randomized controlled trial to explore the impact of ONS on elderly patients after surgery for gastric cancer with nutritional risk. Methods: Patients discharged after gastric cancer radical surgery with nutritional risk who received treatment at Zhongshan Hospital affiliated with Fudan University from January 2017 to December 2018 were selected. The control group received dietary advice three months after discharge, while the ONS group received dietary advice combined with ONS three months after discharge. The weight, body mass index (BMI), hemoglobin, plasma albumin, and chemotherapy tolerance of the two groups were compared three months after discharge. The data for this study was based on a previous randomized controlled trial (ChiCTR2000029708) which had received ethical approval. This study was approved by the Ethics Committee of Zhongshan Hospital Affiliated to Fudan University (B2019-257R2). Results: A total of 125 patients who met the inclusion criteria were finally selected, including 69 in the ONS group and 56 in the control group. After 3 months of intervention, there were no significant differences in weight, BMI, hemoglobin, and plasma albumin levels between the two groups. However, the ONS group showed a significantly smaller decrease in weight change during the intervention period compared to the control group [(2.50±1.60)kg vs (4.24±1.80)kg, P<0.05]. The chemotherapy tolerance of the ONS group was significantly improved compared to the control group, with a decrease in the overall chemotherapy change rate (15.9% vs 41.1%, P=0.002), and fewer patients in the ONS group experienced chemotherapy delays, reduced drug dosages, and discontinuation of chemotherapy than those in the control group. Multivariate analysis showed that body weight, plasma albumin, hemoglobin, NRS2002, and BMI had no significant effect on the normal course of chemotherapy (P>0.05); only ONS was a significant protective factor, significantly reducing the risk of chemotherapy modification (OR=0.227, P=0.001). Conclusion: ONS helps improve the chemotherapy tolerance of elderly postoperative gastric cancer patients and to some extent enhances their nutritional outcomes. For elderly postoperative gastric cancer patients with nutritional risk, nutritional intervention after discharge has a positive impact on improving clinical outcomes.

Key words: Gastric cancer, Oral nutritional supplements, Elderly, Discharged patients, Chemotherapy tolerance

中图分类号:

R735.2

奚秋磊, 王歆艺, 谈善军, 张知格, 吴国豪. 口服营养补充对胃癌根治术后存在营养风险的老年出院患者影响的前瞻性研究[J]. 中国癌症杂志, 2025, 35(10): 899-905.

XI Qiulei, WANG Xinyi, TAN Shanjun, ZHANG Zhige, WU Guohao. Prospective trial on impact of oral nutritional supplements on elderly patients with nutritional risk after radical surgery for gastric cancer[J]. China Oncology, 2025, 35(10): 899-905.

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参考文献 21

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Characteristic	ONS (n=69)	Control (n=56)	Parameter	P value
Gender n (%)			χ²=0.475	0.491
Male	46 (66.7)	34 (60.7)
Female	23 (33.3)	22 (39.3)
Age/year	71.86±5.89	71.36±5.48	t=0.485	0.093
Cardiovascular comrobidiy n (%)	18 (26.1)	9 (16.1)	χ²=1.831	0.176
Respiratory comboribity n (%)	7 (10.1)	5 (8.9)	χ²=0.053	0.818
Diabetes n (%)	1 (1.4)	6 (10.7)	χ²=5.019	0.025
Extent of resection n (%)			χ²=0.306	0.580
Subtotal gastrectomy	44 (63.8)	33 (58.9)
Total gastrectomy	25 (36.2)	23 (41.1)
Type of reconstruction n (%)			χ²=3.553	0.314
Billroth Ⅰ	21 (30.4)	20 (35.7)
Billroth Ⅱ	20 (29.0)	12 (21.4)
Roux-en-Y	27 (39.1)	20 (35.7)
Others	1 (1.4)	4 (7.1)
Extent of lymph node dissection n (%)			χ²=0.060	0.807
D0 or D1	10 (14.5)	9 (16.1)
D2	59 (85.5)	47 (83.9)
Combined resection n (%)	1 (1.4)	2 (3.6)	χ²=0.594	0.441
AJCC stage n (%)			χ²=2.587	0.460
Ⅰ	12 (17.4)	14 (25.0)
Ⅱ	24 (34.8)	15 (26.8)
Ⅲ	29 (42.0)	21 (37.5)
Ⅳ	4 (5.8)	6 (10.7)
NRS 2002 score n (%)			χ²=1.526	0.676
3 points	35 (50.7)	28 (50.0)
4 points	23 (33.3)	15 (26.8)
5 points	7 (10.1)	7 (12.5)
>5 points	4 (5.8)	6 (10.7)

Item	ONS (n=69)	Control (n=56)	χ²	P value
Chemotherapy modification	11 (15.9)	23 (41.1)	11.459	0.002
Delay	3 (4.3)	10 (17.9)
Dose reduction	7 (10.1)	9 (16.1)
Termination	1 (1.4)	4 (7.1)