Matsuzuka Takashi, Kiyota Naomi, Mizusawa Junki, Akimoto Tetsuo, Fujii Masato, Hasegawa Yasuhisa, Iwae Shigemichi, Monden Nobuya, Matsuura Kazuto, Onozawa Yusuke, Hayashi Ryuichi, Tahara Makoto
Department of Otolaryngology, Fukushima Medical University Hospital, Fukushima, Japan.
Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan.
Jpn J Clin Oncol. 2019 Jan 1;49(1):37-41. doi: 10.1093/jjco/hyy145.
To evaluate the clinical impact of cachexia, defined by the combination of albumin and C-reactive protein levels, in patients with unresectable locally advanced head and neck squamous cell carcinomas who received chemoradiotherapy in a phase II trial of JCOG0706.
Forty-five patients received radiation for a total of 70 Gy/35fr concurrently with S-1 and cisplatin. The present analysis was conducted in 44 patients with available data. The association between treatment efficacy and cachexia was investigated. Pretreatment cachexia was defined as a serum albumin level of less than 3.5 mg/dl and C-reactive protein level of more than 0.5 mg/dl.
Among the 44 patients, 5 patients had cachexia. On comparison with the cachexic and non-cachexic patients, the percentage of clinical complete remission (20% vs 72%), time to treatment failure at 3 years, (20% vs 53%) and proportion of treatment completion (20% vs 79%) were statistically worse in the cachexic patients, while overall survival, progression-free survival and local progression-free survival at 3 years tended to be worse in cachexic patients.
This supplementary analysis from a prospective study suggests that a pretreatment status of cancer cachexia is a prognostic factor for treatment outcomes and compliance in patients with locally advanced head and neck squamous cell carcinomas treated with chemoradiotherapy, and a candidate stratification factor in future prospective trials in this population.
在JCOG0706的一项II期试验中，评估由白蛋白和C反应蛋白水平联合定义的恶病质对接受放化疗的不可切除局部晚期头颈部鳞状细胞癌患者的临床影响。
45例患者接受总量70 Gy/35次分割的放疗，同时使用S-1和顺铂。本分析纳入了44例有可用数据的患者。研究了治疗疗效与恶病质之间的关联。治疗前恶病质定义为血清白蛋白水平低于3.5 mg/dl且C反应蛋白水平高于0.5 mg/dl。
在44例患者中，5例有恶病质。与有恶病质和无恶病质的患者相比，有恶病质患者的临床完全缓解率（20%对72%）、3年治疗失败时间（20%对53%）和治疗完成比例（20%对79%）在统计学上更差，而有恶病质患者3年的总生存期、无进展生存期和局部无进展生存期往往更差。
这项来自前瞻性研究的补充分析表明，癌症恶病质的治疗前状态是接受放化疗的局部晚期头颈部鳞状细胞癌患者治疗结果和依从性的一个预后因素，也是该人群未来前瞻性试验中的一个候选分层因素。
