Nutrition and Dietetics Department, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
Faculty of Health, Social Care and Education, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
Support Care Cancer. 2020 Sep;28(9):4373-4380. doi: 10.1007/s00520-019-05259-1. Epub 2020 Jan 8.
Cancer cachexia (CC) is a syndrome characterised by an ongoing loss of skeletal muscle mass associated with reduced tolerance to treatment. This study explored the prevalence and severity of CC in advanced non-small cell lung cancer (NSCLC) patients and determined its relationship with chemotherapy outcomes.
CC was classified into a four-stage model: no cachexia, pre-cachexia (PC), cachexia and refractory cachexia (RC) with categorisation determined from biochemical and body composition and performance assessment. Associations between the stage of cachexia and chemotherapy outcomes including radiological response, the number of chemotherapy cycles completed and the number of cycles delayed or dose reduced were explored.
Twenty-four patients were included with 4 (18%) classified as having no cachexia, 4 (18%) PC, 3 (14%) cachexia (13.6%), and 11 (50%) RC. No association was observed between the stage of cachexia and the radiological response to chemotherapy number of cycles delayed or the number of cycle's dose reduced; however, there was an association with the number of cycles completed (p = 0.030). An association between C-reactive protein (CRP) and the number of chemotherapy cycles completed (p = 0.044) and the number of dose reductions (p = 0.044) was also identified.
Limited conclusions can be drawn given the small sample size. However, the majority of patients presented with some degree of cachexia at diagnosis. A relationship was identified between the increasing severity of cachexia and a lower number of chemotherapy cycles completed, as well as between CRP and the number of chemotherapy cycles completed and the number of dose reductions required, and therefore warrants further exploration in larger studies.
癌症恶病质（CC）是一种以持续骨骼肌丢失为特征的综合征，伴有对治疗的耐受性降低。本研究探讨了晚期非小细胞肺癌（NSCLC）患者中 CC 的患病率和严重程度，并确定了其与化疗结果的关系。
CC 分为四阶段模型：无恶病质、前驱恶病质（PC）、恶病质和难治性恶病质（RC），通过生化和身体成分及表现评估进行分类。探讨了恶病质阶段与化疗结果（包括影像学反应、完成的化疗周期数、延迟或减少的周期数）之间的关系。
共纳入 24 例患者，其中 4 例（18%）无恶病质，4 例（18%）PC，3 例（14%）恶病质（13.6%），11 例（50%）RC。恶病质阶段与化疗反应、延迟的周期数或减少的周期数之间无相关性；然而，与完成的周期数有关（p=0.030）。C 反应蛋白（CRP）与完成的化疗周期数（p=0.044）和剂量减少数（p=0.044）之间也存在相关性。
鉴于样本量小，只能得出有限的结论。然而，大多数患者在诊断时就已经存在一定程度的恶病质。恶病质的严重程度与化疗周期数减少呈正相关，与 CRP 呈正相关与完成的化疗周期数和所需的剂量减少数呈正相关，因此需要在更大的研究中进一步探讨。
