癌症恶病质对晚期非小细胞肺癌患者的预后影响
Prognostic impact of cancer cachexia in patients with advanced non-small cell lung cancer.
作者信息
Kimura Madoka, Naito Tateaki, Kenmotsu Hirotsugu, Taira Tetsuhiko, Wakuda Kazushige, Oyakawa Takuya, Hisamatsu Yasushi, Tokito Takaaki, Imai Hisao, Akamatsu Hiroaki, Ono Akira, Kaira Kyoichi, Murakami Haruyasu, Endo Masahiro, Mori Keita, Takahashi Toshiaki, Yamamoto Nobuyuki
机构信息
Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan.
出版信息
Support Care Cancer. 2015 Jun;23(6):1699-708. doi: 10.1007/s00520-014-2534-3. Epub 2014 Nov 29.
PURPOSE
Cancer cachexia (CC) is commonly seen in advanced lung cancer patients and associated with poor prognosis. However, little is known about CC that develops during chemotherapy. We evaluated the prognostic impact of CC and skeletal muscle wasting that develops during the course of chemotherapy in advanced non-small cell lung cancer (NSCLC) patients.
METHODS
The clinical data of 134 newly diagnosed NSCLC patients were retrospectively reviewed. CC was defined as a body weight loss >5 or >2 % in patients with a body mass index of <20 kg/m(2). CC was assessed at baseline (T1) and 3 months (T2), 6 months (T3), and 12 months (T4) after chemotherapy initiation. Skeletal muscle mass was assessed using the lumber skeletal muscle index (LSMI).
RESULTS
The proportion of patients with CC at T1, T2, T3, and T4 was 45.6, 46.1, 25.5, and 26.0 %, respectively. The frequency of grade 3 chemotherapy-induced anorexia was higher in patients with CC than those without CC at T2 (15.4 vs. 0.0 %, P = 0.0044). At all time points, patients with CC had shorter survival times than those without CC. Patients with low LSMIs (men, <41 cm(2)/m(2); women, <38 cm(2)/m(2)) tended to have poor prognosis. Adjusted Cox proportional hazard ratios and corresponding confidence intervals for CC at T1, T2, T3, and T4 were 2.53 (1.33-4.88), 1.97 (1.27-3.06), 3.86 (2.14-6.81), and 1.62 (0.80-3.16), respectively.
CONCLUSION
CC presence and decreased skeletal muscle mass are associated with poor prognosis in advanced NSCLC patients receiving chemotherapy.
目的
癌症恶病质（CC）在晚期肺癌患者中常见，且与预后不良相关。然而，对于化疗期间发生的CC了解甚少。我们评估了晚期非小细胞肺癌（NSCLC）患者化疗过程中发生的CC和骨骼肌消瘦的预后影响。
方法
回顾性分析134例新诊断NSCLC患者的临床资料。CC定义为体重指数<20 kg/m²的患者体重减轻>5%或>2%。在化疗开始后的基线（T1）、3个月（T2）、6个月（T3）和12个月（T4）评估CC。使用腰椎骨骼肌指数（LSMI）评估骨骼肌质量。
结果
T1、T2、T3和T4时CC患者的比例分别为45.6%、46.1%、25.5%和26.0%。T2时，CC患者3级化疗引起的厌食频率高于无CC患者（15.4%对0.0%，P = 0.0044）。在所有时间点，CC患者的生存时间均短于无CC患者。LSMI低的患者（男性，<41 cm²/m²；女性，<38 cm²/m²）预后往往较差。T1、T2、T3和T4时CC的校正Cox比例风险比及相应置信区间分别为2.53（1.33 - 4.88）、1.97（1.27 - 3.06）、3.86（2.14 - 6.81）和1.62（0.80 - 3.16）。
结论
CC的存在和骨骼肌质量降低与接受化疗的晚期NSCLC患者的不良预后相关。
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