A retrospective matched cohort study evaluating the effects of percutaneous endoscopic gastrostomy feeding tubes on nutritional status and survival in patients with advanced gastroesophageal malignancies undergoing systemic anti-cancer therapy

<div><p>Background</p><p>Many patients with cancer or other systemic illnesses can experience malnutrition. One way to mitigate malnutrition is by insertion of a percutaneous endoscopic gastrostomy feeding tube (PEG tube). The goal of this retrospective matched cohort study is to evaluate if PEG tube placement improved nutritional status and overall survival (OS) in advanced gastroesophageal (GE) cancer patients who are undergoing anti-neoplastic therapy.</p><p>Methods</p><p>GE cancer patients who were treated and evaluated by a nutritionist and had at least 2 nutritionist follow-up visits were identified. Patients with PEG tube were matched to patients that did not undergo PEG placement (non-PEG). Clinical characteristics, GE symptoms reported at nutrition follow-up visits, and OS were recorded.</p><p>Results</p><p>20 PEG and 18 non-PEG cases met criteria for further analyses. After correction for multiple testing, there were no OS differences between PEG and non-PEG, treatment naive and previously treated. However, PEG esophageal carcinoma has statistically significant inferior OS compared with non-PEG esophageal carcinoma. PEG placement did not significantly reduce the proportion of patients with weight loss between the initial nutrition assessment and 12-week follow-up.</p><p>Conclusions</p><p>In this small study, PEG placement had inferior OS outcome for GE esophageal carcinoma, no improvement in OS for other evaluated groups, and did not reduce weight loss between baseline and 12-week follow-up. Unless there is prospective randomized trial that can show superiority of PEG placement in this population, PEG placement in this group cannot be endorsed.</p></div

Clinical characteristics.

<p>Clinical characteristics.</p

Symptoms of non-PEG patients (n = 18).

<p>Symptoms of non-PEG patients (n = 18).</p

CONSORT diagram.

<p>CONSORT diagram depicting number of patients evaluated for eligibility and number of patients included in analysis.</p

OS comparing PEG vs non-PEG in all patients.

<p>Kaplan-Meier curve depicting the estimated OS of all patients. The line with circles depicts PEG patients, while the line with squares depicts non-PEG patients. P-value is not significant after Bonferroni correction.</p

Symptoms of PEG patients (n = 20).

<p>Symptoms of PEG patients (n = 20).</p

OS comparing PEG vs non-PEG in esophageal carcinoma.

<p>Kaplan-Meier curve depicting the estimated OS for patients with esophageal carcinoma. The line with circles depicts PEG esophageal carcinoma patients, while the line with squares depicts non-PEG esophageal carcinoma patients. P-value is significant after Bonferroni correction.</p

OS comparing PEG vs non-PEG in adenocarcinoma.

<p>Kaplan-Meier curve depicting the estimated OS for patients with adenocarcinoma. The line with circles depicts PEG adenocarcinoma patients, while the line with squares depicts non-PEG adenocarcinoma patients. P-value is not significant after Bonferroni correction.</p

Additional file 1: of Multiparametric analysis of anti-proliferative and apoptotic effects of gold nanoprisms on mouse and human primary and transformed cells, biodistribution and toxicity in vivo

Figure S1. a) SEM micrograph of the initial NPR-P. b) Length (L) distribution of the NPRs, average length is 146.2 ± 32.4 nm. c) UV/Vis spectra of a NPR-P solution. Figure S2. a) Agarose gel (0.7%, 100 V, 1 h) of the pegylated NPRs (NPR-P) and the modified ones (NPR-PT, NPR-PTG and NPR-PG). b) ζ-potential measurements of the final NPRs measured in water and using a concentration of 0.04 mg/mL. Figure S3. Fluorescence spectra of NPRs solutions labeled with TAMRA. In black, there is the normalized spectrum for NPR-PT, and in red the normalized spectra for NPR-PTG. Figure S4. UV/Vis spectra of NPRs before (red) and after (black) their incubation in complete cell media during 24 h. Figure S5. (A) Analysis of cell morphology changes by flow cytometry. MiaPaca, HeLa, A549, MEF, B16, MC57G line cells were incubated with four types of nanoparticles (NPR-P, NPR-PG, NPR-PT, NPR-PTG) at four concentrations (25, 50, 100 and 200 μg/mL) for 48 h as indicated in experimental section. After incubation time, cells were analyzed by flow cytometry. A representative experiment is shown at the concentration of 200 μg/mL Note: Ctrl = negative control. Figure S6. Periodic acid-Schiff (PAS) and periodic acid-Schiff diastasa (PAS/D) stain of the liver of mice treated with NPRs. Mice were injected (i.v) with 6 μg/g NPR-PTG and sacrificed after 4 months, the organs were fixed and processed for PAS staining, as indicated in experimental section. Representative images are shown. (DOCX 45107 kb