Bachmann Jeannine, Ketterer Knut, Marsch Christiane, Fechtner Kerstin, Krakowski-Roosen Holger, Büchler Markus W, Friess Helmut, Martignoni Marc E
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
BMC Cancer. 2009 Jul 28;9:255. doi: 10.1186/1471-2407-9-255.
Dramatic weight loss is an often underestimated symptom in pancreatic cancer patients. Cachexia- defined as an unintended loss of stable weight exceeding 10%--is present in up to 80% of patients with cancer of the upper gastrointestinal tract, and has a significant influence on survival. The aim of the study was to show the multiple systemic effects of cachexia in pancreatic cancer patients, in terms of resection rate, effects on pulmonary function, amount of fat and muscle tissue, as well as changes in laboratory parameters.
In patients with pancreatic cancer, clinical appearance was documented, including the amount of weight loss. Laboratory parameters and lung-function tests were evaluated, and the thickness of muscle and fat tissue was measured with computed tomography scans. Statistical analysis, including multivariate analysis, was performed using SPSS software. Survival curves were calculated using Kaplan-Meier analysis and the log-rank test. To test for significant differences between the examined groups we used Student's t-test and the Mann-Whitney U test. Significance was defined as p < 0.05.
Of 198 patients with a ductal adenocarcinoma of the pancreas, 70% were suffering from weight loss when they presented for operation, and in 40% weight loss exceeded 10% of the stable weight. In patients with cachexia, metastases were diagnosed significantly more often (47% vs. 24%, P < 0.001), leading to a significantly reduced resection rate in these patients. Patients with cachexia had significantly reduced fat tissue amounts. Hence, dramatic weight loss in a patient with pancreatic cancer may be a hint of a more progressed or more aggressive tumour.
Pancreatic cancer patients with cachexia had a higher rate of more progressed tumour stages and a worse nutritional status. Furthermore, patients with cachexia had an impaired lung function and a reduction in fat tissue. Patients with pancreatic cancer and cachexia had significantly reduced survival. If weight loss exceeded 5% there was a significantly reduced resection rate to detect, but the changes were significantly more substantial if weight loss was 10% or more. We propose that a weight loss of 10% be defined as significant in pancreatic cancer.
体重急剧下降是胰腺癌患者中一种常被低估的症状。恶病质（定义为体重意外稳定下降超过10%）在高达80%的上消化道癌症患者中存在，且对生存有重大影响。本研究的目的是从切除率、对肺功能的影响、脂肪和肌肉组织量以及实验室参数变化等方面，展示恶病质在胰腺癌患者中的多种全身影响。
记录胰腺癌患者的临床表现，包括体重下降量。评估实验室参数和肺功能测试，并通过计算机断层扫描测量肌肉和脂肪组织厚度。使用SPSS软件进行统计分析，包括多变量分析。使用Kaplan-Meier分析和对数秩检验计算生存曲线。为检验各研究组之间的显著差异，我们使用了学生t检验和Mann-Whitney U检验。显著性定义为p < 0.05。
在198例胰腺导管腺癌患者中，70%在接受手术时体重下降，40%的患者体重下降超过稳定体重的10%。在恶病质患者中，转移的诊断明显更频繁（47%对24%，P < 0.001），导致这些患者的切除率显著降低。恶病质患者的脂肪组织量显著减少。因此，胰腺癌患者体重急剧下降可能提示肿瘤进展更严重或更具侵袭性。
患有恶病质的胰腺癌患者肿瘤进展阶段更高，营养状况更差。此外，恶病质患者肺功能受损，脂肪组织减少。患有胰腺癌和恶病质的患者生存显著降低。如果体重下降超过5%，可检测到的切除率显著降低，但如果体重下降10%或更多，变化则显著更大。我们建议将胰腺癌患者体重下降10%定义为显著。
