McMillan Donald C
University Dept of Surgery, Royal Infirmary, Glasgow G31 2ER, UK.
Proc Nutr Soc. 2008 Aug;67(3):257-62. doi: 10.1017/S0029665108007131. Epub 2008 May 1.
Progressive involuntary weight loss, in particular the loss of lean tissue, is common in patients with advanced cancer and has long been recognised to result in a deterioration in performance status and quality of life, increased morbidity and mortality. The aetiology of such weight loss or cachexia is complex and involves both tumour and host responses. Thus, identification of patients who are or are likely to become cachectic has been problematic. In addition to a reduction in appetite and increased satiety leading to poor dietary intake, there is now increasing clinical evidence that the activation of a chronic ongoing systemic inflammatory response is one of the earliest and most important contributory factors to cachexia. Such findings help to explain the failure of simple nutritional programmes to reverse weight loss adequately in patients with cancer. In the present paper the development of an inflammation-based score is described, which is derived from the acute-phase proteins C-reactive protein and albumin and is termed the Glasgow prognostic score (GPS). Its value as a predictor of survival, independent of tumour stage, performance status and treatment (active or palliative), has been shown in a variety of advanced common solid tumours. The nature of the relationship between the GPS, appetite, body composition, performance status and quality of life of the patient with advanced cancer will be described. Recently, it has become evident that the systemic inflammatory response is also present in a smaller proportion of patients with primary operable cancer and is also predictive of disease progression and poor survival. The role of GPS in clinical decision making will be discussed.
进行性非自愿体重减轻，尤其是瘦组织的丢失，在晚期癌症患者中很常见，长期以来人们都认识到这会导致身体状况和生活质量恶化，发病率和死亡率增加。这种体重减轻或恶病质的病因很复杂，涉及肿瘤和宿主反应。因此，识别已经或可能发生恶病质的患者一直存在问题。除了食欲下降和饱腹感增加导致饮食摄入不足外，现在越来越多的临床证据表明，慢性持续全身性炎症反应的激活是恶病质最早和最重要的促成因素之一。这些发现有助于解释简单的营养方案为何无法充分逆转癌症患者的体重减轻。在本文中，描述了一种基于炎症的评分系统的开发，该系统源自急性期蛋白C反应蛋白和白蛋白，被称为格拉斯哥预后评分（GPS）。在各种晚期常见实体瘤中，它作为独立于肿瘤分期、身体状况和治疗（积极或姑息）的生存预测指标的价值已得到证实。将描述GPS与晚期癌症患者的食欲、身体组成、身体状况和生活质量之间关系的性质。最近，很明显，在一小部分原发性可手术癌症患者中也存在全身性炎症反应，并且它也可预测疾病进展和不良生存。将讨论GPS在临床决策中的作用。
