Perfil inflamatório/oxidativo, estado nutricional/funcional e sua associação com o estadiamento tumoral em pacientes com câncer colorretal, atendidos em um hospital escola de Maceió-AL

Abstract

Cancer has a major impact on public health and morbidity and mortality rates. In Brazil, it is the second cause of death, in which colorectal cancer (CRC) is the fourth most prevalent among men and third among women. Among the factors related to the progression of CCR are oxidative stress and inflammatory activity that can interfere or be influenced by clinical and nutritional changes. The high prevalence of nutritional deficits in these patients is widely studied, and its interference in the clinical prognosis is known. Despite this, objective nutritional assessment methods are not sensitive to early changes, and subjective ones have some limitations. To contribute to this discussion, this thesis presents two articles. The first, entitled: “Lack of concordance among nutritional diagnostic methods in newly-diagnosed colorectal cancer patients”, aimed to assess the agreement among different methods of nutritional assessment and to identify the prevalence of inadequate nutritional status, according to such methods, in CRC patients newly diagnosed at Hospital Universitário Professor Alberto Antunes (HUPAA). Clinical, nutritional (global subjective assessment applied by the patient – PG-SGA; BMI - body mass index; AC - arm circumference; TSF - tricipital skinfold and AMC - arm muscle circumference)/functional (HGS - handgrip strength) data were evaluated. AC, TSF and AMC were expressed in adequacy (%). Patients with normal weight and overweight/obese were classified as “non-malnourished”. The kappa's agreement test () was performed and interpreted as a poor agreement (<0.0), slight (between 0.01-0.2), fair (between 0.21-0.4), moderate (between 0.41-0.6), substantial (between 0.61-0.8) and almost perfect (between 0.81-1.00) concordance. Were evaluated 31 patients, mean age 58.97 ± 14.96 years and 51.6% were female. TSF and PG-SGA identified the largest number of malnourished patients (80.8% and 80%, respectively). The prevalence of overweight and malnutrition, according to BMI, was the same (30.0%). There was no significant agreement between PG-SGA and BMI (= 0,086; p=0.426), HGS ( = 0.268; p = 0.124), AC ( = 0.015; p = 0.99), TSF ( = 0.195; p = 0.558) and AMC ( = 0.142; p = 0.380. Concludes that PG-SGA can diagnose malnutrition, even among normal and excess weight individuals diagnosed by anthropometric methods, as BMI, pointing out the need of the use of objective and subjective methods in nutritional assessment due to the lack of concordance between the studied methods. The second article, entitled “Interleukin-6 and triceps skinfold is associated with severity cancer stage in newly-diagnosed colorectal cancer patients”, assessed the association between the inflammatory/oxidative profile, nutritional/functional status with the tumor stage of newly diagnosed CRC patients at HUPAA. PG-SGA was used, and weight, height, AC, TSF and HGS were obtained. A blood sample was fast collected and subsequently centrifuged and stored at -80 ºC until analysis. The levels of malonaldehyde (MDA) HPLC analyzed (high-performance liquid chromatography) and cytokines (tumor necrosis factor-alpha - TNF- -, interleukin - IL - 6, IL-8, IL-7) by the method of ELISA, following the manufacturer's specifications, and the reading was performed on a spectrophotometer. Patients were grouped according to cancer stage in group 1 (stage I-III) and group 2 (stage IV). A binary logistic regression was performed to analyze the relationship between the variables (analyzed one by one) and the cancer stage, adjusted by age and sex and was considered significant when p <0.05. Of the 28 patients, 20 (71.4%) were in group 1 and 8 (28.6%) in group 2. The low adequacy of TSF (OR = 0.929; CI 95% = 0.870-0.993; p = 0.029) and increased levels of IL-6 (OR = 1,001; 95% CI = 1,000-1,002; p = 0.012) increased the patient's chance to be in stage IV. Such findings led to the conclusion that IL-6 and TSF can help in the establishment of tumor stage in clinical practice, in addition to the possibility of IL-6 levels modulation as a therapeutic target in the treatment of CRC.