Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Fukuoka, Japan.
Adv Ther. 2020 Dec;37(12):5010-5022. doi: 10.1007/s12325-020-01516-6. Epub 2020 Oct 16.
This retrospective study focused on cancer cachexia in clinical practice. We evaluated the incidence of cancer cachexia and the relationship between cancer cachexia and overall survival (OS) or toxicities in patients with advanced colorectal cancer after undergoing first-line systemic chemotherapy.
We examined 150 patients with colorectal cancer who underwent first-line systemic chemotherapy between February 1, 2010 and August 31, 2016 at Shizuoka Cancer Center Hospital and Kurume University Hospital. Cancer cachexia was defined as > 5% weight loss or > 2% weight loss with a body mass index of < 20 kg/m within the past 6 months according to the European Palliative Care Research Collaborative criteria.
One hundred patients from Shizuoka Cancer Center and 50 from Kurume University Hospital were registered. Median age and body mass index were 65 years (range 29-85) and 21.7 kg/m (14.8-32.5), respectively. Cumulative incidence of cancer cachexia was 50.7% at 24 weeks, and reached 91.3% over the whole study period. OS was significantly different between patients with and without cancer cachexia within 24 weeks after starting first-line treatment, although the onset of cancer cachexia within 24 weeks could not be considered as an independent prognostic factor for OS. Severe appetite loss and fatigue tended to occur more frequently in patients with cancer cachexia within 24 weeks.
Cancer cachexia appears to have an onset in approximately half of patients with advanced colorectal cancer within 24 weeks after starting first-line treatment. Although causal relationships were controversial, the onset of cancer cachexia within 24 weeks tends to be related to worse outcomes. Thus, it would be better to monitor weight loss leading to cachexia in patients with advanced colorectal cancer, especially within 24 weeks after starting first-line chemotherapy.
University Hospital Medical Information Network Clinical Trials Registry (UMIN000035002).
本回顾性研究聚焦于临床实践中的癌症恶病质。我们评估了接受一线全身化疗的晚期结直肠癌患者中癌症恶病质的发生率，以及癌症恶病质与总生存期（OS）或毒性之间的关系。
我们检查了 2010 年 2 月 1 日至 2016 年 8 月 31 日在静冈癌症中心医院和久留米大学医院接受一线全身化疗的 150 例结直肠癌患者。根据欧洲姑息治疗研究协作组的标准，癌症恶病质定义为在过去 6 个月内体重下降>5%，或体重指数<20 kg/m2 时体重下降>2%，且无其他可解释原因。
从静冈癌症中心登记了 100 例患者，从久留米大学医院登记了 50 例患者。中位年龄和体重指数分别为 65 岁（范围 29-85）和 21.7 kg/m2（范围 14.8-32.5）。在 24 周时癌症恶病质的累积发生率为 50.7%，整个研究期间达到 91.3%。在开始一线治疗后 24 周内，有和无癌症恶病质的患者的 OS 差异有统计学意义，尽管 24 周内癌症恶病质的发生不能被认为是 OS 的独立预后因素。在 24 周内有癌症恶病质的患者中，严重的食欲下降和疲劳往往更常见。
在开始一线治疗后 24 周内，大约有一半的晚期结直肠癌患者出现癌症恶病质。虽然因果关系存在争议，但 24 周内癌症恶病质的发生似乎与更差的结局相关。因此，在晚期结直肠癌患者中监测导致恶病质的体重减轻是很重要的，尤其是在开始一线化疗后的 24 周内。
大学医院医疗信息网临床试验注册（UMIN000035002）。
