The heterogeneous nutritional status trajectory and its predictors in elderly patients undergoing lung cancer surgery: a prospective cohort study

TL;DR

This study tracks how elderly lung cancer patients' nutrition changes after surgery and finds that some groups need urgent care to improve their health and quality of life.

Contribution

The study identifies distinct nutritional status trajectories and their predictors in elderly lung cancer surgery patients.

Findings

Three nutritional status trajectories were identified in elderly lung cancer surgery patients.

Age, TNM stage, BMI, social support, and depression score predict these nutritional trajectories.

Patients in the severe and moderate malnutrition groups had lower quality of life at 6 months post-surgery.

Abstract

The assessment and management of nutritional status are particularly important for reducing adverse outcomes in elderly patients undergoing lung cancer surgery. This study aimed to identify the heterogeneous nutritional status trajectory of elderly patients undergoing lung cancer surgery and analyze its predictors.

A prospective cohort study was conducted in a tertiary cancer hospital in mainland China. The nutritional status of the participants was evaluated assessed on the day of admission, the day before discharge, and on the 1st, 3rd, and 6th month postoperatively. Data were analyzed using the latent class growth model, generalized linear model and logistic regression.

A total of 474 eligible elderly patients completed all follow-ups. Three distinct nutritional status trajectories were identified: “Severe Malnutrition-Rapid Improvement Group,” “Moderate Malnutrition-Rapid Improvement Group,” and “Persistent Low Malnutrition Risk Group.” The “Severe Malnutrition-Rapid Improvement Group” and “Moderate Malnutrition-Rapid Improvement Group” had persistent severe and moderate malnutrition, respectively, from the day before discharge to 1 month postoperatively, and both constituted populations in urgent need of clinical intervention; additionally, their quality of life across multiple domains was significantly lower than that of the “Persistent Low Malnutrition Risk Group” at 6 months postoperatively (p < 0.05). Therefore, these two groups were combined as the heterogeneous nutritional status trajectory. Age, TNM stage, preoperative BMI, social support level, and depression score were independent predictive factors for the heterogeneous nutritional status trajectory (p < 0.05).

The nutritional status trajectories of elderly patients undergoing lung cancer surgery are highly heterogeneous and affect postoperative quality of life. Early identification and management of high-risk factors can reduce the risk of malnutrition, improve quality of life, and decrease the occurrence of adverse outcomes.

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