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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-17122019-144806
Document
Author
Full name
Ana Paula Pagano
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Chiarello, Paula Garcia (President)
Navarro, Anderson Marliere
Rabito, Estela Iraci
Souza, Fernanda Fernandes
Title in Portuguese
Composição corporal de pacientes com carcinoma hepatocelular no prognóstico clínico da doença, por meio de impedância bioelétrica por espectroscopia e ressonância magnética
Keywords in Portuguese
Carcinoma hepatocelular
Composição corporal
Impedância bioelétrica
Ressonância magnética
Abstract in Portuguese
Diferentes processos afetam o fígado gerando consequências negativas, incluindo o possível desenvolvimento de carcinoma hepatocelular. A subnutrição contribui para o surgimento de complicações e uma maior mortalidade. O diagnóstico nutricional correto é de suma importância, auxiliando na resposta terapêutica e redução de complicações, podendo ser usado como fator prognóstico em cirróticos. A dificuldade reside na identificação da relação do estado nutricional com o prognóstico da doença e na busca de ferramentas que apoiam uma avaliação mais acurada nestes pacientes. Objetivo: Avaliar o uso de ferramentas de avaliação antropométrica, funcionalidade muscular e composição corporal na predição do prognóstico da doença de pacientes com carcinoma hepatocelular. Métodos: Pacientes do sexo masculino com carcinoma hepatocelular, em seguimento nutricional ambulatorial, entre 18 e 80 anos. O prognóstico da doença foi avaliado por escores de Child-Turcotte-Pugh, Model of End-Stage Liver e Barcelona-Clinic Liver Cancer. Pacientes passaram por avaliação de antropometria, funcionalidade muscular, dados de albumina e de composição corporal. Resultados: Houve redução na taxa de sobrevida estimada de pacientes conforme pior prognóstico, com diferença estatística para o escore de BCLC (p valor = 0,02). Não houve diferença estatística entre os valores de EMAP, FPP e albumina pelos escores de CHILD, MELD e BCLC. IMLG e IATP reduzirem conforme pior o prognóstico de CHILD. AF <=5,04° se associou a redução na taxa de sobrevida estimada dos pacientes (p valor = 0,01). Conclusão: A sobrevida estimada dos pacientes foi menor conforme pior o prognóstico da doença. CHILD e BCLC tiveram maior relação com estado de hidratação, integridade de membrana celular e albumina. EMAP, FPP e albumina, individualmente, podem não ser representativos de preservação da massa muscular ou do estado nutricional. AF demonstrou potencial em ser medida promissora na predição de prognóstico, mortalidade, sobrevida e estado nutricional.
Title in English
Body composition of patients with hepatocellular carcinoma in the clinical prognosis of the disease, through bioelectrical impedance by spectroscopy and magnetic resonance imaging
Keywords in English
Bioelectrical impedance
Body composition
Hepatocellular carcinoma
Magnetic resonance imaging
Abstract in English
Different processes affect the liver causing negative consequences, including the possible development of hepatocellular carcinoma. Malnutrition contributes to the emergence of complications and increased mortality. The correct nutritional diagnosis is important, aiding in the therapeutic response and reduction of complications, being able to be used as a prognostic factor in cirrhotic patients. The difficulty lies in identifying the relationship between nutritional status and the prognosis of the disease and in the search for tools that support a more accurate evaluation in these patients. Objective: To evaluate the use of anthropometric evaluation tools, muscle functionality and body composition in predicting the prognosis of patients with hepatocellular carcinoma. Methods: Male patients with hepatocellular carcinoma, in an outpatient nutritional follow-up, between 18 and 80 years. The prognosis of the disease was assessed by Child-Turcotte-Pugh, Model of End-Stage Liver and Barcelona-Clinic Liver Cancer scores. Patients underwent evaluation of anthropometry, muscular functionality, albumin data and body composition. Results: There was a reduction in the estimated survival rate of patients according to the worst prognosis, with statistical difference for the BCLC score (p value = 0.02). There was no statistical difference between the EMAP, FPP and albumin values for the CHILD, MELD and BCLC scores. IMLG and IATP reduce the worse the prognosis of CHILD. AF <=5.04 ° was associated with a reduction in the patients' estimated survival rate (p value = 0.01). Conclusion: The patients' estimated survival was lower as the prognosis of the disease was worse. CHILD and BCLC had greater relationship with hydration state, cell membrane integrity and albumin. EMAP, FPP and albumin, individually, may not be representative of preservation of muscle mass or nutritional status. AF demonstrated potential to be a promising measure in the prediction of prognosis, mortality, survival and nutritional status.
 
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Publishing Date
2020-04-30
 
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