College of Nursing, University of Florida, HPNP Complex, P.O. Box 100187, Gainesville, FL, USA.
School of Nursing, Hanyang University, Seoul, South Korea.
J Cachexia Sarcopenia Muscle. 2019 Jun;10(3):526-535. doi: 10.1002/jcsm.12398. Epub 2019 Mar 4.
Unintentional weight loss is a major problem for patients with gastrointestinal (GI) cancers because it affects treatment, survival outcomes, and quality of life. To date, little is known about the trajectory of weight loss and the relationship between baseline body mass index (BMI), location of the cancer, and outcomes. The aims of this study were to investigate patterns of weight loss over time in patients with GI cancer according to BMI groups (low, normal, and high) and location of cancer.
We examined de-identified electronic medical record data of 801 adults (>21 years) with GI cancer using ICD-9 codes (150-159). Descriptive statistics and linear mixed models were used to examine unintentional weight loss over time by BMI group (low, normal, and high) and to determine the effect of primary cancer site and patient characteristics on weight loss.
The mean age of patients was 66.5 ± 11.9 years (21-95 years), with 58% male and 86% White. Mean weight loss over 3 years was 21.39 kg. At the first observation point, 7.8% were in the low BMI group, 30.1% were in the normal, and 62% were in the high group. At the end of observation, a majority of deaths (35.5%) occurred in the low BMI group (BMI < 20 kg/m ). Significant weight loss was observed in patients with gastric (t = -5.11, P < 0.001), oesophageal (t = -4.18, P < 0.001), and pancreatic (35.8%, t = -3.58, P < 0.001) cancers. Predictors of weight change were gender (F = 64.93, P < 0.001), cancer stage (F = 7.28, P < 0.001), and site by days (F = 8.24, P < 0.001). Weight loss rates were similar among the three BMI groups, but patterns were different based on primary cancer type as a function of days within each group.
Weight loss in patients with GI cancers has implications for survival. Patients with upper GI cancers experienced more weight loss and decreased survival rates compared with patients with lower GI cancers. Patients with a combination of upper GI cancer (oesophagogastric or pancreatic) and low baseline BMI had the fewest survival days and worst patient outcomes. Early intervention for weight management plays a critical role for improving the health outcomes and fatality rates of these patients.
对于胃肠道（GI）癌症患者来说，非故意体重减轻是一个主要问题，因为它会影响治疗、生存结果和生活质量。迄今为止，人们对体重减轻的轨迹以及基线体重指数（BMI）、癌症部位与结果之间的关系知之甚少。本研究的目的是根据 BMI 组（低、正常和高）和癌症部位，调查胃肠道癌症患者随时间推移的体重减轻模式。
我们使用 ICD-9 代码（150-159）检查了 801 名（>21 岁）胃肠道癌症成人的去识别电子病历数据。使用描述性统计和线性混合模型来检查 BMI 组（低、正常和高）随时间的非故意体重减轻，并确定主要癌症部位和患者特征对体重减轻的影响。
患者的平均年龄为 66.5 ± 11.9 岁（21-95 岁），男性占 58%，白人占 86%。3 年内平均体重减轻 21.39 公斤。在第一个观察点，7.8%的人处于低 BMI 组，30.1%的人处于正常组，62%的人处于高 BMI 组。在观察结束时，大多数死亡（35.5%）发生在低 BMI 组（BMI<20 kg/m）。在患有胃癌（t=-5.11，P<0.001）、食道癌（t=-4.18，P<0.001）和胰腺癌（35.8%，t=-3.58，P<0.001）的患者中观察到明显的体重减轻。性别（F=64.93，P<0.001）、癌症分期（F=7.28，P<0.001）和部位与天数（F=8.24，P<0.001）是体重变化的预测因素。在三个 BMI 组中，体重减轻率相似，但基于原发性癌症类型，各组内的模式不同。
胃肠道癌症患者的体重减轻对生存有影响。与患有下胃肠道癌症的患者相比，患有上胃肠道癌症的患者经历了更多的体重减轻和降低的生存率。患有上胃肠道癌症（胃食管或胰腺）和低基线 BMI 的患者生存天数最少，患者结局最差。体重管理的早期干预对改善这些患者的健康结果和病死率至关重要。
