在胰腺癌诊断之前出现恶病质而非肥胖会使生存率降低，而化疗可消除这种影响。
Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy.
作者信息
Hendifar Andrew E, Chang Jonathan I, Huang Brian Z, Tuli Richard, Wu Bechien U
机构信息
Hematology and Oncology, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Internal Medicine, Kaiser Permanente Los Angeles, Los Angeles, CA, USA.
出版信息
J Gastrointest Oncol. 2018 Feb;9(1):17-23. doi: 10.21037/jgo.2017.11.10.
BACKGROUND
Although advanced pancreatic ductal adenocarcinoma (PDAC) is characterized by progressive weight loss and nutritional deterioration, the effect of cancer cachexia and body mass index (BMI) at diagnosis on survival remains unclear.
METHODS
We retrospectively evaluated a prospectively collected internal cancer registry of PDAC cases from 2006-2014 at the Kaiser Permanente Medical Center. Cancer cachexia was defined as weight loss greater than 5% over the 6 months prior to diagnosis. Multivariate cox proportional hazards regression was used to assess the influence of cachexia on survival. To evaluate effect measure modification of this relationship, we performed additional analyses stratified by race, BMI class, stage, receipt of surgery and receipt of chemotherapy. We tested for heterogeneity by fitting models with an interaction term for cachexia and the modifying variable.
RESULTS
Of the 977 patients, 611 (63%) were identified with cachexia. Cachexia in PDAC patients was prevalent across all stages of disease and BMI classes. Patients with cachexia had lower survival (median 4.3 months, IQR 1.7-10.0) compared to those without cachexia (median 5.2 months, IQR 2.0-10.6), log-rank P=0.03. In this analysis BMI at diagnosis was not associated with survival. In the multivariate Cox regression, cachexia was independently associated with decreased overall survival (HR 1.24, CI: 1.06-1.45, P=0.01). However, the effect of cachexia on survival outcomes was modified by receipt of chemotherapy. Cachectic patients who did not receive chemotherapy had a 40% increase in risk of death compared to non-cachectic patients (HR 1.40, CI: 1.12-1.75), while those receiving chemotherapy were unaffected by cachexia (HR 1.04, CI: 0.82-1.32, P=0.01).
CONCLUSIONS
In the largest cohort of pancreatic cancer patients examined to date, cachexia and not obesity is independently associated with worse survival in PDA and its effect is negated by systemic chemotherapy.
背景
尽管晚期胰腺导管腺癌（PDAC）的特征是进行性体重减轻和营养恶化，但癌症恶病质及诊断时的体重指数（BMI）对生存的影响仍不明确。
方法
我们回顾性评估了2006年至2014年在凯撒医疗机构前瞻性收集的PDAC病例内部癌症登记数据。癌症恶病质定义为诊断前6个月内体重减轻超过5%。采用多变量Cox比例风险回归分析来评估恶病质对生存的影响。为评估这种关系的效应修饰，我们按种族、BMI类别、分期、是否接受手术及是否接受化疗进行了额外分层分析。我们通过拟合带有恶病质与修饰变量交互项的模型来检验异质性。
结果
在977例患者中，611例（63%）被确定存在恶病质。PDAC患者的恶病质在疾病的所有阶段和BMI类别中均普遍存在。与无恶病质的患者相比，有恶病质的患者生存时间更短（中位生存时间4.3个月，四分位间距1.7 - 10.0个月）（无恶病质患者中位生存时间5.2个月，四分位间距2.0 - 10.6个月），对数秩检验P = 0.03。在该分析中，诊断时的BMI与生存无关。在多变量Cox回归中，恶病质与总体生存时间降低独立相关（风险比1.24，置信区间：1.06 - 1.45，P = 0.01）。然而，恶病质对生存结局的影响因是否接受化疗而有所改变。未接受化疗的恶病质患者与非恶病质患者相比死亡风险增加40%（风险比1.40，置信区间：1.12 - 1.75），而接受化疗的患者不受恶病质影响（风险比1.04，置信区间：0.82 - 1.32，P = 0.01）。
结论
在迄今为止研究的最大规模胰腺癌患者队列中，恶病质而非肥胖与PDAC患者较差的生存独立相关，且全身化疗可消除其影响。
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