Research progress of influencing factors of malnutrition in gastric cancer and on clinical effects and its therapy strategies_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Shigong , YU Hongwei , CHE Shengfu ,  JIAO Zuoyi

Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou 730030, P. R. China;

Corresponding author：

JIAO Zuoyi, Email: jiaozy@lzu.edu.cn

Keywords：

gastric cancer; malnutrition; nutritional screening; nutritional support

DOI：

10.7507/1007-9424.202409013

Video：

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Objective To understand the mechanisms of malnutrition in patients with gastric cancer (GC) and which affecting on therapy outcomes, and explore effective nutritional intervention strategies so as to improve general therapy outcomes for patients with GC. Method The literature on studies relevant malnutrition in the patients with GC both domestically and internationally was reviewed and analyzed. Results The mechanisms of malnutrition in the patients with GC are complex and diverse, including abnormal tumor metabolism, side effects of treatment, psychological and economic factors, etc. The malnutrition made the mortality and recurrence rates increase, hospital stay prolong, and medical costs elevate, meanwhile led to the multiple complications. The use of various screening tools could effectively assess the malnutrition status at the different therapy stages, then the individualized nutritional therapy plans could be developed based on the assessment results. These plans included oral nutrition, enteral nutrition, parenteral nutrition, and immunonutrition. Conclusions Malnutrition severely affects the treatment outcomes and quality of life of patients with GC. It is necessary to timely screen and assess. The reasonable nutritional support plan should be chosen based on the patient’s individualized situation. Future research should be needed to explore the long-term efficacy and safety of nutritional support, optimize the application of immunonutrition and parenteral nutrition, and enhance the general treatment outcomes for patients with GC.

Citation： CHEN Shigong, YU Hongwei, CHE Shengfu, JIAO Zuoyi. Research progress of influencing factors of malnutrition in gastric cancer and on clinical effects and its therapy strategies. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(3): 381-388. doi: 10.7507/1007-9424.202409013 Copy

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7.	Schuetz P, Sulo S, Walzer S, et al. Nutritional support during the hospital stay is cost-effective for preventing adverse outcomes in patients with cancer. Front Oncol, 2022, 12: 916073. doi: 10.3389/fonc.2022.916073.
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1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
3. 李茁钰, 刘凯, 张维汉, 等. 全球及中国胃癌的流行病学特点及趋势: 2018–2022《全球癌症统计报告》解读. 中国普外基础与临床杂志, 2024, 31(10): 1236-1245.
4. Kim GH, Choi KD, Ko Y, et al. Impact of comorbidities, sarcopenia, and nutritional status on the long-term outcomes after endoscopic submucosal dissection for early gastric cancer in elderly patients aged ≥ 80 years. Cancers (Basel), 2021, 13(14): 3598. doi: 10.3390/cancers13143598.
5. Chen WZ, Zhang XZ, Zhang FM, et al. Coexistence of GLIM-defined malnutrition and sarcopenia have negative effect on the clinical outcomes in the elderly gastric cancer patients after radical gastrectomy. Front Nutr, 2022, 9: 960670. doi: 10.3389/fnut.2022.960670.
6. Wiwitkeyoonwong J, Jiarpinitnun C, Hiranyatheb P, et al. Impact of weight loss on patients with locally advanced esophageal and esophagogastric junction cancers treated with chemoradiotherapy. Asian Pac J Cancer Prev, 2021, 22(12): 3847-3855.
7. Schuetz P, Sulo S, Walzer S, et al. Nutritional support during the hospital stay is cost-effective for preventing adverse outcomes in patients with cancer. Front Oncol, 2022, 12: 916073. doi: 10.3389/fonc.2022.916073.
8. Zang Y, Xu W, Qiu Y, et al. Association between risk of malnutrition defined by the nutritional risk screening 2002 and postoperative complications and overall survival in patients with cancer: a meta-analysis. Nutr Cancer, 2023, 75(8): 1600-1609.
9. Wells CI, Milne TGE, Seo SHB, et al. Post-operative ileus: definitions, mechanisms and controversies. ANZ J Surg, 2022, 92(1-2): 62-68.
10. Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical nutrition in cancer. Clin Nutr, 2021, 40(5): 2898-2913.
11. Zheng X, Ruan X, Wang X, et al. Bayesian diagnostic test evaluation and true prevalence estimation of malnutrition in gastric cancer patients. Clin Nutr ESPEN, 2024, 59: 436-443.
12. Gascón-Ruiz M, Casas-Deza D, Torres-Ramón I, et al. Comparation of different malnutrition screening tools according to GLIM criteria in cancer outpatients. Eur J Clin Nutr, 2022, 76(5): 698-702.
13. Liu H, Yang XC, Liu DC, et al. Clinical significance of the controlling nutritional status (CONUT) score in gastric cancer patients: A meta-analysis of 9 764 participants. Front Nutr, 2023, 10: 1156006. doi: 10.3389/fnut.2023.1156006.
14. Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis. Eur J Surg Oncol, 2016, 42(8): 1176-1182.
15. Argilés JM, Busquets S, Toledo M, et al. The role of cytokines in cancer cachexia. Curr Opin Support Palliat Care, 2009, 3(4): 263-268.
16. Davis MP, Dreicer R, Walsh D, et al. Appetite and cancer-associated anorexia: a review. J Clin Oncol, 2004, 22(8): 1510-1517.
17. Joshi M, Patel BM. Unveiling the role of the proton gateway, uncoupling proteins (UCPs), in cancer cachexia. Cancers (Basel), 2023, 15(5): 1407. doi: 10.3390/cancers15051407.
18. Tisdale MJ. Cachexia in cancer patients. Nat Rev Cancer, 2002, 2(11): 862-871.
19. Edén E, Edström S, Bennegård K, et al. Glucose flux in relation to energy expenditure in malnourished patients with and without cancer during periods of fasting and feeding. Cancer Res, 1984, 44(4): 1718-1724.
20. Hyltander A, Daneryd P, Sandström R, et al. Beta-adrenoceptor activity and resting energy metabolism in weight losing cancer patients. Eur J Cancer, 2000, 36(3): 330-334.
21. Russell ST, Hirai K, Tisdale MJ. Role of beta3-adrenergic receptors in the action of a tumour lipid mobilizing factor. Br J Cancer, 2002, 86(3): 424-428.
22. Setiawan T, Sari IN, Wijaya YT, et al. Cancer cachexia: molecular mechanisms and treatment strategies. J Hematol Oncol, 2023, 16(1): 54. doi: 10.1186/s13045-023-01454-0.
23. Bossola M, Muscaritoli M, Costelli P, et al. Increased muscle proteasome activity correlates with disease severity in gastric cancer patients. Ann Surg, 2003, 237(3): 384-389.
24. Lorite MJ, Smith HJ, Arnold JA, et al. Activation of ATP-ubiquitin-dependent proteolysis in skeletal muscle in vivo and murine myoblasts in vitro by a proteolysis-inducing factor (PIF). Br J Cancer, 2001, 85(2): 297-302.
25. Amano K, Hopkinson J, Baracos V. Psychological symptoms of illness and emotional distress in advanced cancer cachexia. Curr Opin Clin Nutr Metab Care, 2022, 25(3): 167-172.
26. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr, 2017, 36(1): 11-48.
27. Madariaga A, Lau J, Ghoshal A, et al. MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer. Support Care Cancer, 2022, 30(6): 4711-4728.
28. Kuang ZY, Sun QH, Cao LC, et al. Efficacy and safety of perioperative therapy for locally resectable gastric cancer: A network meta-analysis of randomized clinical trials. World J Gastrointest Oncol, 2024, 16(3): 1046-1058.
29. Colomba E, Alves Costa Silva C, Le Teuff G, et al. Weight and skeletal muscle loss with cabozantinib in metastatic renal cell carcinoma. J Cachexia Sarcopenia Muscle, 2022, 13(5): 2405-2416.
30. Gharagozlian S, Mala T, Brekke HK, et al. Nutritional status, sarcopenia, gastrointestinal symptoms and quality of life after gastrectomy for cancer—A cross-sectional pilot study. Clin Nutr ESPEN, 2020, 37: 195-201.
31. Mak M, Bell K, Ng W, et al. Nutritional status, management and clinical outcomes in patients with esophageal and gastro-oesophageal cancers: A descriptive study. Nutr Diet, 2017, 74(3): 229-235.
32. Wang HM, Wang TJ, Huang CS, et al. Nutritional status and related factors in patients with gastric cancer after gastrectomy: A cross-sectional study. Nutrients, 2022, 14(13): 2634. doi: 10.3390/nu14132634.
33. Jeong A, An JY. The moderating role of social support on depression and anxiety for gastric cancer patients and their family caregivers. PLoS One, 2017, 12(12): e0189808. doi: 10.1371/journal.pone.0189808.
34. Hébuterne X, Lemarié E, Michallet M, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr, 2014, 38(2): 196-204.
35. Pressoir M, Desné S, Berchery D, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer, 2010, 102(6): 966-971.
36. Schneider SM, Veyres P, Pivot X, et al. Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr, 2004, 92(1): 105-111.
37. Lengelé L, Bruyère O, Beaudart C, et al. Correction to: Malnutrition, assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria but not by the mini nutritional assessment (MNA), predicts the incidence of sarcopenia over a 5-year period in the SarcoPhAge cohort. Aging Clin Exp Res, 2022, 34(12): 3179. doi: 10.1007/s40520-021-01901-3.
38. Xie K, He D, Zhao T, et al. Gastric cancer with sarcopenia: an area worth focusing on. Curr Treat Options Oncol, 2023, 24(10): 1305-1327.
39. Di Girolamo FG, Fiotti N, Milanović Z, et al. The aging muscle in experimental bed rest: a systematic review and meta-analysis. Front Nutr, 2021, 8: 633987. doi: 10.3389/fnut.2021.633987.
40. de Oliveira LC, Abreu GT, Lima LC, et al. Quality of life and its relation with nutritional status in patients with incurable cancer in palliative care. Support Care Cancer, 2020, 28(10): 4971-4978.
41. Hill A, Kiss N, Hodgson B, et al. Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr, 2011, 30(1): 92-98.
42. Chen F, Chi J, Liu Y, et al. Impact of preoperative sarcopenia on postoperative complications and prognosis of gastric cancer resection: A meta-analysis of cohort studies. Arch Gerontol Geriatr, 2022, 98: 104534. doi: 10.1016/j.archger.2021.104534.
43. Kang MK, Lee HJ. Impact of malnutrition and nutritional support after gastrectomy in patients with gastric cancer. Ann Gastroenterol Surg, 2024, 8(4): 534-552.
44. Yang B, Wang L, Yu K, et al. Three-stage nutrition diagnosis for surgical patients at the perioperative period. Eur J Surg Oncol, 2024, 50(5): 106759. doi: 10.1016/j.ejso.2022.10.019.
45. Molfino A, Imbimbo G, Laviano A. Current screening methods for the risk or presence of malnutrition in cancer patients. Cancer Manag Res, 2022, 14: 561-567.
46. Cereda E. Mini nutritional assessment. Curr Opin Clin Nutr Metab Care, 2012, 15(1): 29-41.
47. Ge YZ, Fu ZM, Zhang Q, et al. AIWW: a new nutrition-screening tool for the oncologic population. Sci China Life Sci, 2023, 66(8): 1831-1840.
48. Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of the Patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care, 2017, 20(5): 322-329.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress of influencing factors of malnutrition in gastric cancer and on clinical effects and its therapy strategies

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