| Objective: To investigate the nutritional state of patients with advanced gastric cancer by the traditional methods of nutritional assessment, Scored Patient-Generated Subjective Global Assessment(PG-SGA) and nutritional risk screening 2002(NRS 2002), and to find the relationship of nutritional status of patients and their quality of life.Methods: 467 patients with advanced gastric cancer(c T3/4,N0/+,M0)by first visit, including 363 cases of male, 105 cases of female, average age 59.04±10.10,were evaluated by different nutrition screenings or assessment as follows,(1) the traditional:the body mass index(BMI)≤18.5 or albumin(ALB)<35g/L;(2) patient-generated subjective global assessment,(PG-SGA) with the first part is the patient self rating scale, including the changes of body weight, eating, symptoms, activities and physical function score; the second part is the medical staff assessment, including disease age score, score of stress status and score of physical examination;(3) Nutrition risk screening, NRS 2002, Publised by European Society of parenteral and enteral nutrition(ESPEN),which based on 128 nutritional status of the randomized controlled clinical trials(randomizedcontrolledtrial, RCT) to select the core index to reflect the risk of malnutrition,suitable for hospitalized patients: Including the disease score(0 ~ 3), the nutritional score(0 ~ 3), age(over 70 years old with a score of 1 points), three is the sum of the nutrition risk score, total score of 0 to 7. Quantitative evaluation of PG-SGA by four of the total score.When the total score of 0 to 1, without intervention, maintain regular follow-up and evaluation during the treatment period; 2 ~ 3 patients or family education needed by dietitians, nurses or doctors, and drug intervention appropriately according to the symptoms and laboratory examination;from 4 to 8, to intervene by the dietitian, added the doctor or nurse with nutritional intervention according to the severity; more than 9 points needed to improve symptoms and / or nutritional support treatment at the same time. PG-SGA qualitative evaluation is divided into good nutrition(Class A), mild malnutrition or suspected malnutrition(Class B), severe malnutrition(Class C).At the same time,quality of life questionnaire of stomach22(QLQ- STO22) was evaluated.Including 9 subscales, 22 items: dysphagia(4 items), stomach pain(4 items), vomit(3 items), dietary restriction(4 items), anxiety(3 items), dry mouth(1 items), taste(1 items), physical appearance(1 items), hair loss(1 items). Each set of 1 ~ 4, through a special formula to calculate the score of each factor and the total average score.Result:1 Traditional nutrition assessment method showed: the malnutrition incidence of patients with advanced gastric cancer was 24.41%.2 Using the nutrition of traditional evaluation methods, normal nutrition group BMI was 23.53±3.29, malnutrition group was 18.80± 3.02. Normal nutrition group albumin was 40.61±3.46, and malnutrition group, albumin(ALB) was 37.48±5.43. On the other hand, compared with the normal nutrition group, in the pre albumin(PA), hemoglobin(Hb), lymphocyte count(TLC), mid arm circumference(MAC), triceps skinfold thickness(TSF), arm muscle circumference(MAMC) and the non-profit grip have obvious difference(P < 0.05).3 PG-SGA evaluation showed: mild malnutrition or suspected malnutrition(B) incidence rate was 45.82%, severe malnutrition(C) incidence rate was 30.41%.Using the conventional methods of nutritional assessment as the standard, the sensitivity of PG-SGA was 94.74%, the specificity was 29.75%, the positive predictive value was 30.33%, the negative predictive value was 94.59%.4 NRS 2002 showed: Patients with nutrition risk incidence rate is 51.61%, if using the traditional methods of nutritional assessment as the standard, the sensitivity of NRS 2002 was 91.23%, the specificity was 61.19%, the positive predictive value was 43.15%, the negative predictive value was 95.58%.5 There were significant correlation between the scores of PG-SGA and BMI, ALb, PA, Hb, weight loss, eating less, MAC, TSF, MAMC and the non-profit grip(P < 0.05).6 There were obviously correlation between the NRS2002 score and BMI, ALb, PA, Hb, weight loss, diet reduce, MAC and the non-profit grip(P < 0.05).7 In the group of traditional nutrition assessment method,malnutrition group the QLQ-STO22 score was 20.08±6.47, was significantly higher than that in the normal nutrition group 11.09±4.78(P < 0.05), and the malnutrition group in patients with dysphagia, hiccup, dietary restriction and anxiety,the scores were higher than normal nutrition group(P < 0.05).8 In the PG-SGA group, a good nutritional status(Grade A) QLQ-STO22 score was 9.61±4.54, and the B+C score was 13.32±6.06, and the B+C level in patients with difficulty in swallowing, stomach pain, limited diet, physical appearance and dimension scores higher, there was significant difference with group A(P < 0.05).9 In the NRS 2002 group, QLQ-STO22 score in no nutritional was 10.32±4.24, while the nutritional risk group score was 14.70±6.70, and the patients in nutritional risk with difficulty in swallowing, stomach pain, hiccup, restricted diet, physical appearance dimension score were higher, had statistical difference with no nutritional risk group(P < 0.05).Conclusion:1 Patients with advanced gastric cancer has different degree of nutritional problems.2 Nutrition status of patients with gastric cancer at the first visit could be evaluated by traditional assessment, PG- SGA, NRS 2002.3 PG-SGA was a more efficient tool than traditional nutrition assessment and NRS 2002.4 Patients with nutritional risk or malnutrition had poor life quality. |
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