晚期癌症患者的食欲及其与死亡率的关系——姑息 D 研究的事后分析。
Appetite and its association with mortality in patients with advanced cancer - a Post-hoc Analysis from the Palliative D-study.
机构信息
Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Division of Clinical Epidemiology (KEP), Solna, Karolinska Institutet, Stockholm, Sweden.
出版信息
BMC Palliat Care. 2023 Oct 26;22(1):159. doi: 10.1186/s12904-023-01287-1.
BACKGROUND
Loss of appetite is a common nutrition symptom in patients with cancer. Understanding the trajectory of appetite could be of clinical use for prognostication in palliative cancer care. Our primary aim was to explore the association between self-assessed appetite and mortality in patients suffering from advanced cancer. Secondary aims included the relation between fatigue, albumin levels and CRP/albumin ratio and mortality. We also aimed to study potential sex-differences in the associations.
METHODS
Post-hoc analyses were performed using data from the Palliative D-study comprising 530 patients with cancer admitted to palliative care. Appetite and fatigue were assessed with the Edmonton Symptom Assessment System (ESAS). Cox proportional hazards models were used to calculate Hazard ratios (HR) with 95% confidence intervals (CI) for exposures of appetite, fatigue, albumin and CRP/albumin ratio, and time from study inclusion to death or censoring. Analyses were also performed stratified by sex.
RESULTS
The follow-up time ranged between 7 to 1420 days. Moderate and poor appetite were significantly associated with a higher mortality rate compared to reporting a good appetite; HR 1.44 (95%CI: 1.16-1.79) and HR 1.78 (95%CI: 1.39-2.29), respectively. A higher mortality rate was also seen among participants reporting severe fatigue compared to those reporting no fatigue; HR 1.84 (95%CI:1.43-2.36). Participants with low albumin levels (< 25 g/L) and those in the highest tertile of CRP/albumin ratio, had higher mortality rates, HR 5.35 (95%CI:3.75-7.63) and HR 2.66 (95%CI:212-3.35), compared to participants with high albumin levels (> 36 g/L) and those in lowest tertile of CRP/albumin ratio. These associations were more pronounced in men than in women.
CONCLUSION
Poor appetite, severe fatigue, low albumin level and a high CRP/albumin ratio were associated with increased mortality rates among patients with advanced cancer. All these variables might be clinically useful for prognostication in palliative cancer care.
TRIAL REGISTRATION
Clinicaltrial.gov. Identifier: NCT03038516;31, January 2017.
背景
食欲不振是癌症患者常见的营养症状。了解食欲的变化轨迹可能对姑息治疗中癌症患者的预后具有临床意义。我们的主要目的是探讨晚期癌症患者自我评估的食欲与死亡率之间的关系。次要目的包括疲劳、白蛋白水平和 CRP/白蛋白比值与死亡率之间的关系。我们还旨在研究这些关联中潜在的性别差异。
方法
本研究为事后分析，数据来自于包括 530 名癌症姑息治疗患者的 Palliative D 研究。采用埃德蒙顿症状评估系统（ESAS）评估食欲和疲劳。使用 Cox 比例风险模型计算食欲、疲劳、白蛋白和 CRP/白蛋白比值的暴露与从研究纳入到死亡或删失的时间的风险比（HR），置信区间（CI）为 95%。还按性别进行了分层分析。
结果
随访时间为 7 至 1420 天。与报告良好的食欲相比，中度和较差的食欲与更高的死亡率显著相关；HR 1.44（95%CI：1.16-1.79）和 HR 1.78（95%CI：1.39-2.29）。与无疲劳的患者相比，报告严重疲劳的患者死亡率也更高；HR 1.84（95%CI：1.43-2.36）。与白蛋白水平较高（>25g/L）的患者相比，白蛋白水平较低（<25g/L）和 CRP/白蛋白比值最高三分位的患者死亡率更高，HR 5.35（95%CI：3.75-7.63）和 HR 2.66（95%CI：212-3.35），而与 CRP/白蛋白比值最低三分位的患者相比。这些关联在男性中比女性更为明显。
结论
晚期癌症患者的食欲差、严重疲劳、低白蛋白水平和高 CRP/白蛋白比值与死亡率升高相关。所有这些变量在姑息治疗癌症患者的预后中可能具有临床意义。
试验注册
Clinicaltrial.gov。标识符：NCT03038516；31 年 1 月 2017 日。
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