The Potential Clinical Significance of the Serum Iron and Ferritin Status in Lung Cancer Patients

Background An increasing number of studies have shown that iron, one of the indispensable trace elements in the human body, is closely related to the occurrence and development of cancer. However, few studies have clearly demonstrated the role of the iron levels in lung cancer patients, or the potential effects of inflammation on iron levels. Methods The clinical data for lung cancer patients and non-lung cancer participants were retrospectively analyzed. The serum iron and ferritin levels were measured and compared using a rank-sum test. The correlation between the serum iron/ferritin and C-reactive protein (CRP) was analyzed by rank correlation. The cut-off values for continuous variables were obtained by the receiver operating characteristic curve (ROC) method. An analysis of potential prognostic factors in lung cancer patients was conducted by univariate and multivariate survival analyses. Results The serum iron levels in patients with extensive small-cell lung cancer (SCLC) were lower than those with limited-stage SCLC, and the levels of serum ferritin and CRP in those with extensive SCLC were higher than those with limited-stage SCLC. Similarly, the serum iron levels in patients with stage IV non-small cell lung cancer (NSCLC) were lower than those of patients with stage Ⅰ-Ⅲ disease, and the levels of serum ferritin and CRP in those with stage IV NSCLC were higher than those in stages Ⅰ-Ⅲ. The serum iron level was negatively correlated with the level of CRP, while the serum ferritin level was positively correlated with CRP. The stage of lung cancer, but not the serum iron/ ferritin level, was an independent prognostic factor in lung cancer patients. Conclusions The serum iron and ferritin levels are associated with the staging of lung cancer. The later stages of lung cancer are associated with a lower serum iron level, a higher serum ferritin level, and a higher CRP level. Inflammation may play an important role in regulating the serum iron and ferritin levels in lung cancer patients.

Nutritional Profile of Oncology Patients from an Outpatient Nutritional Service in Brazil

Objective To characterize the nutritional variables of patients referred to an outpatient oncology nutrition service. Methods The electronic medical records of patients diagnosed with malignant neoplasms were analyzed for several parameters: weight loss, body mass index (BMI), hand-grip strength (HGS), fat-free mass index (FFMI) and serum C-reactive protein (CRP). Statistical methods included Pearson’s correlation (significance was set at P ≤ 0.05). Results There was a high prevalence of malnutrition (44%, n = 28) and sarcopenia (61%, n = 23) and a relatively low prevalence of cachexia (13%, n = 6). Moderate positive correlations were observed between the tumor site and CRP level, correlation r = 0.328 (P = 0.026); the tumor site and BMI (r = 0, P = 0.001); FFMI and BMI (r = 0.606, P = 4.334056e-005) and CRP and weight loss (r = 0.355, P = 0.024). There were negative correlations between the tumor staging and BMI r = -0.409, P = 0.001) and weight loss and FFMI (r = -0.467, P = 3,228325e-004). Conclusion These preliminary findings may help institutions implement nutritional approaches, such as the adoption of a line-ofcare focused on nutrition in the department of oncology.

Predictive Value of Body Composition Analysis for the Prognosis of Patients with Advanced Gastrointestinal Tumors

Objective There is strong evidence that the body composition can affect the progression-free survival (PFS) and overall survival (OS) in patients with a variety of cancers. The main objective of this study was to investigate the effect of body composition on the prognosis of patients with advanced gastrointestinal and colorectal cancers who received first-line palliative chemotherapy. Methods Patients who were newly-diagnosed with advanced gastrointestinal or colorectal cancer and received standard first-line palliative chemotherapy from January 2017 to December 2018 were included in this retrospective study. An analysis of computed tomography images was performed to determine the skeletal muscle index (SMI), which reflects the skeletal muscle mass and skeletal muscle density (SMD) related to muscle strength. A Kaplan-Meier survival analysis and log-rank test were used to compare the survival relationships among groups stratified by the SMI, and a Cox proportional hazard model was used for a multivariate analysis. Results A total of 108 patients met the inclusion criteria, including 41 cases of gastric cancer, 46 cases of left colorectal cancer, and 21 cases of right colon cancer. In patients with gastric cancer, the OS of women was significantly shorter than that of men. The OS of patients with a low SMI, low SMD, and low phase angle (PA) was significantly shorter than that of patients with high values (P ≤ 0.05). In the multivariate analysis, the SMD was significantly associated with the patients' long-term survival [Hazard Ratio (HR) = 0.904, 95% CI: 0.840~0.974, P = 0.008]. For patients with a low SMI and PA, the PFS was significantly shorter than that of patients with high values (P ≤ 0.05). In patients with left colon cancer, the PA and SMD were both independent risk factors for a poorer long-term prognosis (HR = 0.375, 95% CI: = 0.167~0.840, P = 0.017; HR = 0.887, 95% CI: 0.824~0.954, P = 0.001). Among right colon cancer patients, the PFS and OS of those with a low SMD were significantly lower than those for patients with high values (P ≤ 0.05). Conclusion The PA is an independent risk factor for the OS of left colon cancer patients; the SMD is an independent risk factor for the survival of patients with gastric cancer, left colon cancer, and right colon cancer.

Investigation of Anxiety, Depression, Stress and Related Factors in the Primary Caregivers of Inpatients with Cancer

Objectives To explore the anxiety, depression, stress and related factors in the primary caregivers of inpatients with cancer. Methods A total of 235 selected caregivers of inpatients with cancer were included as the research subjects, and the Depression-Anxiety-Stress Self-Rating Scale 21 (DASS-21) was used to evaluate their depression, anxiety and stress. The data were statistically analyzed using SPSS 25.0 software. Results The study showed that the caregivers of cancer patients had different levels of depression, anxiety and stress, but all rates were above the normal range, with 51.7%, 56.0% and 34.9% of subjects respectively reporting these conditions. In addition, the above indicators were correlated with the caregivers’ gender, age, relationship with the cancer patients, the family’s economic status, religious belief and duration of caregiving: being female (T-Statistic = -2.061, P = 0.040) and having a low income (F = 2.627, P = 0.035) were positively correlated with the caregivers’ stress level. Having a low income (F = 2.804, P = 0.027) was also positively correlated with the depression scores. When the caregivers were the patient's parents, they had higher levels of anxiety (F = 2.429, P = 0.036) than caregivers in other relationships. The results of a linear correlation analysis showed that the depression of caregivers was negatively correlated with the family’s economic status (r value = -0.244, P < 0.01) and positively correlated with the duration of caregiving (r = 0.138, P < 0.05). The anxiety score was positively correlated with the caregivers’ age (r = 0.141, P < 0.05) and duration of caregiving (R = 0.132, P < 0.05), but negatively correlated with the family’s economic status (r = -0.187, P < 0.01). The stress level was positively correlated with the caregivers’ gender (r = 0.137, P < 0.05), age (r = 0.210, P < 0.01), duration of caregiving (r = 0.171, P < 0.01) and current job status (r = 0.165, P < 0.05), but negatively correlated with the family’s economic status (r = -0.202, P < 0.01). The results of a multiple stepwise regression showed that age and religious belief were significant predictors of stress, while the family’s economic status was a significant predictor of depression, and age was a significant predictor of anxiety. Conclusion The caregivers of hospitalized cancer patients showed varying degrees of anxiety, depression and stress, according the psychological assessments; the provision or interventions might be helpful for these individuals.

Prevalence of Malnutrition and Frailty in Elderly Cancer Patients and Resulting Impact on Primary Treatment Recommendations in Colorectal and Breast Cancer

Objectives To estimate the prevalence of malnutrition in elderly cancer patients and its association with frailty and primary cancer treatment recommendations in patients with the two most prevalent cancers (colorectal cancer, CRC and breast cancer, BC) in the Centre-Val de Loire region of France. Methods The entire cohort of 704 patients aged 75 years or older presenting with cancer who underwent comprehensive geriatric assessment (CGA) between 2014 and 2017 was included. Nutritional status, frailty (defined by the Balducci classification system based on CGA parameters and comorbidity), and pathological criteria were analyzed in terms of the cancer treatment recommendations suggested by geriatricians both in the whole cohort and in those with CRC and BC. Results In the whole group of 704 patients (84.3 +/- 4.8 years), the prevalence of malnutrition was 62.9%, and was higher in CRC than in BC patients (71.1% vs 55.4%, P < 0.01). In a multivariate analysis, malnutrition and frailty (as determined by the Balducci classification system) were independently related in CRC patients (OR: 7.28, 95%CI, 1.58~34.03; P = 0.012) and were unrelated to metastasis [odds ratio (OR): 1.34, 95%CI, 0.56~3.18; P = 0.5]. By contrast, malnutrition in BC patients was related exclusively to the extent of metastasis (OR: 3.52, 95%CI, 1.50~8.24; P = 0.002). It was also demonstrated that geriatricians had a greater tendency to suggest only palliative care to CRC patients presenting with malnutrition (15.4% vs 2.7%, P = 0.006) than to BC patients (9.8% vs 5.4%, NS). Conclusion Malnutrition in elderly cancer patients is prevalent, especially in those with colorectal cancer, where malnutrition is frailty-related and may strongly impact on cancer treatment strategies.

Application of Nutritional Support in the Comprehensive Treatment of Gastric Cancer: A Case Report

Objective To relieve long-term malnutrition caused by a malignant tumor affecting the pylorus and to prolong the patient survival. Methods A patient presented with complete pyloric obstruction due to pyloric tumors, and achieved good therapeutic effects through nutritional support and effective chemotherapy. Results After about 40 days of treatment, all physiological indicators were improving. After chemotherapy, the pyloric tumor shrank and the complete obstruction was relieved. The patient was able to eat and drink normally. Conclusion Nutritional support, combined with chemotherapy, may effectively treat complete pyloric obstruction caused by advanced tumors.

Linking Lipid Metabolism with Cell Transformation and Tumor Progression

Carbohydrates, lipids, and proteins are the three major nutrients required by the human body. The lipids, comprising triglycerides, phospholipids, and sterols, provide energy and essential fatty acids for the body, and are required for the growth and maintenance of human cells and tissues. A variety of lipid molecules and their intermediates are involved in cell signaling and inflammation, and have been reported to promote tumor transformation and progression. Fatty acid biosynthetic enzymes are also involved in the lipid metabolism of tumors. Dyslipidemia is closely related to many solid tumors, and may both play a role in both tumorigenesis and be a consequence of tumor development. Therefore, abnormal lipid metabolism is strongly associated with tumor transformation and progression. This review discusses the signaling pathways, related genes, enzymes, and inflammatory cell factors involved in tumor lipid metabolism, as well as the roles of dyslipidemia in tumor transformation and progression. We believe the information provided will serve as valuable reference highlighting molecules that can be targeted to improve the treatment of tumors.