Changes in nutritional status of 9 vitamins in esophageal cancer patients during chemotherapy

The article is written by Master, Doctor Mai Vien Phuong - Gastroenterologist - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.

Esophageal cancer (EC) is the 9th most commonly diagnosed disease and the 6th leading cause of cancer death worldwide. The incidence and mortality of esophageal cancer are heterogeneous in terms of sex, histological type, geographic distribution, and race. The incidence and mortality from esophageal cancer in China is higher than the global average. Chemotherapy remains the mainstay of treatment for patients with advanced esophageal cancer.
The most common complications in chemotherapy for esophageal cancer include weight loss, malnutrition, bone marrow suppression, electrolyte disturbances, hypoproteinemia and quality of life.
Many vitamins participate in the pathogenesis, progression, and prognosis of tumors and are closely related to the tumor microenvironment. Vitamin testing is valuable in patients with esophageal cancer because it can determine whether a specific vitamin deficiency is present and/or justifies vitamin therapy.
Most clinical studies show that vitamin nutritional status varies greatly in tumors of different systems. Although many studies have investigated the relationship between vitamins B, A, D, and C with esophageal cancer, most of these studies have focused on the role of vitamins in the prevention and treatment of cancer. manage . Few studies have examined changes in vitamin nutritional status and their influencing factors before and after chemotherapy for esophageal cancer.

Vitamin supplements can reduce the risk of tumor formation and prevent abnormal changes in DNA methylation in tumor cells. With the advances in nutritional therapy in China, nutritional screening, assessment and intervention are increasingly being applied in tumor patients. Standard nutritional therapies involve the three main macronutrients, including carbohydrates, proteins, and fats, however have specific micronutrient requirements.
Nutritional therapy for esophageal cancer patients provides nutrients and energy and focuses on the metabolic regulation of nutrients.

Serum vitamin concentrations vary in patients with different tumors. Zhang et al analyzed the vitamin nutritional status of about 1000 hospitalized tumor patients and found that vitamin B1 levels were low in patients with gastrointestinal cancers (esophageal cancer and gastric cancer). ).
A study on nutritional deficiencies after surgery in patients with esophageal cancer or gastric cancer showed that the rate of deficiency of ferritin, folic acid, vitamin B12 and vitamin D was 42.86%; 9.52%; 6.35%; 36.67% and vitamin levels improved significantly after nutritional interventions.
In another study, most of the patients with advanced tumors had symptoms of vitamin deficiency (especially vitamins D, B6 and C) during palliative care, further analysis showing an association correlation between vitamin deficiency and clinical discomfort in these patients. Most vitamins have been found to be negatively associated with the risk of colorectal cancer and gastric cancer other than esophageal cancer, yet interventional treatment has not demonstrated a clear preventive effect on these diseases. this malignancy.

A study was performed, a total of 203 esophageal cancer patients (181 men and 22 women) aged 37-78 years (mean: 60.03 ± 7.95 years) were receiving chemotherapy at the center. of the authors from July 2017 to September 2020 were enrolled in this study. The majority of subjects had esophageal squamous cell carcinoma (n = 192, 94.58%) and 166 patients (81.77%) at stage III-IV. Variable degrees of vitamin A, D, C, and B2 deficiency and weight loss were found in these patients, and the prevalence of vitamin B2 and vitamin C deficiencies increased significantly after chemotherapy (both P < 0.05). ). Serum concentrations of vitamins A, C, B2, B6 and BMI before and after chemotherapy were statistically significant (all P < 0.05).
Multivariate analysis showed that vitamin A levels were significantly different between male and female esophageal cancer patients, while vitamin D levels were significantly different in esophageal cancer patients in different stages ( all P<0.05). A correlation was observed between the change in serum vitamin A and C concentrations before as well as after two cycles of chemotherapy and the change in BMI (P < 0.05). The concentrations of hemoglobin, total protein, serum albumin, and blood calcium were significantly reduced in patients with esophageal cancer after chemotherapy (all P < 0.05), while serum phosphorus levels were significantly increased after chemotherapy. (P < 0.05). Therefore, the authors found that vitamins A, D, C and B2 were mainly deficient in chemotherapy patients for esophageal cancer. So what should esophageal cancer eat? Accordingly, multivitamin supplementation can help improve nutritional status, tolerability, and reduce side effects of chemotherapy.

It has been found that patients with esophageal cancer have varying degrees of vitamin deficiency during chemotherapy. Hemoglobin, total protein, serum albumin levels, and blood calcium levels decreased significantly after chemotherapy. In addition, the proportion of patients with weight loss, anemia and hypoproteinemia also increased significantly. The authors' subjects were most deficient in vitamin B2 and vitamin C, followed by vitamins A and D.
In the present studies, patients undergoing chemotherapy for esophageal cancer were the most vitamin B2 deficient (31.53, respectively). % and 46.80% before and after chemotherapy) and vitamin B2 levels decreased significantly after chemotherapy (P < 0.05). Deficiency or excess of vitamins B1, B9, B12 and B6 were not found in any of the esophageal cancer patients in this study. Comparison of vitamin levels before and after chemotherapy showed that vitamin B6 levels decreased significantly after chemotherapy but remained within normal limits.
It has been reported that vitamin B intake is correlated with the risk of esophageal cancer. Appropriate intake of the B vitamins B6 and B9 (also known as folate) may reduce the risk, while higher amounts of vitamin B12 may increase the risk. A study of residents in Yanting County, Sichuan Province (a region with a high incidence of esophageal cancer in China) found markedly deficient riboflavin intake and riboflavin toughness in the high-risk group. reduce the incidence of esophageal cancer. In a multicenter study in China, total blood riboflavin was tested in 764 patients with esophageal cancer (in the control group) and analysis showed that total blood riboflavin levels were not significantly correlated. with the incidence of esophageal cancer. However, high blood levels of total riboflavin are more favorable for survival in elderly esophageal cancer patients aged 50-70 years. Therefore, vitamin B supplementation in patients undergoing chemotherapy for esophageal cancer is beneficial to improve vitamin nutritional status and reduce complications. In summary, vitamin deficiencies (mainly vitamin A, D, C and B2) are common in patients with esophageal cancer during chemotherapy and may be associated with changes in BMI. In addition, chemotherapy drugs reduce hematological parameters such as hemoglobin and albumin. Therefore, appropriate nutritional interventions and vitamin supplementation can reduce the side effects of chemotherapy, improve nutritional status, and increase drug tolerance and quality of life.

References: Liang LQ, Meng LL, Cai BN, Cui ZP, Ma N, Du LH, Yu W, Qu BL, Feng SQ, Liu F. Changes in the nutritional status of nine vitamins in patients with esophageal cancer during chemotherapy. World J Gastroenterol 2021; 27(19): 2366-2375 [DOI: 10.3748/wjg.v27.i19.2366]