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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
Prospective trial on impact of oral nutritional supplements on elderly patients with nutritional risk after radical surgery for gastric cancer
- 中国癌症杂志 2025年35卷第10期 页码：899-905
- 作者机构：
1. 复旦大学附属中山医院普通外科胃肠外科，上海 200032
2. 复旦大学附属中山医院临床营养科，上海 200032
- 作者简介：
[ "奚秋磊（ORCID: 0009-0007-6329-528X），博士，复旦大学附属中山医院普外科主治医师。" ]
[ "王歆艺（ORCID: 0009-0004-4738-3894），学士，复旦大学附属中山医院营养技师。" ]
[ "吴国豪，复旦大学附属中山医院普通外科主任医师、教授、博士研究生导师。现任复旦大学外科学系主任，上海市临床营养研究中心主任等。长期从事普通外科工作，专长于临床营养的理论研究及临床实践，在临床营养规范化实施、外科及危重症营养支持、肿瘤恶病质防治的临床和基础研究方面取得丰硕成果。先后牵头编撰了6部临床营养指南和专家共识，主编9本临床营养专著，承担国家“211工程”外科重点项目临床营养部分、国家“863”攻关项目子课题、国家自然科学基金、教育部项目、上海市科委课题等20余项科研项目，在Gastroenterology、Annals of Surgery、Nature Communications、Clinical Nutrition、Molecular Therapy、Cell Reports、Cell Discovery等期刊发表论文200余篇。" ]
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2025.10.001
中图分类号： R735.2收稿：2025-08-01，
修回：2025-09-17，
纸质出版：2025-10-30
- 稿件说明：
移动端阅览
奚秋磊, 王歆艺, 谈善军, 等. 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.
Qiulei XI, Xinyi WANG, Shanjun TAN, et al. 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.
奚秋磊, 王歆艺, 谈善军, 等. 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. DOI： 10.19401/j.cnki.1007-3639.2025.10.001.
Qiulei XI, Xinyi WANG, Shanjun TAN, et al. 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. DOI： 10.19401/j.cnki.1007-3639.2025.10.001.
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。
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.
关键词
Keywords
references
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