McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; Supportive and Palliative Care, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada.
Geriatric Medicine, McGill University Health Centre, Royal Victoria Hospital, Room H6.61, 687 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
Clin Nutr. 2017 Oct;36(5):1378-1390. doi: 10.1016/j.clnu.2016.09.008. Epub 2016 Sep 20.
Cachexia is a highly prevalent syndrome in cancer and chronic diseases. However, due to the heterogeneous features of cancer cachexia, its identification and classification challenge clinical practitioners.
To determine the clinical relevance of a cancer cachexia classification system in advanced cancer patients.
Beginning with the four-stage classification system proposed for cachexia [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca) and refractory cachexia (RCa)], we assigned patients to these cachexia stages according to five classification criteria available in clinical practice: 1) biochemistry (high C-reactive protein or leukocytes, or hypoalbuminemia, or anemia), 2) food intake (normal/decreased), weight loss: 3) moderate (≤5%) or 4) significant (>5%/past six months) and 5) performance status (Eastern Cooperative Oncology Group Performance Status ≥ 3). We then determined if symptom severity, body composition changes, functional levels, hospitalizations and survival rates varied significantly across cachexia stages.
Two-hundred and ninety-seven advanced cancer patients with primary gastrointestinal and lung tumors were included. Patients were classified into Ca (36%), PCa and RCa (21%, respectively) and NCa (15%). Significant (p < 0.05) differences were observed among cachexia stages for most of the outcome measures (symptoms, body composition, handgrip strength, emergency room visits and length of hospital stays) according to cachexia severity. Survival also differed between cachexia stages (except between PCa and Ca).
Five clinical criteria can be used to stage cancer cachexia patients and predict important clinical, nutritional and functional outcomes. The lack of statistical difference between PCa and Ca in almost all clinical outcomes examined suggests either that the PCa group includes patients already affected by early cachexia or that more precise criteria are needed to differentiate PCa from Ca patients. More studies are required to validate these findings.
恶病质是癌症和慢性疾病中普遍存在的综合征。然而，由于癌症恶病质的异质性特征，其识别和分类给临床医生带来了挑战。
确定癌症恶病质分类系统在晚期癌症患者中的临床相关性。
从恶病质的四阶段分类系统[非恶病质（NCa）、恶病质前期（PCa）、恶病质（Ca）和难治性恶病质（RCa）]开始，根据临床实践中可用的五个分类标准，将患者分配到这些恶病质阶段：1）生化（高 C 反应蛋白或白细胞，或低白蛋白血症，或贫血），2）食物摄入（正常/减少），体重减轻：3）中度（≤5%）或 4）显著（>5%/过去六个月）和 5）表现状态（东部肿瘤协作组表现状态≥3）。然后，我们确定症状严重程度、身体成分变化、功能水平、住院率和生存率是否在恶病质阶段之间存在显著差异。
共纳入 297 例原发性胃肠道和肺部肿瘤的晚期癌症患者。患者被分为 Ca（36%）、PCa 和 RCa（分别为 21%）和 NCa（15%）。根据恶病质的严重程度，大多数结局指标（症状、身体成分、握力、急诊室就诊次数和住院时间）在恶病质阶段之间存在显著差异（p<0.05）。生存也在恶病质阶段之间存在差异（PCa 和 Ca 之间除外）。
可以使用五种临床标准对癌症恶病质患者进行分期，并预测重要的临床、营养和功能结局。在几乎所有检查的临床结局中，PCa 和 Ca 之间没有统计学差异，这表明 PCa 组可能包含已经受到早期恶病质影响的患者，或者需要更精确的标准来区分 PCa 和 Ca 患者。需要更多的研究来验证这些发现。
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