Prevalence and Prognostic Value of Malnutrition Among Elderly Cancer Patients Using Three Scoring Systems

Qi Zhang; Liang Qian; Tong Liu; Jia-Shan Ding; Xi Zhang; Meng-Meng Song; Zi-Wen Wang; Yi-Zhong Ge; Chun-Lei Hu; Xiang-Rui Li; Meng Tang; Kun-Hua Wang; Rocco Barazzoni; Chun-Hua Song; Hong-Xia Xu; Han-Ping Shi; Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group

doi:10.3389/fnut.2021.738550

Prevalence and Prognostic Value of Malnutrition Among Elderly Cancer Patients Using Three Scoring Systems

Front Nutr. 2021 Oct 11:8:738550. doi: 10.3389/fnut.2021.738550. eCollection 2021.

Authors

Qi Zhang^{1

2

3

4}, Liang Qian^{5

6

7}, Tong Liu^{1

2}, Jia-Shan Ding⁸, Xi Zhang^{1

2

3}, Meng-Meng Song^{1

2

3}, Zi-Wen Wang^{1

2}, Yi-Zhong Ge⁹, Chun-Lei Hu^{1

2

3}, Xiang-Rui Li^{1

2

3}, Meng Tang^{1

2

3}, Kun-Hua Wang¹⁰, Rocco Barazzoni¹¹, Chun-Hua Song¹², Hong-Xia Xu¹³, Han-Ping Shi^{1

2

3}; Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group

Affiliations

¹ Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
² Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
³ Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
⁴ Graduate school, Capital Medical University, Beijing, China.
⁵ Department of Obstetrics and Gynecology, Hangzhou Women's hospital, Hangzhou, China.
⁶ Department of Obstetrics and Gynecology, Hangzhou Maternal and ChildHealth Hospital, Hangzhou, China.
⁷ Department of Obstetrics and Gynecology, Hangzhou First People92s Hospital Qianjiang, Hangzhou, China.
⁸ Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, China.
⁹ The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
¹⁰ Department of Gastrointestinal Surgery, Institute of Gastroenterology, the First Affiliated Hospital of Kunming Medical University, Kunming, China.
¹¹ Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
¹² Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China.
¹³ Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing, China.

Abstract

Background: Malnutrition is common in patients with cancer and is associated with adverse outcomes, but few data exist in elderly patients. The aim of this study was to report the prevalence of malnutrition using three different scoring systems and to examine the possible clinical relationship and prognostic consequence of malnutrition in elderly patients with cancer. Methods: Nutritional status was assessed by using controlling nutritional status (CONUT), the prognostic nutritional index (PNI), and the nutritional risk index (NRI). Quality-of-life (Qol) was assessed during admission by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30. Performance status (PS) was assessed by using the Eastern Cooperative Oncology Group (ECOG) classification. The relationship between nutritional status and overall survival and Qol were examined. Results: Data were available for 1,494 elderly patients with cancer (63.65% male), the mean age was 70.76 years. According to the CONUT, NRI, and PNI, 55.02, 58.70, and 11.65% patients were diagnosed with malnutrition, respectively. Worse nutritional status was related to older, lower BMI, lower hand grip strength, and more advanced tumor stage. All malnutrition indexes were correlated with each other (CONUT vs. PNI, r = -0.657; CONUT vs. NRI scores, r = -0.672; PNI vs. NRI scores, r = 0.716, all P < 0.001). During a median follow-up of 43.1 months, 692 (46.32%) patients died. For patients malnourished, the incidence rate (events-per-1,000person-years) was as follows: CONUT (254.18), PNI (429.91), and NRI (261.87). Malnutrition was associated with increased risk for all-cause mortality (adjust HR [95%CI] for CONUT: 1.09 [1.05-1.13], P < 0.001; PNI: 0.98[0.97-0.99], P < 0.001; NRI: 0.98 [0.98-0.99], P < 0.001). All malnutrition indexes improved the predictive ability of the TNM classification system for all-cause mortality. Deterioration of nutritional status was associated with deterioration in Qol parameters and immunotherapeutic response (P < 0.001). Conclusions: Malnutrition was prevalent in elderly patients with cancer, regardless of the assessment tools used, and associated with lower Qol and the immunotherapy response.

Keywords: NRI; cancer; elderly patients; malnutrition index; prognostic.

Copyright © 2021 Zhang, Qian, Liu, Ding, Zhang, Song, Wang, Ge, Hu, Li, Tang, Wang, Barazzoni, Song, Xu, Shi and Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group.