The relationship between nutritional status and prognosis in advanced gastrointestinal cancer patients in palliative care: an observational cohort study

Abstract

Abstract Objective The study aimed to determine the nutritional status and its prognostic effect on survival of patients with advanced gastrointestinal cancer. Methods An observational cohort study design was conducted in a tertiary hospital in Shanghai, China. The study consisted of 202 advanced gastrointestinal (GI) cancer patients from a palliative care unit. The following data was collected from the patients: biochemical indicators, i.e. anemia (hemoglobin levels), albumin, pre-albumin, C-reactive protein (CRP), and anthropometric parameters, i.e. body mass index, nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA), symptoms in nutrition by a structured questionnaire and performance status by Karnofsky Performance Status (KPS). Severe malnutrition was confirmed with the PG-SGA score of ≥9. Kaplan-Meier survival analysis and the log-rank test were used to calculate overall survival (OS). The effect of nutritional status on survival was performed by Cox regression analysis. Results Severe malnutrition was found in 71.3% of patients according to the cutoff of the PG-SGA. PG-SGA score ≥ 9, albumin level < 35 g/L and CRP level ≥10 mg/L predicted shorten life expectancy. Multivariate Cox regression analysis results showed that PG-SGA score ≥ 9 and the albumin level < 35 g/L were predictive of OS. Conclusion Our data supported that severe malnutrition was a predictor for OS in advanced GI cancer patients. Information on nutritional status should be considered to individualize palliative care plan for these patients, and hence improve their quality of life.