Clinical and Surgical Sciences, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, UK.
Lancet Oncol. 2011 May;12(5):489-95. doi: 10.1016/S1470-2045(10)70218-7. Epub 2011 Feb 4.
To develop a framework for the definition and classification of cancer cachexia a panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. Cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (body-mass index [BMI] <20 kg/m(2)) or skeletal muscle mass (sarcopenia). An agreement was made that the cachexia syndrome can develop progressively through various stages--precachexia to cachexia to refractory cachexia. Severity can be classified according to degree of depletion of energy stores and body protein (BMI) in combination with degree of ongoing weight loss. Assessment for classification and clinical management should include the following domains: anorexia or reduced food intake, catabolic drive, muscle mass and strength, functional and psychosocial impairment. Consensus exists on a framework for the definition and classification of cancer cachexia. After validation, this should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management.
为了制定癌症恶病质的定义和分类框架，一组专家参与了一个正式的共识过程，包括焦点小组和两轮 Delphi 法。癌症恶病质被定义为一种多因素综合征，其特征是持续的骨骼肌减少（伴有或不伴有脂肪减少），不能通过常规营养支持完全逆转，并导致进行性功能障碍。其病理生理学的特点是蛋白质和能量呈负平衡，由减少的食物摄入和异常代谢的可变组合驱动。恶病质的商定诊断标准是体重减轻大于 5%，或已经根据当前体重和身高（BMI<20 kg/m(2)）或骨骼肌质量（肌少症）出现消耗的个体体重减轻大于 2%。专家们一致认为，恶病质综合征可以通过不同阶段逐步发展——前恶病质到恶病质到难治性恶病质。严重程度可以根据能量储存和身体蛋白质（BMI）的消耗程度以及持续体重减轻的程度来分类。为了分类和临床管理，评估应包括以下领域：厌食或食物摄入减少、分解代谢驱动、肌肉质量和力量、功能和心理社会损害。目前已经存在癌症恶病质定义和分类的框架共识。经过验证后，这应该有助于临床试验设计、实践指南的制定，最终有助于常规临床管理。
