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A novel model with nutrition-related parameters for predicting overall survival of cancer patients

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Abstract

Background

Increasing evidence indicates that nutritional status could influence the survival of cancer patients. This study aims to develop and validate a nomogram with nutrition-related parameters for predicting the overall survival of cancer patients.

Patients and methods

A total of 8749 patients from the multicentre cohort study in China were included as the primary cohort to develop the nomogram, and 696 of these patients were recruited as a validation cohort. Patients’ nutritional status were assessed using the PG-SGA. LASSO regression models and Cox regression analysis were used for factor selection and nomogram development. The nomogram was then evaluated for its effectiveness in discrimination, calibration, and clinical usefulness by the C-index, calibration curves, and decision curve analysis. Kaplan–Meier survival curves were used to compare the survival rate.

Results

Seven independent prognostic factors were identified and integrated into the nomogram. The C-index was 0.73 (95% CI, 0.72 to 0.74) and 0.77 (95% CI, 0.74 to 0.81) for the primary cohort and validation cohort, which were both higher than 0.59 (95% CI, 0.58 to 0.61) of the TNM staging system. DCA demonstrated that the nomogram was higher than the TNM staging system and the TNM staging system combined with PG-SGA. Significantly median overall survival differences were found by stratifying patients into different risk groups (score < 18.5 and ≥ 18.5) for each TNM category (all Ps < 0.001).

Conclusion

Our study screened out seven independent prognostic factors and successfully generated an easy-to-use nomogram, and validated and shown a better predictive validity for the overall survival of cancer patients.

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References

  1. Glare P, Sinclair C, Downing M, Stone P, Maltoni M, Vigano A (2008) Predicting survival in patients with advanced disease. Eur J Cancer 44:1146–1156

    Article  Google Scholar 

  2. Shida D, Kanemitsu Y, Hamaguchi T, Shimada Y (2019) Introducing the eighth edition of the tumor-node-metastasis classification as relevant to colorectal cancer, anal cancer and appendiceal cancer: a comparison study with the seventh edition of the tumor-node-metastasis and the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma. Jpn J Clin Oncol 49: 321-328

  3. Liang W, Zhang L, Jiang G, Wang Q, Liu L, Liu D, Wang Z, Zhu Z, Deng Q, Xiong X, Shao W, Shi X, He J (2015) Development and validation of a nomogram for predicting survival in patients with resected non-small-cell lung cancer. J Clin Oncol 33:861–869

    Article  Google Scholar 

  4. Kanesvaran R, Li H, Koo KN, Poon D (2011) Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. J Clin Oncol 29:3620–3627

    Article  Google Scholar 

  5. Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, Plastino F, Gori S, Magarotto R, Carteni G, Chiurazzi B, Pavese I, Marchetti L, Zagonel V, Bergo E, Tonini G, Imperatori M, Iacono C, Maiorana L, Pinto C, Rubino D, Cavanna L, Di Cicilia R, Gamucci T, Quadrini S, Palazzo S, Minardi S, Merlano M, Colucci G, Marchetti P, PreMi OSG (2017) Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget 8:79884–79896

    Article  Google Scholar 

  6. Kruizenga H, van Keeken S, Weijs P, Bastiaanse L, Beijer S, Huisman-de Waal G, Jager-Wittenaar H, Jonkers-Schuitema C, Klos M, Remijnse-Meester W, Witteman B, Thijs A (2016) Undernutrition screening survey in 564,063 patients: patients with a positive undernutrition screening score stay in hospital 1.4 d longer. Am J Clin Nutr 103:1026–1032

    Article  CAS  Google Scholar 

  7. Song C, Cao J, Zhang F, Wang C, Guo Z, Lin Y, Shi Y, Hu W, Ba Y, Xu H, Li W, Shi H (2019) Nutritional risk assessment by scored patient-generated subjective global assessment associated with demographic characteristics in 23,904 common malignant tumors patients. Nutr Cancer 71:50–60

    Article  Google Scholar 

  8. Attar A, Malka D, Sabate JM, Bonnetain F, Lecomte T, Aparicio T, Locher C, Laharie D, Ezenfis J, Taieb J (2012) Malnutrition is high and underestimated during chemotherapy in gastrointestinal cancer: an AGEO prospective cross-sectional multicenter study. Nutr Cancer 64:535–542

    Article  CAS  Google Scholar 

  9. Gupta D, Vashi PG, Lammersfeld CA, Braun DP (2011) Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Ann Nutr Metab 59:96–106

    Article  CAS  Google Scholar 

  10. Bozzetti F, Cotogni P, Lo Vullo S, Pironi L, Giardiello D, Mariani L (2015) Development and validation of a nomogram to predict survival in incurable cachectic cancer patients on home parenteral nutrition. Ann Oncol 26:2335–2340

    Article  CAS  Google Scholar 

  11. Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12:S15-19

    Article  CAS  Google Scholar 

  12. Guerra RS, Fonseca I, Pichel F, Restivo MT, Amaral TF (2015) Usefulness of six diagnostic and screening measures for undernutrition in predicting length of hospital stay: a comparative analysis. J Acad Nutr Diet 115:927–938

    Article  Google Scholar 

  13. Fujiya K, Kawamura T, Omae K, Makuuchi R, Irino T, Tokunaga M, Tanizawa Y, Bando E, Terashima M (2018) Impact of malnutrition after gastrectomy for gastric cancer on long-term survival. Ann Surg Oncol 25:974–983

    Article  Google Scholar 

  14. Poulia KA, Klek S, Doundoulakis I, Bouras E, Karayiannis D, Baschali A, Passakiotou M, Chourdakis M (2017) The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition. Clin Nutr 36:1130–1135

    Article  Google Scholar 

  15. Skipper A, Ferguson M, Thompson K, Castellanos VH, Porcari J (2012) Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enteral Nutr 36:292–298

    Article  Google Scholar 

  16. Martin L, Watanabe S, Fainsinger R, Lau F, Ghosh S, Quan H, Atkins M, Fassbender K, Downing GM, Baracos V (2010) Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction. J Clin Oncol 28:4376–4383

    Article  Google Scholar 

  17. Erickson N, Storck LJ, Kolm A, Norman K, Fey T, Schiffler V, Ottery FD, Jager-Wittenaar H (2019) Tri-country translation, cultural adaptation, and validity confirmation of the Scored Patient-Generated Subjective Global Assessment. Support Care Cancer 27:3499–3507

    Article  Google Scholar 

  18. Yu JM, Yang M, Xu HX, Li W, Fu ZM, Lin Y, Shi YY, Song CH, Shi HP, Guo ZQ, Investigation on Nutrition S, Clinical Outcome of Common Cancers G (2019) Association between serum C-reactive protein concentration and nutritional status of malignant tumor patients. Nutr Cancer 71:240–245

    Article  CAS  Google Scholar 

  19. Guo ZQ, Yu JM, Li W, Fu ZM, Lin Y, Shi YY, Hu W, Ba Y, Li SY, Li ZN, Wang KH, Wu J, He Y, Yang JJ, Xie CH, Song XX, Chen GY, Ma WJ, Luo SX, Chen ZH, Cong MH, Ma H, Zhou CL, Wang W, Luo Q, Shi YM, Qi YM, Jiang HP, Guan WX, Chen JQ, Chen JX, Fang Y, Zhou L, Feng YD, Tan RS, Li T, Ou JW, Zhao QC, Wu JX, Deng L, Lin X, Yang LQ, Yang M, Wang C, Song CH, Xu HX, Shi HP, Investigation on the Nutrition S, Clinical Outcome of Common Cancers G (2020) Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life. Support Care Cancer 28:373–380

    Article  Google Scholar 

  20. Kubrak C, Olson K, Jha N, Jensen L, McCargar L, Seikaly H, Harris J, Scrimger R, Parliament M, Baracos VE (2010) Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck 32:290–300

    PubMed  Google Scholar 

  21. Mauricio SF, Xiao J, Prado CM, Gonzalez MC, Correia M (2018) Different nutritional assessment tools as predictors of postoperative complications in patients undergoing colorectal cancer resection. Clin Nutr 37:1505–1511

    Article  Google Scholar 

  22. O’Sullivan B, Brierley J, Byrd D, Bosman F, Kehoe S, Kossary C, Pineros M, Van Eycken E, Weir HK, Gospodarowicz M (2017) The TNM classification of malignant tumours-towards common understanding and reasonable expectations. Lancet Oncol 18:849–851

    Article  Google Scholar 

  23. Cho JK, Lee GJ, Yi KI, Cho KS, Choi N, Kim JS, Kim H, Oh D, Choi SK, Jung SH, Jeong HS, Ahn YC (2015) Development and external validation of nomograms predictive of response to radiation therapy and overall survival in nasopharyngeal cancer patients. Eur J Cancer 51:1303–1311

    Article  Google Scholar 

  24. Schneider SM, Correia M (2020) Epidemiology of weight loss, malnutrition and sarcopenia: A transatlantic view. Nutrition 69:110581

    Article  Google Scholar 

  25. Derks MG, de Glas NA, Bastiaannet E, de Craen AJ, Portielje JE, van de Velde CJ, van Leeuwen FE, Liefers GJ (2016) Physical functioning in older patients with breast cancer: a prospective cohort study in the TEAM trial. Oncologist 21:946–953

    Article  Google Scholar 

  26. Klute KA, Brouwer J, Jhawer M, Sachs H, Gangadin A, Ocean A, Popa E, Dai T, Wu G, Christos P, Shah MA (2016) Chemotherapy dose intensity predicted by baseline nutrition assessment in gastrointestinal malignancies: a multicentre analysis. Eur J Cancer 63:189–200

    Article  Google Scholar 

  27. Aapro M, Arends J, Bozzetti F, Fearon K, Grunberg SM, Herrstedt J, Hopkinson J, Jacquelin-Ravel N, Jatoi A, Kaasa S, Strasser F, Esmo (2014) Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol 25:1492–1499

    Article  CAS  Google Scholar 

  28. Beattie AH, Prach AT, Baxter JP, Pennington CR (2000) A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients. Gut 46:813–818

    Article  CAS  Google Scholar 

  29. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489–495

    Article  Google Scholar 

  30. Sanchez-Lara K, Ugalde-Morales E, Motola-Kuba D, Green D (2013) Gastrointestinal symptoms and weight loss in cancer patients receiving chemotherapy. Br J Nutr 109:894–897

    Article  CAS  Google Scholar 

  31. Van Calster B, Vickers AJ (2015) Calibration of risk prediction models: impact on decision-analytic performance. Med Decis Making 35:162–169

    Article  Google Scholar 

  32. Argiles JM, Muscaritoli M (2017) Unifying diagnostic criteria for cachexia: an urgent need. Clin Nutr 36:910–911

    Article  Google Scholar 

  33. Isenring E, Elia M (2015) Which screening method is appropriate for older cancer patients at risk for malnutrition? Nutrition 31:594–597

    Article  Google Scholar 

  34. Rutten IJ, van Dijk DP, Kruitwagen RF, Beets-Tan RG, OldeDamink SW, van Gorp T (2016) Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients. J Cachexia Sarcopenia Muscle 7:458–466

    Article  Google Scholar 

Download references

Acknowledgements

Sincere thanks to Yu Duan and Jianshan Ding for their statistical guidance of the manuscript, and we thank all of our colleagues for assistance in this study.

Author information

Author notes

  1. Qi Zhang, Kangping Zhang and Xiangrui Li contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China

    Qi Zhang, Kangping Zhang, Xiangrui Li, Xi Zhang, Mengmeng Song, Tong Liu & Han-ping Shi

  2. Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China

    Qi Zhang, Kangping Zhang, Xiangrui Li, Xi Zhang, Mengmeng Song, Tong Liu & Han-ping Shi

  3. Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China

    Chunhua Song

  4. Department of Medical, Surgical and Health Sciences – University of Trieste, Trieste, Italy

    Rocco Barazzoni

  5. Department of Gastrointestinal Surgery, Institute of Gastroenterology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China

    Kunhua Wang

  6. Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing, 400042, China

    Hongxia Xu

  7. Cancer Center, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Zhenming Fu

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  1. Qi Zhang
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Contributions

Conception and design: Hanping Shi, Qi Zhang, Zhenming Fu; administrative support: Hanping Shi, Hongxia Xu, Wei Li; provision of study materials or patients: Zhaoping Li, Rocco Barazzoni, Zengqing Guo, Tao Li, Junqiang Chen, Zengning Li, Ming Liu, Kaitao Yuan, Minghua Cong, Kunhua Wang, Min Weng, Miao Yu; collection and assembly of data: Kangping Zhang, Xiangrui Li; data analysis and interpretation: Xi Zhang, Mengmeng Song, Tong Liu; manuscript writing: all authors; final approval of manuscript: all authors.

Corresponding authors

Correspondence to Zhenming Fu or Han-ping Shi.

Ethics declarations

Ethics approval

The study was conducted in line with the Helsinki declaration; its design was approved by the local Ethics Committees of all participant hospitals. All patients signed an informed consent form before participating in the study. The trial was registered at http://www.chictr.org.cn with registration number ChiCTR1800020329.

Consent to participate

All patients provided written consent for the scientific use of their data.

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N/A.

Conflict of interest

The authors declare no competing interests.

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Zhang, Q., Zhang, K., Li, X. et al. A novel model with nutrition-related parameters for predicting overall survival of cancer patients. Support Care Cancer 29, 6721–6730 (2021). https://doi.org/10.1007/s00520-021-06272-z

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  • DOI: https://doi.org/10.1007/s00520-021-06272-z

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