Inflamação sistêmica e estado nutricional nos pacientes em tratamento paliativo para câncer: uma revisão sistemática de estudos observacionais aplicada no prognóstico e direcionamento de terapias oncológicas

Abstract

This study aimed to systematic literature review explores the results of studies that have analyzed the association between inflammation and nutritional status in cancer patients in palliative care. The bibliographic research was performed in May 2019, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Group guidelines. The inclusion criteria were papers that: (1) had an on-line abstract available; (2) were original; (3) used a cohort or cross-sectional design; (4) involved patients with advanced cancer in palliative care; and (5) assessed the association between inflammation and nutritional status. The quality assessment was performed using the Newcastle-Ottawa Scale. Nine studies were selected. Weight loss (WL; n = 7) was the most common nutritional marker employed and C-reactive protein (CRP; n = 6) was the most common inflammatory marker. There was considerable variability (39.0%–92.2%) in the proportion of patients who had WL in a six-month period, while CRP > 5 mg/L was common in 45.3% – 73.9% of patients.Systemic inflammation was related to nutritional status, highlighting the relationship between CRP and WL and lean mass (LM). Patients with CRP > 10 mg/L have been found to have a lower LM (p < 0.001) and a faster rate of loss of LM at a faster rate during the disease trajectory (p = 0.030). In most articles, intensified systemic inflammation, as reflected by the elevation of the modified Glasgow Prognostic Score (EPGm), was related to poorer nutritional status assessed by the Global Patient-Produced Subjective Assessment (ASG-PPP) and both associated with poorer overall survival in advanced cancer. Nutritional status is associated with systemic inflammatory response. Inflammatory markers should be considered an additional parameter for the nutritional diagnosis of cancer patients in palliative care. The main validated prognostic tools for assessing nutritional status and systemic inflammation in this population were, respectively, ASG-PPP and EPGm, both of which are reliable indicators to assist in the most favorable therapeutic decision for cancer patients in palliative care. The main prognostic tools considered validated for nutritional status assessment were weight loss, lean mass loss and ASG-PPP; to assess systemic inflammation was PCR and EPGm; therefore, they could ideally be used together as reliable indicators to aid in the most favorable therapeutic decision for advanced cancer patients.