Laviano Alessandro, Meguid Michael M, Inui Akio, Muscaritoli Maurizio, Rossi-Fanelli Filippo
Department of Clinical Medicine, University La Sapienza, Rome, Italy.
Nat Clin Pract Oncol. 2005 Mar;2(3):158-65. doi: 10.1038/ncponc0112.
Tumor growth is associated with profound metabolic and neurochemical alterations, which can lead to the onset of anorexia-cachexia syndrome. Anorexia is defined as the loss of the desire to eat, while cachexia results from progressive wasting of skeletal muscle mass--and to a lesser extent adipose tissue--occurring even before weight loss becomes apparent. Cancer anorexia-cachexia syndrome is highly prevalent among cancer patients, has a large impact on morbidity and mortality, and impinges on patient quality of life. However, its clinical relevance is frequently overlooked, and treatments are usually only attempted during advanced stages of the disease. The pathogenic mechanisms of cachexia and anorexia are multifactorial, but cytokines and tumor-derived factors have a significant role, thereby representing a suitable therapeutic target. Energy expenditure in anorexia is frequently increased while energy intake is decreased, which further exacerbates the progressive deterioration of nutritional status. The optimal therapeutic approach to anorectic-cachectic cancer patients should be based on both changes in dietary habits, achieved via nutritional counseling; and drug therapy, aimed at interfering with cytokine expression or activity. Our improved understanding of the influence a tumor has on the host's metabolism is advancing new therapeutic approaches, which are likely to result in better preservation of nutritional status if started concurrently with specific antineoplastic treatment.
肿瘤生长与深刻的代谢和神经化学改变相关，这可导致厌食 - 恶病质综合征的发生。厌食被定义为食欲丧失，而恶病质是由骨骼肌质量的进行性消耗引起的——脂肪组织的消耗程度较小——甚至在体重减轻明显之前就已发生。癌症厌食 - 恶病质综合征在癌症患者中非常普遍，对发病率和死亡率有很大影响，并影响患者的生活质量。然而，其临床相关性常常被忽视，治疗通常只在疾病的晚期阶段才尝试。恶病质和厌食的致病机制是多因素的，但细胞因子和肿瘤衍生因子起着重要作用，因此是合适的治疗靶点。厌食患者的能量消耗通常增加而能量摄入减少，这进一步加剧了营养状况的逐渐恶化。针对厌食 - 恶病质癌症患者的最佳治疗方法应基于通过营养咨询实现的饮食习惯改变，以及旨在干扰细胞因子表达或活性的药物治疗。我们对肿瘤对宿主代谢影响的更好理解正在推动新的治疗方法，如果与特定的抗肿瘤治疗同时开始，这些方法可能会更好地保持营养状况。
