Desnutrición como factor pronóstico en la supervivencia del paciente pediátrico con cáncer en una institución colombiana

Información del artículo

Resumen

Objetivo

Determinar si la desnutrición es un factor pronóstico en la supervivencia de los niños con cáncer.

Métodos

Se evaluó retrospectivamente una cohorte de 471 pacientes pediátricos con diagnóstico nuevo de cáncer, a los cuales se les determinó mediante Kaplan-Meier la supervivencia global y libre de recaída hasta 60 meses de seguimiento, según el estado nutricional al diagnóstico medido por los puntajes Z para los índices antropométricos peso y talla para la edad. Con el fin de evaluar el efecto del estado nutricional sobre la supervivencia teniendo en cuenta variables demográficas y oncológicas, se realizó el análisis multivariado Regresión de Cox.

Resultados

La supervivencia global a los 12 meses fue menor en los desnutridos clasificados por puntaje Z peso para la edad y talla para la edad. El puntaje Z peso para la edad influyó en la supervivencia independientemente de las otras variables, p=0,027, razón de riesgo ajustado de 3,3, intervalo de confianza 95% 1,1-9,5.

Conclusiones

La desnutrición de acuerdo con el puntaje Z peso para la edad y talla para la edad al ingreso es un factor pronóstico adverso en la supervivencia global en los pacientes pediátricos con cáncer. El efecto de la desnutrición en la supervivencia del paciente oncológico pediátrico aún es controversial.

Palabras clave:

Desnutrición

supervivencia

neoplasias

asistentes de pediatría

Abstract

Objective

To determine if malnutrition is a prognostic factor in the survival of children with cancer.

Methods

A retrospective evaluation was carried out on a cohort of 471 pediatric patients recently diagnosed with cancer; patients' overall survival and relapse free rates up to 60 months follow up was determined by Kaplan-Meier in accordance with nutritional state at diagnosis, measured by anthropometric index Z- score for weight and height according to age. The multivariable Cox regression analysis was used to evaluate the effect of nutritional state on survival in relation to demographic and oncological variables.

Results

Overall survival at 12 months was lower among the malnourished classified by weight and height Z- score according to age. The Z- weight score according to age influenced survival independent of other variables, p=0.027, adjusted risk cause at 3.3, 95% confidence interval: 1.1-9.5.

Conclusions

Malnutrition as classified by Z-weight and height score according to age at admission is an adverse prognostic factor for the overall survival of pediatric cancer patients. The effect of malnutrition on pediatric cancer patients remains controversial.

Key words:

Desnutrition

Survival

Neoplasms

Pediatric Assistans

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References

[1.]

M.A. Smith, N.L. Seibel, S.F. Altekruse, et al.

Outcomes for children and adolescents with cancer: challenges for the twenty-first century.

J Clin Oncol, 28 (2010), pp. 2625-2634

http://dx.doi.org/10.1200/JCO.2009.27.0421 | Medline

[2.]

S.F. Altekruse, C.L. Kosary, M. Krapcho, et al.

SEER cancer statistics review 1975-2007.

National Cancer Institute, (2009),

[3.]

G. Masera, T. Edem, M. Schrappe, et al.

Statement by members of the Ponte di Legno Group on the right of children to have full access to essential treament for acute lymphoblastic leukemia.

Pediatr Blood Cancer, 43 (2004), pp. 103-104

http://dx.doi.org/10.1002/pbc.20135 | Medline

[4.]

M.T.A. Buendia, G. Terselich, J.M. Lozano, et al.

Acute lymphoblastic leukemia in children : nonrandomized comparison of conventional vs. intensive-chemotherapy at the National Cancer Institute of Colombia.

Med Pediatr Oncol, 28 (1997), pp. 108-116

Medline

[5.]

M.T.A. Buendia, J.M. Lozano, G.E. Suarez, et al.

The impact of acute lymphoblastic leukemia treatment on central nervous system results in Bogota Colombia.

J Pediatr Hematol Oncol, 30 (2008), pp. 643-650

http://dx.doi.org/10.1097/MPH.0b013e31817e4a7d | Medline

[6.]

F. Pedrosa, M. Bonilla, A. Liu, et al.

Effect of malnutrition at the time of diagnosis on the survival of children treated for cancer in El Salvador and Northern Brazil.

J Pediatr Hematol Oncol, 22 (2000), pp. 502-505

Medline

[7.]

A. Sala, P. Pencharz, R. Barr.

Children, cancer, and nutritional dynamic triangle in review.

Cancer, 100 (2004), pp. 667-687

http://dx.doi.org/10.1002/cncr.20019 | Medline

[8.]

S. Ballal, Bechard, T. Jaksic, et al.

Nutritional supportive care.

Principles and practice of pediatric oncology, pp. 1243-1255

[9.]

B. Lange, R. Gerbing, J. Feusner.

Mortality in overweight and underweight children with acute myeloid leukemia.

JAMA, 293 (2005), pp. 203-211

http://dx.doi.org/10.1001/jama.293.2.203 | Medline

[10.]

A.M. Butturini, F.J. Dorey, B.J. Lange, et al.

Obesity and outcome in pediatric acute lymphoblastic leukemia.

J Clin Oncol, 25 (2007), pp. 2063-2069

http://dx.doi.org/10.1200/JCO.2006.07.7792 | Medline

[11.]

E. Lobato-Mendizábal, G.J. Ruiz-Arguelles, A. Marín-Lopez.

Leukaemia and nutrition I: malnutrition is an adverse prognostic factor in the outcome of treatment of patients with standard-risk acute lymphoblastic leukaemia.

Leuk Res, 13 (1989), pp. 899-906

Medline

[12.]

E. Lobato-Mendizábal, B. López-Martínez, G.J. Ruíz-Argüelles.

A critical review of the prognostic value of the nutritional status at diagnosis in the outcome of therapy of children with acute lymphoblastic leukemia.

Rev Invest Clin, 55 (2003), pp. 31-35

Medline

[13.]

V. Jain, S.K. Gupta.

Nutritional parameters in children with malignancy.

Indian Pediatr, 40 (2003), pp. 976-984

Medline

[14.]

A.U. Khan, M.U. Sheikh, K. Intekhab.

Pre-existing malnutrition and treatment outcome in children with acute lymphoblastic leukaemia.

J Pak Med Assoc, 56 (2006), pp. 171-173

Medline

[15.]

J. Bakish, D. Hargrave, N. Tariq, et al.

Evaluation of dietetic intervention in children with medulloblastoma or supratentorial primitive neuroectodermal tumors.

Cancer, 98 (2003), pp. 1014-1020

http://dx.doi.org/10.1002/cncr.11598 | Medline

[16.]

R. Elhasid, A. Laor, S. Lischinsky, et al.

Nutritional status of children with solid tumors.

Cancer, 86 (1999), pp. 119-125

Medline

[17.]

J. Eys.

Nutrition and cancer in children.

CA Cancer J Clin, 29 (1979), pp. 40-45

Medline

[18.]

J. Weir.

No evidence for an effect of nutritional status at diagnosis of prognosis in children with acute lymphoblastic leukemia.

J Pediatr Hematol Oncol, 20 (1998), pp. 534-538

Medline

[19.]

M.D. Onis, World Health Organization child growth standards.

Length/height-for-age, weight-for-age, weight-forlength, weight-for-height and body mass index-forage: methods and development.

World Health Organization Press, (2006),

[20.]

M.D. Onis, WHO Child Growth Standards.

growth velocity based on weight, lengthand head circumference: methods and development.

World Health Organization Press, (2009),

[21.]

República de Colombia. Ministerio de Protección Social (MPS). Resolución 00002121 de junio 9: Por la cual se adoptan los patrones de crecimiento publicados por la Organización Mundial de la Salud en el 2006 y 2007 para los niños, niñas y adolescentes de 0 a 18 años de edad y se dictan otras disposiciones. Bogotá: NPS; 2010.

[22.]

World Health Organization. Anthro for personal computers. Software for assessing growth and development of the world's children [internet]. 2009 [citado: 13 de junio de 2011]. Disponible en: http://www.who.int/childgrowth/software/en/.

[23.]

World Health Organizatin. Anthro Plus for personal computers. Software for assessing growth of the world's children and adolescents [internet]. 2009 [citado: 13 de junio de 2011]. Disponible en: http://www.who.int/growthref/tools/en/.

[24.]

H. Yang, M. de Onis.

Algorithms for converting estimates of child malnutrition based on the NCHS reference into estimates based on the WHO Child Growth Standards.

BMC Pediatrics, 8 (2008), pp. 19

http://dx.doi.org/10.1186/1471-2431-8-19 | Medline

[25.]

C.K. Lutter, C.M. Chaparro, S. Muñoz.

Progress towards Millennium Development Goal 1 in Latin America and the Caribbean: the importance of the choice of indicator for undernutrition.

Bull World Health Organ, 89 (2011), pp. 22-30

http://dx.doi.org/10.2471/BLT.10.078618 | Medline

[26.]

M.P.M. Aguirre, V.A. Zinser, R.C. Cardos, et al.

Metabolismo y nutrición en el niño con cáncer.

Nutrición Clínica, 9 (2006), pp. 24-30

[27.]

K. Motil.

Sensitive measures of nutritional status in children in hospital and in the field.

Int J Cancer, (1998), pp. S2-S9

[28.]

Encuesta nacional de la situación nutricional en Colombia, 2005. Primera edición. Bogotá: Instituto Colombiano de de Bienestar Familiar; 2006.

[29.]

M. Jiménez, J. Orellana, P. Armelini, et al.

Nutricional evaluation and predicted morbility and mortality in children with cancer.

Exp Med, 7 (1989), pp. 3-12

[30.]

A. Garofolo, F.A. Lopez, F. Petrilli.

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements.

Sao Paulo Med J, 123 (2005), pp. 277-281

http://dx.doi.org//S1516-31802005000600005 | Medline

[31.]

M. Fuentes, C. Sánchez, M. Granados, et al.

Evaluación del estado nutricional en niños con cáncer.

Rev Venez Oncol, 19 (2007), pp. 204-209

[32.]

R. Rivera-Luna, A. Olaya-Vargas, M. Velásquez-Ávila, et al.

Early death in children with acute lymphoblastic leukemia: does malnutrition play a role?.

Pediatr Hematol Oncol, 25 (2008), pp. 17-26

http://dx.doi.org/10.1080/08880010701774132 | Medline

[33.]

M. Viana, M. Murao, G. Ramos, et al.

Malnutrition as a prognostic factor in lymphoblastic leukaemia: a multivariate analysis.

Arch Dis Child, 71 (1994), pp. 304-310

Medline

[34.]

M.J. Scopinaro, S.J. Casak.

Oncología pediátrica en la Argentina: pobreza globalización e inequidad Algunos aspectos médicos y éticos.

Lancet (Oncol), 2 (2002), pp. 111-117

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