高代谢是转移性非小细胞肺癌患者生存的独立预后因素。
Hypermetabolism is an independent prognostic factor of survival in metastatic non-small cell lung cancer patients.
机构信息
Medical Oncology Department, Paris Centre Teaching Hospitals, AP-HP, Paris, France; Cancer Research for PErsonalized Medicine (CARPEM), Paris, France; Paris Descartes University, USPC, Paris, France; Institut Cochin, INSERM U1016, CNRS UMR8104, Paris Descartes University, Paris, France.
Clinical Chemistry, Paris Centre Teaching Hospitals, AP-HP, Paris Descartes University, USPC, Paris, France; EA 4466 PRETRAM, Pharmacy Faculty, Paris Descartes University, USPC, Paris, France.
出版信息
Clin Nutr. 2020 Jun;39(6):1893-1899. doi: 10.1016/j.clnu.2019.08.003. Epub 2019 Aug 10.
BACKGROUND & AIMS: Metastatic non-small cell lung cancer (NSCLC) is the first cause of cancer death worldwide. Increased resting energy expenditure (REE) is frequent among cancer patients and may contribute to cancer cachexia. The aim of this study was to examine the prognostic value of increased REE in metastatic NSCLC patients.
METHODS
This observational study was conducted between June 2012 and November 2017 in the outpatient unit of the oncology department of Cochin hospital, Paris. Consecutive patients with newly diagnosed stage IV NSCLC underwent measurement of REE by indirect calorimetry before treatment initiation. Uni- and multivariate analysis of overall survival (OS, Cox models) included age, sex, smoking habit, histological subtype, performance status, body mass index, weight loss, albumin and CRP levels and the ratio of measured REE to the REE predicted by the Harris Benedict formula (mREE/pREE).
RESULTS
144 patients were enrolled: mean age 64 years, 63% male, 90% non-squamous carcinoma, including 17% with ALK/EGFR alteration. In univariate analysis, tobacco consumption (p = 0.007), histo-molecular subtype (p < 10), performance status (p = 0.04), weight loss (p < 10), albumin (p < 10), CRP (p = 0.001) and mREE/pREE ratio (>vs ≤ 120%: HR = 2.16, p < 10) were significant prognostic factors of OS. Median OS were 6.1 and 17.3 months in patients with mREE/pREE ratio > and ≤120%, respectively. In multivariate analysis, histo-molecular subtype (non-squamous ALK/EGFR mutated vs squamous carcinoma: HR = 0.25, p = 0.006), weight loss (>vs ≤ 5%: HR = 1.98, p = 0.004), albumin (≥vs < 35 g/L: HR = 0.56, p = 0.02) and mREE/pREE ratio (> vs ≤120%: HR = 1.90, p = 0.004) were identified as independent prognostic factors.
CONCLUSIONS
Elevated resting energy expenditure emerges as an independent prognostic factor in metastatic NSCLC.
背景与目的
转移性非小细胞肺癌（NSCLC）是全球癌症死亡的首要原因。癌症患者常伴有静息能量消耗（REE）增加，这可能导致癌症恶病质。本研究旨在探讨转移性 NSCLC 患者中 REE 增加的预后价值。
方法
这是一项于 2012 年 6 月至 2017 年 11 月在巴黎 Cochin 医院肿瘤科门诊进行的观察性研究。连续入组新诊断为 IV 期 NSCLC 的患者，在治疗前通过间接热量法测量 REE。采用单因素和多因素分析（Cox 模型）评估总生存期（OS），包括年龄、性别、吸烟习惯、组织学亚型、体能状态、体重指数、体重减轻、白蛋白和 C 反应蛋白（CRP）水平以及测量的 REE 与 Harris-Benedict 公式预测的 REE 之比（mREE/pREE）。
结果
共纳入 144 例患者：平均年龄 64 岁，63%为男性，90%为非鳞状细胞癌，其中 17%存在 ALK/EGFR 改变。单因素分析显示，吸烟习惯（p=0.007）、组织分子亚型（p<10）、体能状态（p=0.04）、体重减轻（p<10）、白蛋白（p<10）、CRP（p=0.001）和 mREE/pREE 比值（>vs≤120%：HR=2.16，p<10）是 OS 的显著预后因素。mREE/pREE 比值>和≤120%的患者中位 OS 分别为 6.1 和 17.3 个月。多因素分析显示，组织分子亚型（非鳞状 ALK/EGFR 突变 vs 鳞状细胞癌：HR=0.25，p=0.006）、体重减轻（>vs≤5%：HR=1.98，p=0.004）、白蛋白（≥vs<35g/L：HR=0.56，p=0.02）和 mREE/pREE 比值（>vs≤120%：HR=1.90，p=0.004）是独立的预后因素。
结论
REE 升高是转移性 NSCLC 的独立预后因素。
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