背景:营养不良通常发生在癌症患者中,影响他们的生活质量和生存时间。这项荟萃分析和系统评价的目的是评估营养干预对接受新辅助放化疗的患者的影响。
方法:在PubMed中进行了全面搜索,Embase,和Cochrane图书馆数据库,以获得新辅助放化疗患者营养干预的随机对照试验。评估的结果包括新辅助治疗的毒性反应,炎症相关标志物的水平,营养状况,和相关的临床结果。使用相对风险(RR)或加权平均差(WMD)和95%置信区间(CI)作为效应大小。
结果:共纳入16项研究,954名患者。营养干预可显著降低新辅助放化疗患者呕吐(RR=0.37,95CI:0.21~0.67,P=0.001)和黏膜炎(RR=0.82,95CI:0.67~1.00,P=0.046)的发生率。对于癌症患者的营养状况,营养干预显著增加了营养良好患者的比例(RR=12.74,95CI:4.43~36.69,P<0.001).此外,营养干预也减少了术后新辅助放化疗患者的住院时间(WMD=-0.82,95CI:-1.61--0.02,P=0.043).然而,恶心没有改善(P=0.534),腹泻(P=0.068),发热性中性粒细胞减少症(P=0.551),白蛋白水平(P=0.211),前白蛋白(P=0.063),C反应蛋白(P=0.430),临床缓解(P=0.148),或术后并发症(P=0.098)。
结论:营养干预可以减少新辅助放化疗的毒性(呕吐和黏膜炎),改善患者的营养状况,缩短术后住院时间。精心设计和高质量的研究是必要的,以证实营养干预对癌症患者的影响,特别注重达到营养目标和提供正确的营养。
BACKGROUND: Malnutrition commonly occurs in cancer patients, impacting their quality of life and survival duration. The objective of this meta-analysis and systematic review is to assess the effects of nutritional interventions on patients undergoing neoadjuvant chemoradiotherapy.
METHODS: A comprehensive search was conducted in PubMed, Embase, and the Cochrane Library databases to obtain randomized controlled trials of nutritional interventions in patients with neoadjuvant chemoradiotherapy. Outcomes assessed included toxicity reactions to neoadjuvant therapy, levels of inflammation-related markers, nutritional status, and relevant clinical outcomes. The relative risk (RR) or weighted mean difference (WMD) and 95% confidence interval (CI) were used as effect sizes.
RESULTS: A total of 16 studies were included, involving 954 patients. Nutritional intervention significantly reduced the incidence of vomiting (RR = 0.37, 95%CI: 0.21-0.67, P = 0.001) and mucositis (RR = 0.82, 95%CI: 0.67-1.00, P = 0.046) in patients with neoadjuvant chemoradiotherapy. For the nutritional status of cancer patients, nutritional intervention significantly increased the proportion of well-nourished patients (RR = 12.74, 95%CI: 4.43-36.69, P < 0.001). In addition, nutritional intervention also reduced the length of hospital stay in neoadjuvant chemoradiotherapy patients after surgery (WMD = - 0.82, 95%CI: - 1.61- - 0.02, P = 0.043). However, there was no improvement in nausea (P = 0.534), diarrhea (P = 0.068), febrile neutropenia (P = 0.551), levels of albumin (P = 0.211), prealbumin (P = 0.063), C-reactive protein (P = 0.430), clinical remission (P = 0.148), or postoperative complications (P = 0.098).
CONCLUSIONS: Nutritional intervention can reduce the toxicity of neoadjuvant chemoradiotherapy (vomiting and mucositis), improve the nutritional status of patients, and shorten the length of postoperative hospital stay. Well-designed and high-quality studies are necessary to confirm the effect of nutritional interventions on cancer patients, with a specific focus on reaching nutritional goals and providing the right nutrients.