营养不足是老年癌症患者早期死亡的独立预测因子

　　微型营养评定简表（MNA-SF）可以快速有效地确定老年患者营养不良或营养不足的早期风险。通过MNA-SF评定出的老年肿瘤患者营养不足可能与其早期死亡相关，并可提示医务人员有针对性地优化治疗方案。

　　为了验证这种可能性，巴西国家癌症研究所、里约热内卢州立大学对136例≥65岁的老年肿瘤患者，在入院48小时内进行MNA-SF评分。

　　结果发现：41.2%的患者存在营养不良风险，29.4%的患者存在营养不足。其中营养不足患者一年死亡率显著升高，紧随其后的是存在营养不良风险的患者（P＜0.001）。多变量回归模型显示营养不足是一年死亡的独立风险因素（风险比：5.59，P＜0.001）。

　　因此，MNA-SF评分＜7分或营养不足的老年患者早期死亡风险较高。

JPEN J Parenter Enteral Nutr. 2017;41(2):278.

Undernutrition as independent predictor of early mortality in elderly cancer patients.

Renata B. Martucci; Mariana V. Barbosa; Cristiane D'Almeida; Viviane D. Rodrigues; Anke Bergmann; Nivaldo B. de Pinho; Luiz Claudio S. Thuler.

Instituto Nacional de Cancer, Rio de Janeiro, Brazil; State University of Rio de Janeiro, Rio de Janeiro, Brazil.

PURPOSE: Mini Nutritional Assessment-Short Form (MNA-SF) is a tool that fulfills screening and nutrition evaluation criteria, validated for patients aged ≥65 years, and can be applied by professional nutritionists, nurses, or doctors. It then becomes a simple and useful tool in clinical practice, identifying quickly an early risk of malnutrition or undernutrition in elderly patients. Investigating whether undernutrition assessed by the MNA-SF predicts early mortality can help oncologists in deciding the treatment of elderly patients with cancer. The aim of this study was to evaluate the 1-year survival of elderly patients with cancer and the association between undernutrition and mortality.

METHODS: Cohort study with elderly patients ≥65 years admitted in the period from September to October 2014. A nutritionist performed a MNA-SF for 48 hours of hospital admission and collected data about potential confounding variables (comorbidities, stage of cancer, treatment in the past 3 months, and reason for hospitalization). Vital status was determined from the medical records or public records office. Overall survival was estimated using the Kaplan-Meier method. Cox regression was performed to estimate unadjusted hazard ratios. Variables with P values <.20 by univariate analysis were selected for multivariate analysis. P values <.05 were considered statistically significant.

RESULTS: Of the 136 patients (mean age, 73.1 years; 52.2% men), 29.4%, 41.2%, and 29.4% were classified as normal, at risk of malnutrition and undernutrition, respectively, according to the MNA-SF. Half of patients with oral cavity cancer and respiratory tract cancer were classified as undernourished by the MNA-SF. The majority (75%) of undernourished patients had cancer in advanced stage (P < .001). Fifty-three percent of patients who were hospitalized for medical reasons (P < .001) and 47% of those with advanced disease (P < .001) were also undernourished, according to the MNA-SF. The mortality rate was 31.6% after 12 months. One-year mortality was higher among the undernourished patients, followed by patients at risk of malnutrition (P < .001). After adjustment for confounding variables, the multivariate regression Cox model showed that being undernourished according to the MNA-SF increased the risk of death at 1 year (hazard ratio [HR], 5.59; 95% confidence interval [CI], 1.8-17.3; P < .001).

CONCLUSIONS: The search for predictive factors of survival in elderly cancer patients is not only of speculative interest but also crucial to treatment decision. A MNA-SF score below 7 or undernutrition could identify patients with risk of early mortality, independent of other known predicted factors. The results show that the MNA-SF can be useful in identifying elderly patients at higher risk of 1-year mortality. We also encourage conducting further research with larger samples and specific approach about the impact of risk of malnutrition and undernutrition in elderly patients with cancer.

DOI: 10.1177/0148607116686023