Impact of perioperative high-protein nutritional support on postoperative outcomes in the treatment of primary lung cancer: Russian prospective multicenter comparative study (NUTRILUNC-study)

Abstract

BACKGROUND: Up to 60% of lung cancer pts experience weight loss. Prevalence of sarcopenia in patients (pts) with non-small cell lung cancer (NSCLC) is about 43% and is an independent predictor of worse overall survival. It was shown that nutritional support improves outcomes in pts with cancer.

AIM: To evaluate impact of perioperative nutritional support on surgical treatment outcomes of patients with NSCLC.

MATERIALS AND METHODS: Patients with primary NSCLC (n=112, 69 males), aged 57,2±8,2, awaiting lung surgery and being at risk of malnutrition (Nutritional Risk Screening Assessment 2002 score ≥3) were randomized into 2 groups. Study group (n=55) received oral nutritional support (Nutridrink Compact Protein, Nutricia LLC), 250 ml/d (36 g of protein, 612 kcal) for 14 d before and 14 d after surgery in addition to standard diet. Control group (n=57) had a standard diet. The number of respiratory complications after surgery, length of hospitalization, anthropometric, functional, laboratory parameters, quality of life (according to Quality of Life Questionnaire Core-30) were assessed. Results were presented as mean ± standard deviation. Differences were considered significant at p ≤0.05.

RESULTS: In the study group there were fewer respiratory complications (p <0.01), and a shorter length of hospitalization (p=0.03). Body weight in the study group did not change significantly, while in the control group it decreased (0.15±3.7 kg versus loss of 3.47±3.6 kg). Results of six-minute walk test and hand grip dynamometry were higher in the study group then in the control group (411.8±56.0 m versus 383.2±52.1 m; 33.5±8.4 kg versus 27.1±6.8 kg). Quality of life was better in the study group, p <0.05. The total protein and albumin levels were higher in the study group (70.9±5.6 g/l versus 63.1±4.0 g/l; 38.5±5.8 g/l versus 33.2±3.0 g/l). One patient in study group experienced 1st grade diarrhea.

CONCLUSION: In patients with NSCLC at risk of malnutrition perioperative nutritional support with high protein oral nutritional support has a positive effect on surgical treatment outcomes.

Keywords

lung cancer / perioperative nutritional support / postoperative complications

References

[1] Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30. doi: 10.3322/caac.21387

[2] Siegel R.L., Miller K.D., Jemal A. Cancer Statistics, 2017 // CA Cancer J Clin. 2017. Vol. 67, N 1. P. 7–30. doi: 10.3322/caac.21387

[3] Laktionov KK, Artamonova EV, Borisova TN, et al. Malignant neoplasm of the bronchi and lung: Russian clinical guidelines. Journal of Modern Oncology. 2022;24(3):269–304. EDN: AXJEXX doi: 10.26442/18151434.2022.3.201848

[4] Лактионов К.К., Артамонова Е.В., Борисова Т.Н., и др. Злокачественное новообразование бронхов и лёгкого // Современная онкология. 2022. Т. 24, № 3. С. 269–304. EDN: AXJEXX doi: 10.26442/18151434.2022.3.201848

[5] Bozzetti F. Nutrition support in patients with cancer. In: Payne-James E, Grimble G, Silk D, editors. Artificial nutrition support in clinical practice. London: Greenwich Medical Media Limited; 2001.

[6] Bozzetti F. Nutrition support in patients with cancer. In: Payne-James E., Grimble G., Silk D., editors. Artificial nutrition support in clinical practice. London : Greenwich Medical Media Limited, 2001.

[7] Von Haehling S, Anker SD. Prevalence, incidence and clinical impact of cachexia: facts and numbers — update 2014. J Cachexia Sarcopenia Muscle. 2014;5(4):261–263. doi: 10.1007/s13539-014-0164-8

[8] Von Haehling S., Anker S.D. Prevalence, incidence and clinical impact of cachexia: facts and numbers — update 2014 // J Cachexia Sarcopenia Muscle. 2014. Vol. 5, N 4. P. 261–263. doi: 10.1007/s13539-014-0164-8

[9] Yang M, Shen Y, Tan L, Li W. Prognostic value of sarcopenia in lung cancer: a systematic review and meta-analysis. Chest. 2019;156(1):101–111. doi: 10.1016/j.chest.2019.04.115

[10] Yang M., Shen Y., Tan L., Li W. Prognostic value of sarcopenia in lung cancer: a systematic review and meta-analysis // Chest. 2019. Vol. 156, N 1. P. 101–111. doi: 10.1016/j.chest.2019.04.115

[11] Obukhova OA, Kurmukov IA, Ryk AA. The effect of nutritional support on nutritional status, quality of life, and survival in cancer patients receiving systemic anticancer therapy. Clinical nutrition and metabolism. 2022;3(1):50–61. EDN: VJKFTI doi: 10.17816/clinutr104771

[12] Обухова О.А., Курмуков И.А., Рык А.А. Влияние нутритивной поддержки на питательный статус, качество жизни и выживаемость у онкологических больных, получающих системное лекарственное противоопухолевое лечение // Клиническое питание и метаболизм. 2022. Т. 3, № 1. С. 50–61. EDN: VJKFTI doi: 10.17816/clinutr104771

[13] Ivanova AS, Obukhova OA, Kurmukov IA, Volf LY. Review of ESPEN-2021 Practice Guidelines for Patients with Cancer. Part 2: Interventions Relevant to Specific Patient Categories. Clinical nutrition and metabolism. 2022;3(4):193–206. EDN: TKPXSS doi: 10.17816/clinutr119059

[14] Иванова А.С., Обухова О.A., Курмуков И.А., Вольф Л.Я. Обзор практических рекомендаций ESPEN-2021 для онкологических больных. Часть 2: частные вопросы нутритивной поддержки // Клиническое питание и метаболизм. 2022. Т. 3, № 4. С. 193–206. EDN: TKPXSS doi: 10.17816/clinutr119059

[15] Yang J, Zhang Q, Wang X. Role of nutritional support for postoperative recovery of respiratory function in patients with primary lung cancer. Oncol Lett. 2018;16(5):5978–5982. doi: 10.3892/ol.2018.9348

[16] Yang J., Zhang Q., Wang X. Role of nutritional support for postoperative recovery of respiratory function in patients with primary lung cancer // Oncol Lett. 2018. Vol. 16, N 5. P. 5978–5982. doi: 10.3892/ol.2018.9348

[17] 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. doi: 10.1177/0148607113502674

[18] 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. Vol. 38, N 2. P. 196–204. doi: 10.1177/0148607113502674

[19] O’Sullivan E, McAdam A, O’Sullivan M, et al. Nutritional status of pre-operative early stage lung cancer patients and dietary intake assessment post-operatively. Clin Nutr ESPEN. 2017;22:138. doi: 10.1016/j.clnesp.2017.07.057

[20] O’Sullivan E., McAdam A., O’Sullivan M., et al. Nutritional status of pre-operative early stage lung cancer patients and dietary intake assessment post-operatively // Clin Nutr ESPEN. 2017. Vol. 22. P. 138. doi: 10.1016/j.clnesp.2017.07.057

[21] Kononets PV, Obukhova OA, Sergienko AD. The role of nutritional support in non-small-cell lung cancer treatment. Clinical nutrition and metabolism. 2022;3(1):2837. EDN: WAQBUG doi: 10.17816/clinutr101394

[22] Кононец П.В., Обухова О.А., Сергиенко А.Д. Роль нутритивной поддержки в лечении немелкоклеточного рака лёгкого // Клиническое питание и метаболизм. 2022. Т. 3, № 1. С. 2837. EDN: WAQBUG doi: 10.17816/clinutr101394

[23] Smedley F, Bowling T, James M, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care. Br J Surg. 2004;91(8):983–990. doi: 10.1002/bjs.4578

[24] Smedley F., Bowling T., James M., et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care // Br J Surg. 2004. Vol. 91, N 8. P. 983–990. doi: 10.1002/bjs.4578

[25] Tsiryateva SB, Sativaldaev MN, Abgaryan AS, Pilenko SA. Clinical and pharmacoeconomical efficacy of preoperative nutrition support in early rehabilitation of patients with lung cancer. Medical science and education of Ural. 2019;20(3(99)):154–157. EDN: PCORFA

[26] Цирятьева С.Б., Сатывалдаев М.Н., Абгарян А.С., Пыленко С.А. Клиническая и фармако-экономическая эффективность предоперационной нутритивной поддержки в ранней реабилитации пациентов с раком лёгкого // Медицинская наука и образование Урала. 2019. Т. 20, № 3 (99). С. 154–157. EDN: PCORFA

[27] Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–655.

[28] Oken M.M., Creech R.H., Tormey D.C., et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group // Am J Clin Oncol. 1982. Vol. 5, N 6. P. 649–655.

[29] Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–336. doi: 10.1016/s0261-5614(02)00214-5

[30] Kondrup J., Rasmussen H.H., Hamberg O., et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials // Clin Nutr. 2003. Vol. 22, N 3. P. 321–336. doi: 10.1016/s0261-5614(02)00214-5

[31] Fietkau R, Lewitzki V, Kuhnt T, et al. A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: results of a randomized, controlled, multicenter trial. Cancer. 2013;119(18):3343–3353. doi: 10.1002/cncr.28197

[32] Fietkau R., Lewitzki V., Kuhnt T., et al. A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: results of a randomized, controlled, multicenter trial // Cancer. 2013. Vol. 119, N 18. P. 3343–3353. doi: 10.1002/cncr.28197

[33] Park S, Ahn HJ, Yang M, et al. The prognostic nutritional index and postoperative complications after curative lung cancer resection: A retrospective cohort study. J Thorac Cardiovasc Surg. 2020;160(1):276–285.e1. doi: 10.1016/j.jtcvs.2019.10.105

[34] Park S., Ahn H.J., Yang M., et al. The prognostic nutritional index and postoperative complications after curative lung cancer resection: A retrospective cohort study // J Thorac Cardiovasc Surg. 2020. Vol. 160, N 1. P. 276–285.e1. doi: 10.1016/j.jtcvs.2019.10.105

[35] Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–376. doi: 10.1093/jnci/85.5.365

[36] Aaronson N.K., Ahmedzai S., Bergman B., et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology // J Natl Cancer Inst. 1993. Vol. 85, N 5. P. 365–376. doi: 10.1093/jnci/85.5.365

[37] Sommer MS, Trier K, Vibe-Petersen J, et al. Perioperative rehabilitation in operation for lung cancer (PROLUCA) — rationale and design. BMC Cancer. 2014;14:404. doi: 10.1186/1471-2407-14-404

[38] Sommer M.S., Trier K., Vibe-Petersen J., et al. Perioperative rehabilitation in operation for lung cancer (PROLUCA) — rationale and design // BMC Cancer. 2014. Vol. 14. P. 404. doi: 10.1186/1471-2407-14-404

[39] Gillis C, Li C, Lee L, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121:937–947. doi: 10.1097/ALN.0000000000000393

[40] Gillis C., Li C., Lee L., et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer // Anesthesiology. 2014. Vol. 121. P. 937–947. doi: 10.1097/ALN.0000000000000393

[41] Ivanova AS, Obukhova OA, Kurmukov IA. Pre-rehabilitation as a possible component of eras protocol in modern operative gynecologic oncology. Onkoginekologiya. 2022;(4 (44)):60–70. EDN: KMPRWN doi: 10.52313/22278710_2022_4_60

[42] Иванова А.С., Обухова О.А., Курмуков И.А. Предреабилитация как возможный компонент протокола ERAS в современной оперативной онкогинекологии // Онкогинекология. 2022. № 4 (44). С. 60–70. EDN: KMPRWN doi: 10.52313/22278710_2022_4_60

[43] West MA, Wischmeyer PE, Grocott MPW. Prehabilitation and nutritional support to improve perioperative outcomes. Curr Anesthesiol Rep. 2017;7(4):340–349. doi: 10.1007/s40140-017-0245-2

[44] West M.A., Wischmeyer P.E., Grocott M.P.W. Prehabilitation and nutritional support to improve perioperative outcomes // Curr Anesthesiol Rep. 2017. Vol. 7, N 4. P. 340–349. doi: 10.1007/s40140-017-0245-2

[45] Voorn MJJ, Beukers K, Trepels CMM, et al. Associations between pretreatment nutritional assessments and treatment complications in patients with stage I-III non-small cell lung cancer: A systematic review. Clin Nutr ESPEN. 2022;47:152–162. doi: 10.1016/j.clnesp.2021.12.026

[46] Voorn M.J.J., Beukers K., Trepels C.M.M., et al. Associations between pretreatment nutritional assessments and treatment complications in patients with stage I-III non-small cell lung cancer: A systematic review // Clin Nutr ESPEN. 2022. Vol. 47. P. 152–162. doi: 10.1016/j.clnesp.2021.12.026

[47] Sytov AV, Zuzov SA, Kukosh MYu, et al. Practical recommendations on nutritional support for cancer patients. Zlokačestvennye opuholi. 2022;12(3S2-2):123–133. (In Russ). EDN: MHWFRW doi: 10.18027/2224-5057-2022-12-3s2-123-133

[48] Сытов А.В., Зузов С.А., Кукош М.Ю., и др. Практические рекомендации по нутритивной поддержке онкологических больных // Злокачественные опухоли. 2022. Т. 12, № 3S2-2. С. 123–133. EDN: MHWFRW doi: 10.18027/2224-5057-2022-12-3s2-123-133

[49] Liu Z, Qiu T, Pei L, et al. Two-week multimodal prehabilitation program improves perioperative functional capability in patients undergoing thoracoscopic lobectomy for lung cancer: a randomized controlled trial. Anesth Analg. 2020;131(3):840–849. doi: 10.1213/ANE.0000000000004342

[50] Liu Z., Qiu T., Pei L., et al. Two-week multimodal prehabilitation program improves perioperative functional capability in patients undergoing thoracoscopic lobectomy for lung cancer: a randomized controlled trial // Anesth Analg. 2020. Vol. 131, N 3. P. 840–849. doi: 10.1213/ANE.0000000000004342

[51] Fiorelli A, Vicidomini G, Mazzella A, et al. The influence of body mass index and weight loss on outcome of elderly patients undergoing lung cancer resection. Thorac Cardiovasc Surg. 2014;62(7):578–587. doi: 10.1055/s-0034-1373733

[52] Fiorelli A., Vicidomini G., Mazzella A., et al. The influence of body mass index and weight loss on outcome of elderly patients undergoing lung cancer resection // Thorac Cardiovasc Surg. 2014. Vol. 62, N 7. P. 578–587. doi: 10.1055/s-0034-1373733

[53] Takahashi M, Sowa T, Tokumasu H, et al. Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2020;162(4):1257–1268. doi: 10.1016/j.jtcvs.2020.06.030

[54] Takahashi M., Sowa T., Tokumasu H., et al. Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer // J Thorac Cardiovasc Surg. 2020. Vol. 162, N 4. P. 1257–1268. doi: 10.1016/j.jtcvs.2020.06.030

[55] Jagoe RT, Goodship TH, Gibson GJ. The influence of nutritional status on complications after operations for lung cancer. Ann Thorac Surg. 2001;71(3):936–943. doi: 10.1016/s0003-4975(00)02006-3

[56] Jagoe R.T., Goodship T.H., Gibson G.J. The influence of nutritional status on complications after operations for lung cancer // Ann Thorac Surg. 2001. Vol. 71, N 3. P. 936–943. doi: 10.1016/s0003-4975(00)02006-3

[57] Madariaga MLL, Troschel FM, Best TD, et al. Low thoracic skeletal muscle area predicts morbidity after pneumonectomy for lung cancer. Ann Thorac Surg. 2020;109(3):907–913. doi: 10.1016/j.athoracsur.2019.10.041

[58] Madariaga M.L.L., Troschel F.M., Best T.D., et al. Low thoracic skeletal muscle area predicts morbidity after pneumonectomy for lung cancer // Ann Thorac Surg. 2020. Vol. 109, N 3. P. 907–913 doi: 10.1016/j.athoracsur.2019.10.041

[59] Ornaghi PI, Afferi L, Antonelli A, et al. The impact of preoperative nutritional status on post-surgical complication and mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review of the literature. World J Urol. 2020;39: 1045–1081. doi: 10.1007/s00345-020-03291-z

[60] Ornaghi P.I., Afferi L., Antonelli A., et al. The impact of preoperative nutritional status on post-surgical complication and mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review of the literature // World J Urol. 2020. Vol. 39. P. 1045–1081. doi: 10.1007/s00345-020-03291-z

[61] Jiang S, Wang B, Zhang M, et al. Quality of life after lung cancer surgery: sublobar resection versus lobectomy. BMC Surg. 2023;23(1):353. doi: 10.1186/s12893-023-02259-1

[62] Jiang S., Wang B., Zhang M., et al. Quality of life after lung cancer surgery: sublobar resection versus lobectomy // BMC Surg. 2023. Vol. 23, N 1. P. 353. doi: 10.1186/s12893-023-02259-1

RIGHTS & PERMISSIONS

Eco-Vector