Antoun Sami, Rossoni Caroline, Lanoy Emilie
Emergency Unit.
Biostatistics and Epidemiology Unit, Gustave Roussy Cancer Campus.
Curr Opin Support Palliat Care. 2018 Dec;12(4):427-433. doi: 10.1097/SPC.0000000000000388.
Cachexia (CAX), a protein metabolism disorder commonly associated with cancer, can be evaluated by computed tomography (CT) scan assessment of skeletal muscle mass (SMM), a parameter associated with patient outcome. This review analyzes current barriers for using CT scans of SMM in routine management for defining prognostic risk groups, and proposes new areas of research to reach a better understanding of CAX mechanisms.
Current research is focused on establishing a robust and relevant CAX staging system to reach a consensual definition. Previous biomarkers of CAX are poorly associated with outcome and do not exhibit clinical benefit. Systemic inflammatory marker, decrease in intake assessments, and/or nonnutritional criteria have been integrated to develop a multidimensional, highly complex CAX signature and CAX staging.
A standardized definition of sarcopenia is essential, and its value in clinical practice should be evaluated in prospective interventional studies using skeletal muscle assessment. SMM loss may be a key element in defining early protein disorders occurring before weight loss and could be used as a trigger for initiating early nutritional support. Changes in SMM and body composition during follow-up are useful tools for exploring CAX mechanisms in terms of intrinsic factors or tumor evolution.
恶病质（CAX）是一种通常与癌症相关的蛋白质代谢紊乱疾病，可通过计算机断层扫描（CT）评估骨骼肌质量（SMM）来进行评估，SMM是一个与患者预后相关的参数。本综述分析了在常规管理中使用SMM的CT扫描来定义预后风险组的当前障碍，并提出了新的研究领域，以更好地理解CAX的机制。
当前的研究集中在建立一个强大且相关的CAX分期系统，以达成共识性定义。先前的CAX生物标志物与预后的关联性较差，且未显示出临床益处。全身炎症标志物、摄入量评估的降低和/或非营养标准已被整合，以开发多维、高度复杂的CAX特征和CAX分期。
肌少症的标准化定义至关重要，其在临床实践中的价值应在前瞻性干预研究中使用骨骼肌评估进行评估。SMM的丧失可能是定义体重减轻前发生的早期蛋白质紊乱的关键因素，并且可作为启动早期营养支持的触发因素。随访期间SMM和身体成分的变化是从内在因素或肿瘤演变方面探索CAX机制的有用工具。
