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已发表论文
癌症患者营养影响症状、摄入状况与全身性炎症之间的关系
Authors Xie H, Zong M, Sun Q , Xie F, Liu Z, Qiao Y, Xue P, Zhu S
Received 27 June 2025
Accepted for publication 4 November 2025
Published 13 November 2025 Volume 2025:17 Pages 2757—2772
DOI https://doi.org/10.2147/CMAR.S550009
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Lu-Zhe Sun
Hongting Xie,1 Mingtong Zong,2 Quan Sun,3 Feiyu Xie,4 Zehao Liu,2 Yuanhao Qiao,2 Peng Xue,1,* Shijie Zhu1,*
1Department of Oncology, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing, People’s Republic of China; 2Graduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 4Integrated Traditional Chinese and Western Medicine Department, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Shijie Zhu, Department of Oncology, Wangjing Hospital of China Academy of Chinese Medicine Sciences, No. 6, South Zhonghuan Road, Wangjing, Chaoyang District, Beijing, 100102, People’s Republic of China, Email 20180941234@bucm.edu.cn
Purpose: Cancer-related malnutrition (CRM) is characterized by nutrition impact symptoms (NIS), prominently reduced intake, and irreversible systemic inflammation (SI). This study aimed to use NIS as a phenotype to explore the etiological mechanisms of CRM and facilitate a more precise classification approach for CRM patients by symptomatic clusters.
Patients and Methods: 147 CRM patients were included in this study. Exploratory factor analysis (EFA) was used to identify the NIS clusters, analyze their regression factor score (RFS), and explore potential patient groups. Spearman correlation, Kruskal–Wallis tests, and regression analysis were used to analyze the correlation and interaction between RFS and nutrition, SI, and intake status.
Results: EFA identified 4 factors: RFS-1 was significantly correlated with mid-arm circumference (MAC) (r = − 0.28, p = 0.001), calf circumference (r = − 0.32, CC) (p < 0.001), hand grip strength (r = − 0.24, p = 0.004), hemoglobin (r = − 0.19, p= 0.023), albumin (r = − 0.18, ALB) (p = 0.026), pre-albumin (PAB) (r = − 0.26, p = 0.002), C-reactive protein (CRP) (r = 0.33, p < 0.001), neutrophil-to-lymphocyte ratio (NLR) (r = 0.32, p < 0.001), and systemic immune-inflammation index (SII) (r = 0.28, p = 0.001). RFS-2 was also significantly correlated with MAC (r = − 0.21, p =0.010), CC (r = − 0.19, p = 0.030), ALB (r = − 0.23, p = 0.010), and PAB (r = − 0.21, p = 0.010). Two-step cluster analysis identified 3 patient groups: Group 1 and Group 2 had higher MAC than Group 3 (p = 0.001) and had higher CC than Group 3 (p = 0.029). Group 1 and Group 2 had lower CRP than Group 3 (p = 0.007), presented lower NLR than Group 3 (p = 0.004), and had lower SII than Group 3 (p = 0.014). Group 2 (p < 0.001) had a lower risk of developing anorexia than Group 3, and Group 2 (p = 0.010) had a lower risk of decreasing intake.
Conclusion: This exploratory study identified 4 NIS clusters, 2 significantly related to SI and intake status. Based on CAM etiological mechanisms, 3 potential patient groups were explored, which established a robust phenotypic framework for subsequent large-scale investigations, addressing a critical gap in CRM research and providing a standardized phenotypic tool for future multi-center analyses. These efforts will contribute significantly to enhancing the prevention, treatment, and clinical management of CRM.
Keywords: cancer-related malnutrition, nutrition impact symptom, intake status, systemic inflammation, symptomatic clusters
1Department of Oncology, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing, People’s Republic of China; 2Graduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 4Integrated Traditional Chinese and Western Medicine Department, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Shijie Zhu, Department of Oncology, Wangjing Hospital of China Academy of Chinese Medicine Sciences, No. 6, South Zhonghuan Road, Wangjing, Chaoyang District, Beijing, 100102, People’s Republic of China, Email 20180941234@bucm.edu.cn
Purpose: Cancer-related malnutrition (CRM) is characterized by nutrition impact symptoms (NIS), prominently reduced intake, and irreversible systemic inflammation (SI). This study aimed to use NIS as a phenotype to explore the etiological mechanisms of CRM and facilitate a more precise classification approach for CRM patients by symptomatic clusters.
Patients and Methods: 147 CRM patients were included in this study. Exploratory factor analysis (EFA) was used to identify the NIS clusters, analyze their regression factor score (RFS), and explore potential patient groups. Spearman correlation, Kruskal–Wallis tests, and regression analysis were used to analyze the correlation and interaction between RFS and nutrition, SI, and intake status.
Results: EFA identified 4 factors: RFS-1 was significantly correlated with mid-arm circumference (MAC) (r = − 0.28, p = 0.001), calf circumference (r = − 0.32, CC) (p < 0.001), hand grip strength (r = − 0.24, p = 0.004), hemoglobin (r = − 0.19, p= 0.023), albumin (r = − 0.18, ALB) (p = 0.026), pre-albumin (PAB) (r = − 0.26, p = 0.002), C-reactive protein (CRP) (r = 0.33, p < 0.001), neutrophil-to-lymphocyte ratio (NLR) (r = 0.32, p < 0.001), and systemic immune-inflammation index (SII) (r = 0.28, p = 0.001). RFS-2 was also significantly correlated with MAC (r = − 0.21, p =0.010), CC (r = − 0.19, p = 0.030), ALB (r = − 0.23, p = 0.010), and PAB (r = − 0.21, p = 0.010). Two-step cluster analysis identified 3 patient groups: Group 1 and Group 2 had higher MAC than Group 3 (p = 0.001) and had higher CC than Group 3 (p = 0.029). Group 1 and Group 2 had lower CRP than Group 3 (p = 0.007), presented lower NLR than Group 3 (p = 0.004), and had lower SII than Group 3 (p = 0.014). Group 2 (p < 0.001) had a lower risk of developing anorexia than Group 3, and Group 2 (p = 0.010) had a lower risk of decreasing intake.
Conclusion: This exploratory study identified 4 NIS clusters, 2 significantly related to SI and intake status. Based on CAM etiological mechanisms, 3 potential patient groups were explored, which established a robust phenotypic framework for subsequent large-scale investigations, addressing a critical gap in CRM research and providing a standardized phenotypic tool for future multi-center analyses. These efforts will contribute significantly to enhancing the prevention, treatment, and clinical management of CRM.
Keywords: cancer-related malnutrition, nutrition impact symptom, intake status, systemic inflammation, symptomatic clusters