Vazeille Clara, Jouinot Anne, Durand Jean-Philippe, Neveux Nathalie, Boudou-Rouquette Pascaline, Huillard Olivier, Alexandre Jérôme, Cynober Luc, Goldwasser François
Medical Oncology, Cochin Teaching Hospital, AP-HP, and
Medical Oncology, Cochin Teaching Hospital, AP-HP, and.
Am J Clin Nutr. 2017 May;105(5):1139-1147. doi: 10.3945/ajcn.116.140434. Epub 2017 Mar 29.
Cachexia is a major cause of death in cancer patients. The role of hypermetabolism in cancer cachexia remains unclear. We studied the relation between resting energy expenditure (REE), the estimated energy balance, clinical and biological markers of cachexia, and survival. REE was measured with the use of indirect calorimetry in cancer patients before the initiation of anticancer therapies. Hypermetabolic, normometabolic, and hypometabolic patients were identified with the use of Boothby's standard. Weight loss, performance status (PS), C-reactive protein (CRP), albumin, the nutritional risk index, daily energy intake, energy balance (equal to daily energy intakes minus the REE), and survival were recorded. Of 390 enrolled patients, 49% of subjects were hypermetabolic, 30% of subjects were normometabolic, and 21% of subjects were hypometabolic. Mean daily energy intakes did not differ significantly between the 3 groups. Hypermetabolic patients, compared with normometabolic patients, were more likely to have a negative energy balance [45% compared with 32%, respectively; OR: 1.74 (95% CI: 1.05, 2.91); = 0.024], weight loss >5% [48% compared with 34%, respectively; OR: 1.83 (95% CI: 1.11, 3.04); = 0.013], PS ≥2 [40% compared with 29%, respectively; OR: 1.70 (95% CI: 1.01, 2.88); = 0.038], and CRP concentrations ≥10 mg/L [52% compared with 33%, respectively; OR: 2.2 (95% CI: 1.33, 3.66); = 0.001]. In metastatic patients, compared with normometabolism, hypermetabolism was associated with a reduced median survival [14.6 compared with 21.4 mo, respectively; OR: 1.48 (95% CI: 1.01, 2.17); = 0.044]. Hypermetabolism is correlated with clinical and biological markers of cancer cachexia and is associated with a shorter survival in metastatic cancer patients. The development of therapeutic strategies that aim to blunt hypermetabolism appears warranted. This trial was registered at www.controlled-trials.com as ISRCTN46152275.
恶病质是癌症患者死亡的主要原因。高代谢在癌症恶病质中的作用仍不清楚。我们研究了静息能量消耗（REE）、估计的能量平衡、恶病质的临床和生物学标志物与生存之间的关系。在抗癌治疗开始前，采用间接测热法测量癌症患者的REE。使用布斯比标准识别高代谢、正常代谢和低代谢患者。记录体重减轻、体能状态（PS）、C反应蛋白（CRP）、白蛋白、营养风险指数、每日能量摄入、能量平衡（等于每日能量摄入减去REE）和生存情况。在390名入组患者中，49%的受试者为高代谢，30%的受试者为正常代谢，21%的受试者为低代谢。三组患者的平均每日能量摄入无显著差异。与正常代谢患者相比，高代谢患者更易出现能量负平衡[分别为45%和32%；比值比（OR）：1.74（95%置信区间：1.05，2.91）；P = 0.024]、体重减轻>5%[分别为48%和34%；OR：1.83（95%置信区间：1.11，3.04）；P = 0.013]、PS≥2[分别为40%和29%；OR：1.70（95%置信区间：1.01，2.88）；P = 0.038]以及CRP浓度≥10 mg/L[分别为52%和33%；OR：2.2（95%置信区间：1.33，3.66）；P = 0.001]。在转移性患者中，与正常代谢相比，高代谢与中位生存期缩短相关[分别为14.6个月和21.4个月；OR：1.48（95%置信区间：1.01，2.17）；P = 0.044]。高代谢与癌症恶病质的临床和生物学标志物相关，且与转移性癌症患者的生存期缩短有关。制定旨在抑制高代谢的治疗策略似乎是必要的。本试验在www.controlled-trials.com上注册，注册号为ISRCTN46152275。
