Avaliação e previsões de sobrevivência do PROtocol for Nutritional Risk in Oncology (PRONTO)

Abstract

Cancer is a complex disease characterized by the irregular growth of malignant cells and represents the second leading cause of death in the world. It causes metabolic changes that often result in nutritional deficits, including malnutrition. Approximately 20% of cancer patients die from malnutrition and associated complications, not from the disease itself. Therefore, early identification of nutritional risk favors earlier and more assertive interventions, the continuous monitoring of which contributes to risk reduction. The aim of this study was to evaluate the discriminatory and mortality prediction performance of the PROtocol for Nutritional Risk in Oncology (PRONTO) instrument in outpatients and hospitalized cancer patients. The study is a secondary analysis of a cohort with prospective data collection, which evaluated cancer patients in a hospital setting at the Onofre Lopes University Hospital - HUOL, of both sexes, aged over 20 years. Sociodemographic and anthropometric data were collected (weight and height to calculate body mass index - BMI). Nutritional risk was assessed using the shortened version of the Subjective Global Assessment Produced by the Patient (ASG-PPP), applied up to 48 hours after hospitalization, while PRONTO was assessed using retrospective data. Patients were followed up to assess immortality outcomes at 6 and 12 months. To verify the concurrent validity of PRONTO for assessing nutritional risk, accuracy metrics were calculated and Cox regression analysis was conducted to verify the association between the outcomes of interest and the presence of nutritional risk in order to test its predictive validity. A total of 390 patients were evaluated. They were elderly (45.6%), female (53.6%), with solid tumors (89%) and advanced stages of the disease (42.3%). Approximately half of the sample underwent chemotherapy treatment only (39.5%). The frequency of nutritional risk was higher using the PRONTO tool when compared to the ASGPPP (84.4% vs 76.4%, respectively). The classification of nutritional risk according to PRONTO showed moderate accuracy in identifying patients at nutritional risk (AUC 0.76, 95% CI 0.68 - 0.79), high sensitivity (95.3%) and positive predictive value (86.3%) obtained, low specificity (51.1%) and low negative predictive value (77.7%). The risk status identified by PRONTO was an independent and satisfactory predictor of mortality at 6 and 12 months (adjusted HR 2.96; 95% CI 1.05 to 8.32, adjusted HR 2.88; 95% CI 1.20 to 6.63). The study presents an initial assessment of the applicability of the PRONTO protocol, highlighting its potential as a tool for rapid identification of nutritional risk and prognosis in cancer patients. In clinical settings where formal nutritional screening is not available, PRONTO may represent an efficient and easy-to-implement approach, facilitating the early identification of patients at risk and enabling timely nutritional interventions in clinical practice.