Oncological Palliative Medicine, Division of Oncology/Hematology, Department of Internal Medicine and Palliative Care Center, Cantonal Hospital, St. Gallen, Switzerland.
Crit Rev Oncol Hematol. 2011 Oct;80(1):114-44. doi: 10.1016/j.critrevonc.2010.10.004. Epub 2011 Jan 8.
The concept of cancer-related anorexia/cachexia is evolving as its mechanisms are better understood. To support consensus processes towards an updated definition and classification system, we systematically reviewed the literature for items and domains associated with involuntary weight loss in cancer.
Two search strings (cachexia, cancer) explored five databases from 1976 to 2007. Citations, abstracts and papers were included if they were original work, in English/German language, and explored an item to distinguish advanced cancer patients with variable degrees of involuntary weight loss. The items were grouped into the 5 domains proposed by formal expert meetings.
Of 14,344 citations, 1275 abstracts and 585 papers reviewed, 71 papers were included (6325 patients; 40-50% gastrointestinal, 10-20% lung cancer). No single domain or item could consistently distinguish cancer patients with or without weight loss or having various degrees of weight loss. Anorexia and decreased nutritional intake were unexpectedly weakly related with weight loss. Explanations for this could be the imprecise measurement methods for nutritional intake, symptom interactions, and the importance of systemic inflammation as a catabolic drive. Data on muscle mass and strength is scarce and the impact of cachexia on physical and psychosocial function has not been widely assessed.
Current data support a modular concept of cancer cachexia with a variable combination of reduced nutritional intake and catabolic/hyper-metabolic changes. The heterogeneity in the literature revealed by this review underlines the importance of an agreed definition and classification of cancer cachexia.
随着癌症相关性厌食/恶病质机制的深入理解，这一概念也在不断发展。为了支持针对更新定义和分类系统的共识过程，我们系统地回顾了癌症相关非自愿性体重减轻的文献，以寻找与该主题相关的项目和领域。
我们使用两个搜索字符串（cachexia，cancer）在 1976 年至 2007 年间搜索了五个数据库。如果文献是原始研究、使用英文或德文、探讨可用于区分不同程度非自愿性体重减轻的晚期癌症患者的项目，我们就将其纳入研究。这些项目被归入正式专家会议提出的五个领域。
在 14344 条引文、1275 篇摘要和 585 篇全文中，我们共审查了 71 篇文献（涉及 6325 名患者；其中 40-50%为胃肠道癌症，10-20%为肺癌）。没有任何一个单一的领域或项目能够始终如一地区分有或没有体重减轻以及体重减轻程度不同的癌症患者。厌食和营养摄入减少与体重减轻的相关性出乎意料地较弱。对这种情况的解释可能是对营养摄入的测量方法不精确、症状相互作用以及系统性炎症作为分解代谢驱动的重要性。关于肌肉质量和力量的数据很少，而且恶病质对身体和心理社会功能的影响也没有得到广泛评估。
目前的数据支持癌症恶病质的模块化概念，即存在各种不同的营养摄入减少和分解代谢/高代谢变化的组合。本综述揭示了文献中的异质性，强调了对癌症恶病质达成共识的定义和分类的重要性。
