Faculty of Medicine, University of Milan, via Festa del Perdono 7, 20122 Milano, Italy.
Ann Oncol. 2017 Sep 1;28(9):2107-2118. doi: 10.1093/annonc/mdx271.
Sarcopenia has recently emerged as a new condition that, independently from malnutrition, may adversely affect the prognosis of cancer patients. Purpose of this narrative review is to define the prevalence of sarcopenia in different primaries, its role in leading to chemotherapy toxicity and decreased compliance with the oncological therapy and the effect of some drugs on the onset of sarcopenia. Finally, the review aims to describe the current approaches to restore the muscle mass through nutrition, exercise and anti-inflammatory agents or multimodal programmes with a special emphasis on the results of randomized controlled trials. The examination of the computed tomography scan at the level of the third lumbar vertebra-a common procedure for staging many tumours-has allowed the oncologist to evaluate the muscle mass and to collect many retrospective data on the prevalence of sarcopenia and its clinical consequences. Sarcopenia is a condition affecting a high percentage of patients with a range depending on type of primary tumour and stage of disease. It is noteworthy that patients may be sarcopenic even if their nutritional status is apparently maintained or they are obese. Sarcopenic patients exhibited higher chemotherapy toxicity and poorer compliance with oncological treatments. Furthermore, several antineoplastic drugs appeared to worsen the sarcopenic status. Therapeutic approaches are several and this review will focus on those validated by randomized controlled trials. They include the use of ω-3-enriched oral nutritional supplements and orexigenic agents, the administration of adequate high-protein regimens delivered enterally or parenterally, and programmes of physical exercise. Better results are expected combining different procedures in a multimodal approach. In conclusion, there are several premises to prevent/treat sarcopenia. The oncologist should coordinate this multimodal approach by selecting priorities and sequences of treatments and then involving a nutrition health care professional or a physical therapist depending on the condition of the single patient.
肌肉减少症最近成为一种新的病症，它独立于营养不良，可能会对癌症患者的预后产生不利影响。本综述的目的是定义不同原发性疾病中肌肉减少症的患病率，它在导致化疗毒性和降低对肿瘤治疗的依从性中的作用，以及一些药物对肌肉减少症发病的影响。最后，本综述旨在描述通过营养、运动和抗炎剂或多模式方案恢复肌肉质量的当前方法，并特别强调随机对照试验的结果。在第三腰椎水平进行计算机断层扫描检查（这是对许多肿瘤进行分期的常见程序），使肿瘤学家能够评估肌肉质量，并收集大量关于肌肉减少症的患病率及其临床后果的回顾性数据。肌肉减少症是一种影响很大比例患者的疾病，其患病率取决于原发性肿瘤的类型和疾病的阶段。值得注意的是，即使患者的营养状况明显维持或肥胖，也可能患有肌肉减少症。肌肉减少症患者表现出更高的化疗毒性和对肿瘤治疗的依从性较差。此外，几种抗肿瘤药物似乎会恶化肌肉减少症的状态。治疗方法有很多，本综述将重点介绍那些经过随机对照试验验证的方法。这些方法包括使用富含 ω-3 的口服营养补充剂和开胃剂、给予足够的高蛋白肠内或肠外方案，以及进行身体锻炼方案。通过多模式方法联合使用不同的程序，预计会取得更好的效果。总之，有几个前提可以预防/治疗肌肉减少症。肿瘤学家应通过选择治疗的优先顺序和序列来协调这种多模式方法，然后根据患者的具体情况，涉及营养保健专业人员或物理治疗师。
