Gabriela Villaça Chaves

Nutritional status assessed by Patient-Generated Subjective Global Assessment is associated with toxicity to chemoradiotherapy in women with cervical cancer: a prospective study

Patient-generated subjective global assessment (PG-SGA), a validated tool for nutritional assessment, has been associated with worse clinical outcomes in patients with cancer. However, studies assessing its relationship in chemoradiotherapy outcomes are scarce. The study aimed to determine the prevalence of malnutrition according to PG-SGA and its association with the incidence of toxicity to chemoradiotherapy treatment in women with cervical cancer. In a single-centre prospective observational study, we enrolled 391 women with locally advanced cervical cancer. Patients were assessed on the day of their first chemotherapy infusion, when nutritional status was evaluated by the PG-SGA form and anthropometric measurements. Sociodemographic and clinical data were also collected. Toxicity to chemoradiotherapy was assessed weekly and toxicity-induced modification of treatment (TIMT) was defined as any serious adverse event that resulted in treatment delay, interruption, or dose reduction. Multivariate mixed-effects Poisson and Logistic regression models were performed to identify the factors contributing to the outcome number of adverse events ≥ grade 3 and TIMT, respectively. Malnutrition was found in 47.6% of the population. Roughly 1/3 had TIMT and 54.2% experienced at least one symptom ≥grade 3. In the adjusted models, PG-SGA B and C, as well as the score ≥9 were independent predictors of the number of toxicity events ≥grade 3 and higher incidence of TIMT. PG-SGA may represent an important assessment tool to predict toxicity outcomes in women with cervical cancer, besides being considered a simple, fast, and low-cost tool, which allows early nutritional care.

Body composition phenotypes and long-term survival of endometrial cancer

Although overweight and obesity are associated with a higher risk of cancer, some studies have been reporting a better prognosis among overweight patients. The obesity paradox in cancer needs further investigation, since data are still controversial. The study aimed to examine if there is an association between different phenotypes of body composition and 5-year overall survival (OS) among patients with endometrial cancer. In a retrospective cohort study, we enrolled 486 endometrial cancer patients who had computed tomography images available prior to first treatment for body composition assessment. Both adipose and skeletal muscle index (SMI) compartments were presented in tertiles. The lower tertile of SMI was considered low SMI. For visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT), values above the highest tertile were classified as high adiposity. Skeletal muscle radiodensity (SMD) was obtained by averaging the HU of skeletal muscle (SM). The primary outcome was 5-year (OS). A significantly shorter median survival was found for patients with low SMI, low SMD, and high TAT. The combined decline in SMI and SMD had the greatest impact on survival. In adjusted Cox regression models, low SMI and low SMD were independently associated with increased mortality risk, whereas high TAT showed a protective effect against mortality. Phenotypes combining low SMI with low SMD and high or normal adipose tissue (SAT, VAT, or TAT) were linked to reduced survival, except for 'low SMI + normal SAT'. Conversely, normal SMI with high SAT and TAT was associated with lower mortality risk. Our findings underscore the important role of SM mass, especially when combined to muscle radiodensity and adipose tissue in predicting OS in endometrial cancer patients.