Nutritional status and clinical outcomes in pediatric patients with solid tumors : A systematic review of the literature

Introduction: Nutritional status (NS), defined by undernutrition (body mass index [BMI] <5th percentile) or overnutrition (BMI >= 85th percentile), is a poor prognostic indicator in pediatric oncology patients. The impact of NS has been primarily studied in hematologic malignancies. This review is intended to summarize literature reporting on the association of NS and treatment-related outcomes in pediatric solid tumors. Methods: We searched four electronic databases from inception through August 2018 without language restriction, and included studies of children with cancers arising from renal, bone, liver, eye, muscle, vascular, germ cell, and neural crest tissues, reporting on NS as a predictor for toxicity, survival or relapse. Due to data heterogeneity and limited availability of studies, formal statistical analysis was not achievable. Descriptive statistics were summarized in table format. Results: Of 8,991 reports identified, 75 full-text articles were evaluated, 10 of which met inclusion criteria. Up to 62% of patients were over- or undernourished at diagnosis. Abnormal BMI was associated with worse overall survival in Ewing sarcoma (hazard ratio (HR): 3.46, P=.022), osteosarcoma (HR: 1.6, P<.005), and a trend toward poorer overall survival in rhabdomyosarcoma (HR: 1.70, P=.0596). High BMI in osteosarcoma was associated with increased nephrotoxicity (odds ratio: 2.8, P=.01) and postoperative complications. NS was not a significant predictor of outcomes in other included disease categories. Conclusions: Existing literature supports the prognostic significance of NS in pediatric solid tumor patients and underscores the need for prospective studies to better elucidate underlying physiological changes in this population. (C) 2018 Elsevier Inc. All rights reserved.