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      Taiwan Society of Colon and Rectum Surgeons (TSCRS) Consensus for Anti-Inflammatory Nutritional Intervention in Colorectal Cancer

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          Abstract

          Malnutrition and systemic inflammatory response (SIR) frequently occur in patients with colorectal cancer (CRC) and are associated with poor prognosis. Anti-inflammatory nutritional intervention is not only a way to restore the malnourished status but also modulate SIR. Nine experts, including colorectal surgeons, physicians and dieticians from 5 hospitals geographically distributed in Taiwan, attended the consensus meeting in Taiwan Society of Colon and Rectum Surgeons for a 3-round discussion and achieved the consensus based on a systematic literature review of clinical studies and published guidelines. The consensus recommends that assessment of nutritional risk and SIR should be performed before and after CRC treatment and appropriate nutritional and/or anti-inflammatory intervention should be adapted and provided accordingly.

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          The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer.

          Since the initial work, a decade ago that the combination of C-reactive protein and albumin, the Glasgow Prognostic Score (GPS), had independent prognostic value in patients with cancer, there have been more than 60 studies (>30,000 patients) that have examined and validated the use of the GPS or the modified GPS (mGPS) in a variety of cancer scenarios. The present review provides a concise overview of these studies and comments on the current and future clinical utility of this simple objective systemic inflammation-based score. The GPS/mGPS had independent prognostic value in (a) unselected cohorts (4 studies, >19,400 patients) (b) operable disease (28 studies, >8,000 patients) (c) chemo/radiotherapy (11 studies, >1500 patients) (d) inoperable disease (11 studies, >2,000 patients). Association studies (15 studies, >2,000 patients) pointed to an increased GPS/mGPS being associated with increased weight and muscle loss, poor performance status, increased comorbidity, increased pro-inflammatory and angiogenic cytokines and complications on treatment. These studies have originated from 13 different countries, in particular the UK and Japan. A chronic systemic inflammatory response, as evidenced by the GPS/mGPS, is clearly implicated in the prognosis of patients with cancer in a variety of clinical scenarios. The GPS/mGPS is the most extensively validated of the systemic inflammation-based prognostic scores and therefore may be used in the routine clinical assessment of patients with cancer. It not only identifies patients at risk but also provides a well defined therapeutic target for future clinical trials. It remains to be determined whether the GPS has prognostic value in other disease states. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Cancer cachexia: understanding the molecular basis.

            Cancer cachexia is a devastating, multifactorial and often irreversible syndrome that affects around 50-80% of cancer patients, depending on the tumour type, and that leads to substantial weight loss, primarily from loss of skeletal muscle and body fat. Since cachexia may account for up to 20% of cancer deaths, understanding the underlying molecular mechanisms is essential. The occurrence of cachexia in cancer patients is dependent on the patient response to tumour progression, including the activation of the inflammatory response and energetic inefficiency involving the mitochondria. Interestingly, crosstalk between different cell types ultimately seems to result in muscle wasting. Some of the recent progress in understanding the molecular mechanisms of cachexia may lead to new therapeutic approaches.
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              ESPEN expert group recommendations for action against cancer-related malnutrition

              Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity.
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                Author and article information

                Contributors
                Journal
                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                2234-943X
                17 January 2022
                2021
                : 11
                : 819742
                Affiliations
                [1] 1 Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
                [2] 2 Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
                [3] 3 Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung , Kaohsiung, Taiwan
                [4] 4 Division of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
                [5] 5 Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital–Linkou , Taoyuan, Taiwan
                [6] 6 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital , Taipei, Taiwan
                [7] 7 Division of Nutrition, Chang Gung Memorial Hospital–Linkou , Taoyuan, Taiwan
                [8] 8 Division of Nutrition, Taichung Veterans General Hospital , Taichung, Taiwan
                [9] 9 Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
                [10] 10 Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
                [11] 11 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
                [12] 12 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
                [13] 13 Center for Cancer Research, Kaohsiung Medical University , Kaohsiung, Taiwan
                [14] 14 Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University , Kaohsiung, Taiwan
                [15] 15 Clinical Pharmacogenomics and Pharmacoproteinomics, College of Pharmacy, Taipei Medical University , Taipei, Taiwan
                [16] 16 Pingtung Hospital, Ministry of Health and Welfare , Pingtung, Taiwan
                Author notes

                Edited by: Dario Baratti, Fondazione IRCCS Istituto Nazionale Tumori, Italy

                Reviewed by: Emiliano Tognoli, National Cancer Institute Foundation (IRCCS), Italy; Serena Della Valle, National Cancer Institute Foundation (IRCCS), Italy

                This article was submitted to Gastrointestinal Cancers: Colorectal Cancer, a section of the journal Frontiers in Oncology

                Article
                10.3389/fonc.2021.819742
                8801427
                35111685
                aae7f631-b329-4da3-80c3-cf0bab9dbd7b
                Copyright © 2022 Ma, Hu, Huang, Chiang, Hsieh, Wang, Chiang, Hsieh, Chen and Wang

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 22 November 2021
                : 22 December 2021
                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 117, Pages: 11, Words: 4473
                Funding
                Funded by: Kaohsiung Medical University , doi 10.13039/501100004694;
                Award ID: KMU-TC109A04-1
                Categories
                Oncology
                Review

                Oncology & Radiotherapy
                anti-inflammation,systemic inflammatory response,neutrophil-to-lymphocyte ratio,malnutrition,colorectal cancer

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