School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland.
Academic Unit of Surgery, University of Glasgow, Glasgow, UK.
J Cachexia Sarcopenia Muscle. 2020 Feb;11(1):160-168. doi: 10.1002/jcsm.12499. Epub 2019 Nov 6.
Weight loss (WL) has long been recognized as an important factor associated with reduced quality of life (QoL) and reduced survival in patients with cancer. The body mass index (BMI)-adjusted weight loss grading system (WLGS) has been shown to be associated with reduced survival. However, its impact on QoL has not been established. The aim of this study was to assess the relationship between this WLGS and QoL in patients with advanced cancer.
A biobank analysis was undertaken of adult patients with advanced cancer. Data collected included patient demographics, Eastern Cooperative Oncology Group performance status, and anthropometric parameters (BMI and %WL). Patients were categorized according to the BMI-adjusted WLGS into one of five distinct WL grades (grades 0-4). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. The Kruskal-Wallis test and multivariate logistic regression analyses were used to assess the relationship between the WLGS and QoL scores. Overall survival was assessed using Kaplan-Meier curve and Cox proportional hazard models.
A total of 1027 patients were assessed (51% male, median age: 66 years). Gastrointestinal cancer was most prevalent (40%), and 87% of patients had metastatic disease. Half (58%) of patients had a WL grade of 0-1, while 12%, 20%, and 10% had WL grades of 2, 3, and 4, respectively. Increasing WL grades were significantly associated with poorer QoL functioning and symptoms scales (all P < 0.05). Physical, role, and emotional functioning decreased by a median of >20 points between WL grade 0 and WL grade 4, while appetite loss, pain, dyspnoea, and fatigue increased by a median score >20 points, indicative of a large clinical significant difference. Increasing WL grades were associated with deteriorating QoL summary score. WL grades 2, 3, and 4 were independently associated with a QoL summary score below the median (<77.7) [odds ratio (OR) 1.69, P = 0.034; OR 2.06, P = 0.001; OR 4.29, P < 0.001, respectively]. WL grades 3 and 4 were independently associated with reduced overall survival [hazard ratio 1.54 (95% confidence interval: 1.22-1.93), P < 0.001 and hazard ratio 1.87 (95% confidence interval: 1.42-2.45), P < 0.001, respectively].
Our findings support that the WLGS is useful in identifying patients at risk of poor QoL that deteriorates with increasing WL grades. WL grade 4 is independently associated with a particularly worse prognosis and increased symptom burden. Identification and early referral to palliative care services may benefit these patients.
体重减轻（WL）长期以来一直被认为是与癌症患者生活质量（QoL）降低和生存率降低相关的重要因素。体重指数（BMI）调整后的体重减轻分级系统（WLGS）已被证明与生存率降低有关。然而，其对 QoL 的影响尚未确定。本研究的目的是评估该 WLGS 与晚期癌症患者 QoL 之间的关系。
对晚期癌症的成年患者进行了生物样本库分析。收集的数据包括患者人口统计学、东部合作肿瘤学组表现状态和人体测量参数（BMI 和%WL）。根据 BMI 调整后的 WLGS 将患者分为五个不同的 WL 等级之一（等级 0-4）。使用欧洲癌症研究与治疗组织生活质量问卷-C30 收集 QoL。使用 Kruskal-Wallis 检验和多变量逻辑回归分析评估 WLGS 和 QoL 评分之间的关系。使用 Kaplan-Meier 曲线和 Cox 比例风险模型评估总生存率。
共评估了 1027 名患者（51%为男性，中位年龄：66 岁）。胃肠道癌最为常见（40%），87%的患者有转移病灶。一半（58%）的患者 WL 等级为 0-1，而 12%、20%和 10%的患者 WL 等级分别为 2、3 和 4。WL 等级的增加与 QoL 功能和症状量表的恶化显著相关（均 P <0.05）。身体、角色和情感功能在 WL 等级 0 到 WL 等级 4 之间平均下降超过 20 分，而食欲丧失、疼痛、呼吸困难和疲劳的平均评分增加超过 20 分，表明存在较大的临床显著差异。WL 等级的增加与 QoL 总评分的恶化相关。WL 等级 2、3 和 4 与 QoL 总分低于中位数（<77.7）独立相关（优势比[OR]1.69，P=0.034；OR 2.06，P=0.001；OR 4.29，P<0.001）。WL 等级 3 和 4 与总生存时间降低独立相关（风险比 1.54（95%置信区间：1.22-1.93），P<0.001 和风险比 1.87（95%置信区间：1.42-2.45），P<0.001）。
我们的研究结果支持 WLGS 可用于识别生活质量风险较高的患者，这些患者的 QoL 随着 WL 等级的增加而恶化。WL 等级 4 与预后较差和症状负担增加特别相关。识别和早期转介到姑息治疗服务可能对这些患者有益。
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