Department of Nuclear Medicine, Northern Clinical School, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia.
HPB (Oxford). 2010 Jun;12(5):325-33. doi: 10.1111/j.1477-2574.2010.00171.x.
Cachexia is common in pancreatic cancer and may have an influence on longterm survival but few studies have investigated this in patients with operable tumours. Therefore, this study was carried out to document body composition status in patients with pancreatic adenocarcinoma (PCa) presenting for a Whipple's procedure (WP) and to relate the findings to histopathology and longterm survival.
Body composition was measured 1 day before a WP for ductal PCa in 36 patients (15 men, 21 women) aged 41-81 years. Results for total body nitrogen (TBN), nitrogen index (NI), total body water (TBW), fat mass (FM) and total body potassium (TBK) were compared with results in 73 age- and sex-matched controls. Patients' survival and details from histopathology synoptic reports were documented.
Patients undergoing WPs had low TBK values (P < 0.001) and females had lower body fat (P = 0.007) compared with controls. Five of 36 presented with significant protein deficiency, but this was not associated with a prolonged length of stay or reduced survival. The 12 patients who had involved surgical margins had larger tumours and reduced weight (P = 0.015), FM (P = 0.001), TBN (P = 0.045), TBK (P = 0.014) and survival (P = 0.036). However, multivariate Cox's regression analysis only included FM along with vascular invasion and margin status as independent predictors of survival.
PCa patients undergoing a WP have reduced body fat and TBK compared with community controls while those with stage III tumours had greater deficits of fat, TBK and protein stores. However, preoperative body composition was a poor predictor of postoperative survival after pathological data were considered.
恶病质在胰腺癌中很常见，可能对长期生存有影响，但很少有研究调查可手术肿瘤患者的这种情况。因此，本研究旨在记录接受胰十二指肠切除术（Whipple's procedure，WP）的胰腺腺癌（pancreatic adenocarcinoma，PCa）患者的身体成分状况，并将这些发现与组织病理学和长期生存相关联。
对 36 名 41-81 岁的导管 PCa 患者（15 名男性，21 名女性）在 WP 前 1 天进行身体成分测量。将总体氮（total body nitrogen，TBN）、氮指数（nitrogen index，NI）、总体水（total body water，TBW）、体脂质量（fat mass，FM）和总体钾（total body potassium，TBK）的结果与 73 名年龄和性别匹配的对照者进行比较。记录患者的生存情况和组织病理学综合报告中的详细信息。
WP 患者的 TBK 值较低（P < 0.001），女性的体脂较低（P = 0.007）。36 名患者中有 5 名存在显著的蛋白质缺乏，但这与住院时间延长或生存时间缩短无关。12 名有手术切缘累及的患者肿瘤较大，体重（P = 0.015）、FM（P = 0.001）、TBN（P = 0.045）、TBK（P = 0.014）和生存（P = 0.036）降低。然而，多变量 Cox 回归分析仅将 FM 以及血管侵犯和切缘状态作为生存的独立预测因素。
与社区对照者相比，接受 WP 的 PCa 患者体脂和 TBK 减少，而 III 期肿瘤患者的体脂、TBK 和蛋白质储存减少更多。然而，在考虑病理数据后，术前身体成分是术后生存的一个较差的预测因素。
