非小细胞肺癌患者营养障碍的分期：骨骼肌质量评估的效用。
Staging of nutrition disorders in non-small-cell lung cancer patients: utility of skeletal muscle mass assessment.
机构信息
Emergency Unit, Gustave Roussy, Paris Saclay University, Villejuif, France.
Pneumology Department, Centre Hospitalier Régional d'Orleans, Orleans, France.
出版信息
J Cachexia Sarcopenia Muscle. 2019 Aug;10(4):782-793. doi: 10.1002/jcsm.12418. Epub 2019 Apr 1.
BACKGROUND
An international consensus proposed in 2011 a definition and classification system for cachexia (CAX), mainly based on weight loss, sarcopenia [skeletal muscle mass (SMM) loss], inflammation, and anorexia. The aim of this study was to stage CAX in non-small-cell lung cancer (NSCLC) patients by using a classification based on the Fearon criteria and supported by quantifiable parameters.
METHODS
This was a cross-sectional and non-interventional multicentre study. SMM was assessed by analysing L3 computed tomography-scan images. Patients completed the anorexia/CAX subscale of the Functional Assessment of Anorexia/Cachexia Therapy, EORTC QLQ-C30 quality of life (QoL) and International Physical Activity Questionnaire (IPAQ).
RESULTS
Patients were recruited in 56 sites. The analysis population comprised 531 patients, and SMM was assessed in 312 patients. Male patients were 66.5%, with a mean (SD) age of 65.2 (10.0) years, 79.9% were PS 0-1, and the tumour stage was mainly IIIB-IV (87.3%). Overall, 38.7% of patients had CAX, 33.8% pre-CAX, and 0.9% refractory CAX. Molecular tumour profiles were significantly associated with the presence of CAX: 23.9% in EGFR, ALK, ROS1, BRAF, or HER2+ patients, 41.4% in K-RAS+, and 43.2% in patients with no molecular abnormality (P = 0.003). The more advanced the CAX stage, the poorer the scores of functional items of the QoL (P < 0.001) and International Physical Activity Questionnaire (P < 0.001). Sarcopenia was present in 66.7% of CAX and 68.5% of pre-CAX patients. Overall, 43.8% of pre-CAX patients had only sarcopenia with limited weight loss (≤2%) and no anorexia.
CONCLUSIONS
This is the first study to show the distribution of CAX in a population of NSCLC patients and an association between molecular abnormality in NSCLC and CAX. The original Fearon classification for CAX stages was supported by the associated functional QoL scores and physical activity levels, resulting in a clinically relevant system for detection of early stages of CAX.
背景
2011 年，国际上提出了一种恶病质（CAX）的定义和分类系统，主要基于体重减轻、肌肉减少症[骨骼肌量（SMM）减少]、炎症和厌食症。本研究的目的是通过使用基于 Fearon 标准的分类并辅以可量化的参数，对非小细胞肺癌（NSCLC）患者进行 CAX 分期。
方法
这是一项横断面、非干预性多中心研究。通过分析 L3 计算机断层扫描图像评估 SMM。患者完成厌食/CAX 亚量表的功能评估厌食/恶病质治疗量表（EORTC QLQ-C30）生活质量（QoL）和国际体力活动问卷（IPAQ）。
结果
在 56 个地点招募了患者。分析人群包括 531 名患者，其中 312 名患者评估了 SMM。男性患者占 66.5%，平均（SD）年龄为 65.2（10.0）岁，79.9%的 PS 为 0-1，肿瘤分期主要为 IIIB-IV（87.3%）。总体而言，38.7%的患者有 CAX，33.8%的患者有 Pre-CAX，0.9%的患者有难治性 CAX。肿瘤分子谱与 CAX 的存在显著相关：EGFR、ALK、ROS1、BRAF 或 HER2+患者中为 23.9%，K-RAS+患者中为 41.4%，无分子异常的患者中为 43.2%（P=0.003）。CAX 分期越晚，生活质量（QoL）的功能项目评分（P<0.001）和国际体力活动问卷（P<0.001）越差。CAX 患者中有 66.7%和 Pre-CAX 患者中有 68.5%存在肌肉减少症。总体而言，43.8%的 Pre-CAX 患者仅有肌肉减少症，体重减轻有限（≤2%），且无厌食症。
结论
这是第一项研究，表明恶病质（CAX）在非小细胞肺癌（NSCLC）患者人群中的分布情况，以及 NSCLC 中的分子异常与 CAX 之间的关联。CAX 阶段的原始 Fearon 分类得到了相关的 QoL 评分和身体活动水平的支持，从而为检测 CAX 的早期阶段提供了一个具有临床意义的系统。
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