Total parenteral nutrition and tumor growth in malnourished patients with gastric cancer

Aims and background: Evidence that total parenteral nutrition (TPN) can sti mulate tumor growth in humans is scanty and contradictory. The purpose of t his study was to evaluate the impact of TPN on tumor cell proliferation in malnourished patients receiving preoperative TPN, Methods: We evaluated variations in the S-phase cell fraction, defined as H -3-thymidine labeling index (TLI), before and after 10 days of TPN or non-a dministration of nutritional support in 19 malnourished patients (weight lo ss, greater than or equal to 10%) with gastric cancer. TLI was determined o n endoscopic biopsies at the time of diagnosis, and subsequently on the ope rative specimen or through intraoperative sampling. Results: At diagnosis, a higher median TLI value was observed in the contro l than in the TPN group. Administration of TPN enhanced tumor cell prolifer ation in 50% of patients; however, at surgery there was no difference in th e median TLI value of the two groups. Conclusions: The TPN regimen seems to be associated with increased tumor ce ll proliferation, even though this stimulating effect was moderate and at s urgery the TLI, of TPN patients and controls were not different. Although t he potential stimulation probably has little consequence for patients recei ving short-term preoperative nutrition, it may call for further Investigati on in cancer patients undergoing long-term home TPN.