患者主观整体评定法是一种很有前景的癌症恶病质筛查工具。
The patient-generated subjective global assessment is a promising screening tool for cancer cachexia.
作者信息
Cong Minghua, Song Chenxin, Xu Hongxia, Song Chunhua, Wang Chang, Fu Zhenming, Ba Yi, Wu Jing, Xie Conghua, Chen Gongyan, Chen Zihua, Zhou Lan, Li Tao, Deng Li, Xin Lin, Yang Liuqing, Cui Jiuwei, Shi Hanping
机构信息
Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Nutrition, Third Military Medical University Daping Hospital and Research Institute of Surgery, Chongqing, China.
出版信息
BMJ Support Palliat Care. 2022 May;12(e1):e39-e46. doi: 10.1136/bmjspcare-2020-002296. Epub 2020 Aug 21.
BACKGROUND
Cancer cachexia is a complex metabolic syndrome characterised by a loss of muscle with or without loss of fat mass, and is associated with high morbidity and mortality. Despite its clinical importance, there is a lack of simple tools to screen patients for cancer cachexia. The aim of this study was to evaluate and validate the patient-generated subjective global assessment (PG-SGA) as a screening tool for cancer cachexia.
METHODS
This is a secondary analysis of a multicentre, cross-sectional, observational study. Cancer cachexia was diagnosed when there was weight loss ≥5% during the past 12 months and at least three of the five following conditions were present: decreased muscle strength, fatigue, anorexia, low Fat-Free Mass Index (FFMI) and abnormal laboratory findings. A quadratic discriminant analysis was conducted for the ability of PG-SGA to predict cachexia.
RESULTS
A total of 4231 patients with cancer were included in this analysis, and 351 patients (8.3%) were diagnosed as having cachexia. The highest incidence of cachexia was found among patients with pancreatic cancer (32.5%), oesophageal cancer (21.5%) and gastric cancer (17.9%). Compared with patients without cachexia, patients with cachexia had a lower body mass index, FFMI, hand grip strength, total protein, prealbumin, albumin, haemoglobin and Karnofsky performance status (p<0.05), while they had a higher C reactive protein level and PG-SGA Score (4.71±3.71 vs 10.87±4.84, p<0.05). The best cut-off value for PG-SGA was 6.5, with 79.8% of sensitivity and 72.3% specificity for cachexia, and the area under the receiver operating characteristic curve was 0.846 (95% CI 0.826 to 0.866, p<0.001).
CONCLUSIONS
PG-SGA is a highly specific tool that can be used to screen patients for cancer cachexia.
背景
癌症恶病质是一种复杂的代谢综合征，其特征是肌肉量减少，伴或不伴有脂肪量减少，且与高发病率和死亡率相关。尽管其具有临床重要性，但目前缺乏用于筛查癌症恶病质患者的简单工具。本研究的目的是评估和验证患者自评主观全面评定法（PG-SGA）作为癌症恶病质筛查工具的有效性。
方法
这是一项对多中心、横断面观察性研究的二次分析。当患者在过去12个月内体重减轻≥5%，且同时存在以下五个条件中的至少三个时，可诊断为癌症恶病质：肌肉力量下降、疲劳、厌食、低去脂体重指数（FFMI）和异常实验室检查结果。对PG-SGA预测恶病质的能力进行了二次判别分析。
结果
本分析共纳入4231例癌症患者，其中351例（8.3%）被诊断为患有恶病质。恶病质发病率最高的是胰腺癌患者（32.5%）、食管癌患者（21.5%）和胃癌患者（17.9%）。与无恶病质的患者相比，恶病质患者的体重指数、FFMI、握力、总蛋白、前白蛋白、白蛋白、血红蛋白和卡氏功能状态较低（p<0.05），而其C反应蛋白水平和PG-SGA评分较高（4.71±3.71 vs 10.87±4.84，p<0.05）。PG-SGA的最佳截断值为6.5，对恶病质的敏感性为79.8%，特异性为72.3%，受试者工作特征曲线下面积为0.846（95%CI 0.826至0.866，p<0.001）。
结论
PG-SGA是一种高度特异的工具，可用于筛查癌症恶病质患者。
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