Deutsch John, Kolhouse J Fred
Cancer Center, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
Support Care Cancer. 2004 Jul;12(7):503-10. doi: 10.1007/s00520-004-0615-4. Epub 2004 Apr 3.
Cancer-associated anorexia/cachexia syndrome (CACS) is common in advanced gastrointestinal malignancies and felt to be due primarily to cytokine-induced appetite suppression. Therapy with an appetite stimulant (megesterol acetate) is commonly employed, but results are sometimes disappointing. We hypothesize that CACS not only suppresses appetite but also interferes with gastrointestinal function.
We conducted a prospective study in which 21 subjects with advanced gastrointestinal cancer and weight loss had digestive function. Patients were assessed using an indirect stable isotope method, and nutritional parameters were determined following which patients were treated with megesterol acetate for 4 weeks. Nutritional parameters were then reassessed, weight change determined, and the results were correlated with digestive function results obtained at the initiation of the study.
Abnormal gastrointestinal function based on the stable isotope test was common (86% of patients). The majority of the abnormal function appeared to be due to abnormal pancreatic function testing, in which 17/21 subjects recorded low results. Initial albumin, prealbumin, and carotene values were also frequently abnormal (55-65% of patients). Megesterol acetate therapy resulted in a weight gain in most (75%) patients, although serum albumin fell modestly in the group (average decrease of 0.2 mg/dl). However, prealbumin levels rose in 70% and carotene levels rose in 55%. The degree of weight gain was negatively correlated with previous self-reported weight loss ( r=-0.53, p<0.05), and positively correlated ( p<0.05) with pretherapy carotene ( r=0.58), prealbumin ( r=0.61) and the pancreatic function (digestive) phase of the digestive function test ( r=0.41).
These data suggest that abnormal digestive function is commonly seen in subjects with CACS and advanced gastrointestinal cancer, and that both pretherapy digestive function and nutritional status can predict or possibly influence the outcome of hormonal appetite stimulation therapy.
癌症相关性厌食/恶病质综合征（CACS）在晚期胃肠道恶性肿瘤中很常见，主要被认为是由细胞因子诱导的食欲抑制所致。食欲刺激剂（醋酸甲地孕酮）治疗常用，但结果有时令人失望。我们推测CACS不仅抑制食欲，还会干扰胃肠功能。
我们进行了一项前瞻性研究，21例晚期胃肠道癌伴体重减轻的患者接受了消化功能评估。采用间接稳定同位素法对患者进行评估，确定营养参数，随后患者接受醋酸甲地孕酮治疗4周。然后重新评估营养参数，确定体重变化，并将结果与研究开始时获得的消化功能结果进行关联。
基于稳定同位素试验的胃肠功能异常很常见（86%的患者）。大多数异常功能似乎是由于胰腺功能试验异常，其中17/21例受试者结果偏低。初始白蛋白、前白蛋白和胡萝卜素值也经常异常（55 - 65%的患者）。醋酸甲地孕酮治疗使大多数（75%）患者体重增加，尽管该组血清白蛋白略有下降（平均下降0.2mg/dl）。然而，70%的患者前白蛋白水平升高，55%的患者胡萝卜素水平升高。体重增加程度与先前自我报告的体重减轻呈负相关（r = -0.53，p < 0.05），与治疗前胡萝卜素（r = 0.58）、前白蛋白（r = 0.61）以及消化功能试验的胰腺功能（消化）阶段呈正相关（p < 0.05）（r = 0.41）。
这些数据表明，CACS和晚期胃肠道癌患者中常见消化功能异常，治疗前的消化功能和营养状况均可预测或可能影响激素食欲刺激疗法的结果。
