胃癌患者全程营养支持的临床实践与优化策略

Clinical practice and optimization strategies for comprehensive nutritional support in gastric cancer patients

摘要

胃癌是全球发病率及死亡率均较高的恶性肿瘤之一，其治疗效果与患者的营养状况密切相关。营养不良在胃癌患者中普遍存在，严重影响手术耐受性、治疗反应及生活质量，进而对预后产生不利影响。因此，对胃癌患者进行规范的营养风险筛查与评估，并在此基础上实施系统化、个体化的全程营养支持，对于改善其临床结局具有至关重要的意义。本文就胃癌患者的全程营养支持作一综述，以期为建立标准化、个体化的全程营养管理路径提供依据。

Abstract

Gastric cancer is one of the malignant tumors with high incidence and mortality worldwide, and its treatment outcomes are strongly influenced by nutritional status. Malnutrition is frequently observed in this population and may reduce tolerance to surgery, weaken the response to treatment, and compromise quality of life, ultimately leading to poorer prognosis. For this reason, standardized nutritional risk screening and assessment should be conducted, and systematic and individualized nutritional support throughout the whole course of treatment is of critical importance for improving clinical outcomes. This review summarizes the evidence on comprehensive nutritional support for patients with gastric cancer and aims to offer a reference for developing more standardized and personalized nutritional management pathways.

关键词

胃癌 / 营养筛查 / 营养支持 / 全程管理 / 口服营养补充 / 免疫营养

Key words

Gastric cancer / Nutritional screening / Nutritional support / Comprehensive management / Oral nutritional supplement / Immunonutrition

参考文献

[1] BRAY F, LAVERSANNE M, SUNG H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA: A Cancer Journal for Clinicians , 2024, 74(3): 229-263.

[2] 中华医学会肠外肠内营养学分会 , 中国营养学会临床营养分会 , 中国医疗保健国际交流促进会临床营养健康学分会. 成人患者营养不良诊断与应用指南 （2025 版）[J]. 中华医学杂志, 2025, 105(13): 953-980.

[3] FATIREGUN O A, BAKEWELL N. Malnutrition after cancer surgery in low-income and middle-income countries[J]. The Lancet Global Health, 2023, 11(3): e302-e303.

[4] CONG M, SONG C, XU H, et al. The patient-generated subjective global assessment is a promising screening tool for cancer cachexia[J]. BMJ Supportive and Palliative Care, 2022, 12(e1): e39-e46.

[5] DEFTEREOS I, KISS N, ISENRING E, et al. A systematic review of the effect of preoperative nutrition support on nutritional status and treatment outcomes in upper gastrointestinal cancer resection[J]. European Journal of Surgical Oncology , 2020, 46(8): 1423-1434.

[6] Global Surg Collaborative and NIHR Global Health Unit on Global Surgery. Impact of malnutrition on early outcomes after cancer surgery: An international, multicentre, prospective cohort study[J]. The Lancet Global Health , 2023, 11(3): e341-e349.

[7] 朱明炜 , 陈丽如. 价值医疗理念下的医学营养疗法[J]. 中华临床营养杂志, 2022, 30(3): 129-133.

[8] XU L B, MEI T T, CAI Y Q, et al. Correlation between components of malnutrition diagnosed by global leadership initiative on malnutrition criteria and the clinical outcomes in gastric cancer patients: A propensity score matching analysis[J]. Frontiers in Oncology, 2022, 12: 851091.

[9] 中华医学会肠外肠内营养学分会. 肿瘤患者营养支持指南[J]. 中华外科杂志, 2017, 55(11): 801-829.

[10] LI Y F, NIE R C, WU T, et al. Prognostic value of the nutritional risk screening 2002 scale in metastatic gastric cancer: A large-scale cohort study[J]. Journal of Cancer, 2019, 10 (1): 112-119.

[11] JAGER-WITTENAAR H, OTTERY F D. Assessing nutritional status in cancer: Role of the patient-generated subjective global assessment[J]. Current Opinion in Clinical Nutrition and Metabolic Care, 2017, 20(5): 322-329.

[12] 中华医学会外科学分会腹腔镜与内镜外科学组, 中国医师协会外科医师分会上消化道外科医师专家工作组, 《中华消化外科杂志》编辑委员会. 精准胃癌外科诊疗中国专家共识(2024 版)[J]. 中华消化外科杂志, 2024, 23(3): 323-333.

[13] JENSEN G L, CEDERHOLM T, CORREIA M I T D, et al. GLIM consensus approach to diagnosis of malnutrition: A 5-year update[J]. Journal of Parenteral and Enteral Nutrition, 2025, 49(4): 414-427.

[14] KIM K W, HUH J, UROOJ B, et al. Artificial intelligence in gastric cancer imaging with emphasis on diagnostic imaging and body morphometry[J]. Journal of Gastric Cancer, 2023, 23(3): 388-399.

[15] SGUANCI M, PALOMARES S M, CANGELOSI G, et al. Artificial intelligence in the management of malnutrition in cancer patients: A systematic review[J]. Advances in Nutrition, 2025, 16(7): 100438.

[16] GABEL K, CARES K, VARADY K, et al. Current evidence and directions for intermittent fasting during cancer chemotherapy[J]. Advances in Nutrition , 2022, 13(2): 667-680.

[17] ARENDS J, BACHMANN P, BARACOS V, et al. ESPEN guidelines on nutrition in cancer patients[J]. Clinical Nutrition , 2017, 36(1): 11-48.

[18] HAMAKER M E, OOSTERLAAN F, VAN HUIS L H, et al. Nutritional status and interventions for patients with cancer-A systematic review[J]. Journal of Geriatric Oncology, 2021, 12(1): 6-21.

[19] LI Q, CHEN C, WANG X. Perioperative nutritional interventions for gastric cancer patients: A meta-analysis of surgical outcomes[J]. Frontiers in Nutrition, 2025, 12: 1680833.

[20] ZHENG Z, LIU G, WANG Y, et al. Perioperative oral immunonutrient regulation of intestinal barrier and gut microbiota in patients with gastric cancer, a randomized controlled clinical trial[J]. Biomedicines, 2025, 13(9): 2163.

[21] SONOI M, SHIRAKAWA Y, SONOI N, et al. Preoperative nutritional status influences enteral nutrition weaning 6 months post-surgery in patients with esophageal cancer[J]. Asian Pacific Journal of Cancer Prevention, 2025, 26(1): 263-267.

[22] FUKUDA Y, YAMAMOTO K, HIRAO M, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections[J]. Annals of Surgical Oncology, 2015, 22(Suppl 3): S778-S785.

[23] YOON J P, NAM J S, ABIDIN M F B Z, et al. Comparison of preoperative nutritional indexes for outcomes after primary esophageal surgery for esophageal squamous cell carcinoma[J]. Nutrients, 2021, 13(11): 4086.

[24] WEIMANN A, BEZMAREVIC M, BRAGA M, et al. ESPEN guideline on clinical nutrition in surgery-Update 2025[J]. Clinical Nutrition, 2025, 53: 222-261.

[25] CHEN Z, HONG B, HE J J, et al. Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms[J]. World Journal of Gastrointestinal Surgery, 2023, 15(10): 2222-2233.

[26] CEDERHOLM T, BARAZZONI R, AUSTIN P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition[J]. Clinical Nutrition , 2016, 36(1): 49-64.

[27] UENO K, NISHIGORI T, TOKORO Y, et al. Efficacy of simple oral nutritional supplements versus usual care in postoperative patients with gastric cancer: A multicenter, open-label, parallel, randomized controlled trial[J]. Annals of Surgery, 2025: 40772645. (2025-08-07) [2026-02-25]. https://doi.org/10.1097/SLA.0000000000006888.

[28] LIANG Q, WANG S, WANG B, et al. Efficacy and safety of post-discharge oral nutritional supplements for patients with gastric cancer undergoing gastrectomy: A meta-analysis of randomized controlled traials[J]. Frontiers in Nutrition, 2025, 11: 1488054.

[29] KONG S H, LEE H J, NA J R, et al. Effect of perioperative oral nutritional supplementation in malnourished patients who undergo gastrectomy: A prospective randomized trial[J]. Surgery, 2018, 164(6): 1263-1270.

[30] 康军仁 , 于康 , 中国营养学会肿瘤营养管理分会. 肿瘤患者口服营养补充制剂选择专家共识(2024 版)[J]. 中华临床营养杂志, 2024, 32(5): 279-288.

[31] 中国抗癌协会胃癌专业委员会 , 中华医学会外科学分会胃肠外科学组. 胃癌围手术期营养治疗中国专家共识 (2019 版)[J]. 中国实用外科杂志, 2020, 40(2): 145-151.

[32] IMAMURA H, NISHIKAWA K, KISHI K, et al. Effects of an oral elemental nutritional supplement on post-gastrectomy body weight loss in gastric cancer patients: A randomized controlled clinical trial[J]. Annals of Surgical Oncology, 2016, 23(9): 2928-2935.

[33] 曾敏婕, 张梦游, 刘敏, 等. 长沙某三甲医院消化道终末期癌症住院患者营养风险 、 营养不良(GLIM)患病率横断面调查[J]. 中华临床营养杂志, 2021, 29(5): 275-280.

[34] FUKAHORI M, SHIBATA M, HAMAUCHI S, et al. A retrospective cohort study to investigate the incidence of cancer-related weight loss during chemotherapy in gastric cancer patients[J]. Supportive Care in Cancer, 2021, 29 (1): 341-348.

[35] SANZ-PARIS A, MARTINEZ-GARCÍA M, MARTINEZ-TRUFERO J, et al. Oligomeric enteral nutrition in undernutrition, due to oncology treatment-related diarrhea. Systematic review and proposal of an algorithm of action[J]. Nutrients, 2019, 11(8): 1888.

[36] 中国抗癌协会肿瘤营养专业委员会 , 全国卫生产业企业管理协会医学营养产业分会 , 浙江省医学会肿瘤营养与治疗学分会. 肿瘤患者食欲下降的营养诊疗专家共识[J]. 肿瘤代谢与营养电子杂志, 2022, 9(3): 312-319.

[37] 吴国豪 , 谈善军. 成人口服营养补充专家共识[J]. 消化肿瘤杂志(电子版), 2017, 9(3): 151-155.

[38] ZHANG Y, TAN S, WU G. ESPEN practical guideline: Clinical nutrition in surgery[J]. Clinical Nutrition, 2021, 40 (9): 5071.

[39] 中华医学会肠外肠内营养学分会. 中国成人患者肠外肠内营养临床应用指南 (2023 版)[J]. 中华医学杂志 , 2023, 103(13): 946-974.

[40] KUMPF V J, DE AGUILAR-NASCIMENTO J E, DIAZ-PIZARRO GRAF J I, et al. ASPEN-FELANPE Clinical Guidelines[J]. JPEN. Journal of Parenteral and Enteral Nutrition, 2016, 41(1): 104-112.

[41] CHAO K, WANG D, YANG H, et al. Beneficial effect of immune-enhanced enteral nutrition on immune function in patients with severe neurological diseases: A single-center randomized controlled trial[J]. Frontiers in Nutrition, 2021, 8: 685422.

[42] PATEL T H, CECCHINI M. Targeted therapies in advanced gastric cancer[J]. Current Treatment Options in Oncology, 2020, 21(9): 70.

[43] MENG Q, TAN S, JIANG Y, et al. Post-discharge oral nutritional supplements with dietary advice in patients at nutritional risk after surgery for gastric cancer: A randomized clinical trial[J]. Clinical Nutrition, 2021, 40 (1): 40-46.

[44] TAN S, XI Q, ZHANG Z, et al. Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial[J]. Nutrition, 2025, 129: 112597.

[45] WANG N, JIANG J, XI W, et al. Postoperative BMI loss at one year correlated with poor outcomes in Chinese gastric cancer patients[J]. International Journal of Medical Sciences, 2020, 17(15): 2276-2284.

[46] 中国抗癌协会肿瘤营养专业委员会, 谌永毅. 肿瘤患者家庭肠内营养护理专家共识[J]. 肿瘤代谢与营养电子杂志, 2024, 11(3): 314-321.

[47] KOMATSU S, KONISHI T, MATSUBARA D, et al. Night home enteral nutrition as a novel enforced and physiologically effective nutrition therapy following total gastrectomy for gastric cancer[J]. Scientific Reports, 2022, 12(1): 14922.

[48] 中华医学会消化内镜学分会 , 北京医学会核医学分会 , 中国医学影像技术研究会超声分会, 等. 胃轻瘫多学科联合诊疗专家共识 (2025 版)[J]. 中华医学杂志 , 2025, 105 (21): 1700-1714.

[49] 韩雪, 王晚晴, 赵璐璐, 等. 胃癌术后胃瘫的诊疗现状和研究进展[J]. 生物医学转化, 2025, 6(3): 1-7.

[50] SCARPELLINI E, ARTS J, KARAMANOLIS G, et al. International consensus on the diagnosis and management of dumping syndrome[J]. Nature Reviews Endocrinology, 2020, 16(8): 448-466.

[51] LI D, ZHAO M, CHENG X, et al. The strategy of vitamin supplementation in Chinese patients with gastric cancer after gastrectomy: A prospective cohort study[J]. Scientific Reports, 2025, 15(1): 33531.

基金资助

国家自然科学基金项目(82360510)