Barber M D, Ross J A, Fearon K C
University Department of Surgery, Lister Laboratories, Royal Infirmary of Edinburgh, United Kingdom.
Nutr Cancer. 1999;35(2):106-10. doi: 10.1207/S15327914NC352_2.
Weight loss and the acute-phase response have been associated with poor quality of life and survival in advanced pancreatic cancer; however, little information is available on changes in these factors over time and their interrelationships. This study examined changes in weight, Karnofsky performance status, C-reactive protein (CRP), and serum albumin in 25 patients with advanced pancreatic cancer given supportive symptomatic treatment only. Patients were assessed at approximately monthly intervals on a total of 70 occasions, allowing assessment of changes over 37 intervals. Overall, patients had a median weight loss of 2.3 kg/28 days. Median CRP levels rose by 15 mg/l, and serum albumin fell by 1 g/l on average over 28 days. Karnofsky performance status fell by 4 points every 28 days. The nine patients assessed close to death were compared with the 13 assessed close to diagnosis. The increase in CRP level and fall in weight and performance status were significantly greater within eight weeks of death than within eight weeks of diagnosis. Among patients close to diagnosis, 13% had an elevated CRP compared with 100% of those close to death. In multivariate analysis, Karnofsky performance status was significantly associated with percent weight loss and CRP levels. These data further implicate the acute-phase protein response as being associated with the progressive weight loss seen in patients with advanced pancreatic cancer. Changes appear to accelerate close to death. Moreover, the development of cachexia is associated with a reduction in patients' functional capacity.
体重减轻和急性期反应与晚期胰腺癌患者的生活质量差及生存率低有关；然而，关于这些因素随时间的变化及其相互关系的信息却很少。本研究仅对25例接受支持性对症治疗的晚期胰腺癌患者的体重、卡诺夫斯基功能状态、C反应蛋白（CRP）和血清白蛋白的变化进行了研究。患者大约每月接受一次评估，共评估70次，从而能够评估37个时间段内的变化。总体而言，患者体重中位数每28天减轻2.3千克。CRP水平中位数每28天平均升高15毫克/升，血清白蛋白每28天平均下降1克/升。卡诺夫斯基功能状态每28天下降4分。将9例接近死亡时接受评估的患者与13例接近诊断时接受评估的患者进行了比较。死亡前八周内CRP水平的升高以及体重和功能状态的下降明显大于诊断前八周内。在接近诊断的患者中，13%的患者CRP升高，而接近死亡的患者中这一比例为100%。在多变量分析中，卡诺夫斯基功能状态与体重减轻百分比和CRP水平显著相关。这些数据进一步表明急性期蛋白反应与晚期胰腺癌患者出现的进行性体重减轻有关。变化似乎在接近死亡时加速。此外，恶病质的发展与患者功能能力的降低有关。
