随时间推移的体重减轻与生存：1000 余例经前瞻性治疗和监测的肺癌患者的标志性分析。
Weight loss over time and survival: a landmark analysis of 1000+ prospectively treated and monitored lung cancer patients.
机构信息
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Alzheimer's Therapeutic Research Institute, San Diego, CA, USA.
出版信息
J Cachexia Sarcopenia Muscle. 2020 Dec;11(6):1501-1508. doi: 10.1002/jcsm.12625. Epub 2020 Sep 17.
BACKGROUND
Eligibility criteria and endpoints for cancer cachexia trials-and whether weight loss should be included-remain controversial. Although most cachexia trials enrol patients after initial cancer diagnosis, few studies have addressed whether weight loss well after a cancer diagnosis is prognostic.
METHODS
We pooled data from non-small cell lung cancer patients from prospectively conducted trials within the Alliance for Clinical Trials in Oncology (1998-2008), a nationally funded infrastructure. We examined (i) weight data availability and weight changes and (ii) survival.
RESULTS
A total of 822 patients were examined. Of these, 659 (80%) were on treatment at the beginning of Cycle 2 of chemotherapy; weight was available for 656 (80%). By Cycles 3 and 4, weight was available for 448 (55%) and 384 (47%), respectively. From baseline to immediately prior to Cycle 2, 208 (32%) gained weight; 225 (34%) lost <2% of baseline weight; and 223 (34% of 656) lost 2% or more. Median survival from the beginning of Cycle 2 was 13.0, 10.9, and 6.9 months for patients with weight gain, weight loss of <2%, and weight loss of 2% or more, respectively. In multivariate analyses, adjusted for age, sex, performance score, type of treatment, and body mass index, weight loss of 2% or more was associated with poor overall survival compared with weight gain [hazard ratio (HR) = 1.66; 95% confidence interval (CI): 1.33-2.07; P < 0.001] and compared with weight loss of <2% (HR = 1.57; 95% CI: 1.27-1.95; P < 0.001). Although weight loss of <2% was not associated with poorer overall survival compared with weight gain, it was associated with poorer progression-free survival (HR = 1.24; 95% CI: 1.01-1.51; P = 0.036). Similar findings were observed in a separate 255-patient validation cohort.
CONCLUSIONS
Weight should be integrated into cancer cachexia trials because of its ease of frequent measurement and sustained prognostic association.
背景
癌症恶病质试验的入选标准和终点——以及是否应包括体重减轻——仍存在争议。尽管大多数恶病质试验在癌症初始诊断后招募患者，但很少有研究探讨癌症诊断后体重明显减轻是否具有预后意义。
方法
我们汇集了在肿瘤临床联盟（Alliance for Clinical Trials in Oncology，1998-2008 年）开展的前瞻性试验中的非小细胞肺癌患者的数据，该联盟是一个得到国家资助的基础设施。我们研究了（i）体重数据的可用性和体重变化，以及（ii）生存情况。
结果
共检查了 822 名患者。其中，659 名（80%）在化疗第 2 周期开始时接受治疗；656 名（80%）的体重数据可获取。在第 3 周期和第 4 周期，分别有 448 名（55%）和 384 名（47%）可获取体重数据。从基线到第 2 周期前，208 名（32%）患者体重增加；225 名（34%）体重减轻<2%基线体重；223 名（34%的 656 名）体重减轻 2%或更多。从第 2 周期开始时，体重增加、体重减轻<2%和体重减轻 2%或更多的患者的中位生存时间分别为 13.0、10.9 和 6.9 个月。多变量分析显示，与体重增加相比，体重减轻 2%或更多与总体生存不良相关[风险比（HR）=1.66；95%置信区间（CI）：1.33-2.07；P<0.001]，与体重减轻<2%相比也与总体生存不良相关[HR=1.57；95%CI：1.27-1.95；P<0.001]。虽然体重减轻<2%与体重增加相比并不与较差的总体生存相关，但与较差的无进展生存相关[HR=1.24；95%CI：1.01-1.51；P=0.036]。在单独的 255 名患者验证队列中也观察到了类似的发现。
结论
鉴于体重易于频繁测量且与持续的预后相关，应将体重纳入癌症恶病质试验中。
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