Department of Urology, Yale University School of Medicine, New Haven, Connecticut.
Department of Urology, Medical College of Georgia, Augusta, Georgia, USA.
Curr Opin Support Palliat Care. 2021 Dec 1;15(4):260-265. doi: 10.1097/SPC.0000000000000580.
The purpose of this review is to describe the causes, management, and clinical outcomes associated with cachexia and related components including sarcopenia, among patients with bladder cancer (BCa).
Cachexia in patients with BCa is associated with poorer outcomes after radical cystectomy (RC), radiation, and chemotherapy. Nutritional supplements and novel pharmaceutical agents including magnolol, flucoidan and Anamorelin are currently undergoing investigation for their potential use in BCa patients with cachexia.
Cachexia is a hypercatabolic state thought to be caused by an immune-regulated release of cytokines and disruptions of molecular pathways within the tumor microenvironment and systemically. Nutritional deficiencies in patients with BCa also contribute to cachexia and sarcopenia. Patients with BCa -related cachexia and sarcopenia experience worse survival and therapeutic outcomes after RC, chemotherapy, and radiation therapy. Patients with cachexia also experience more postoperative complications after RC. The management of cachexia in patients with BCa remains challenging and requires timely identification, and multidisciplinary management including nutritional supplementation, physical therapy, palliative care, and pharmacological agents. Clinical trials and human studies are still required to determine which pharmacological agents are optimal for BCa cachexia.
本文旨在描述膀胱癌（BCa）患者恶病质及其相关组成部分（包括肌少症）的病因、治疗及临床结局。
根治性膀胱切除术（RC）、放疗和化疗后，BCa 患者恶病质与较差的预后相关。目前正在研究营养补充剂和新型药物，包括厚朴酚、褐藻糖胶和 Anamorelin，以评估其在伴有恶病质的 BCa 患者中的潜在用途。
恶病质是一种高代谢状态，据认为是由免疫调节细胞因子释放和肿瘤微环境及全身分子通路紊乱引起的。BCa 患者的营养缺乏也会导致恶病质和肌少症。伴有 BCa 相关性恶病质和肌少症的患者在接受 RC、化疗和放疗后生存和治疗结局更差。恶病质患者在接受 RC 后也会经历更多的术后并发症。BCa 患者恶病质的管理仍然具有挑战性，需要及时识别，并进行多学科管理，包括营养补充、物理治疗、姑息治疗和药物治疗。仍需要临床试验和人体研究来确定哪些药物对 BCa 恶病质最有效。
