晚期癌症患者恶液质亚洲工作组诊断标准的有效性。
Validity of the diagnostic criteria from the Asian Working Group for Cachexia in advanced cancer.
机构信息
Palliative Care Center, Aichi Medical University, Nagakute, Aichi, Japan.
Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
出版信息
J Cachexia Sarcopenia Muscle. 2024 Feb;15(1):370-379. doi: 10.1002/jcsm.13408. Epub 2023 Dec 19.
BACKGROUND
Recently, the Asian Working Group for Cachexia (AWGC) published a consensus statement on diagnostic criteria for cachexia in Asians. We aimed to validate the criteria in adult patients in Japan with advanced cancer.
METHODS
We conducted a single-institution retrospective cohort study between April 2021 and October 2022. The AWGC criteria include chronic comorbidities and either a weight loss of >2% over 3-6 months or a body mass index (BMI) of <21 kg/m . In addition, any of the following items were required: anorexia as a subjective symptom, decreased grip strength as an objective measurement and an elevated C-reactive protein (CRP) level as a biomarker. We used the cut-off value of grip strength of 28/18 kg for male/female individuals and CRP level of 5 mg/L.
RESULTS
Of the 449 consecutive patients, 85 of those who could not be evaluated because of end-of-life or refractory symptoms (n = 41) or missing data (n = 44) were excluded from the primary analysis. The prevalence of the AWGC-defined cachexia was 76% (n = 277), and the median survival time (MST) for all patients was 215 (95% confidence interval [CI] 145-270) days. The prevalence of the following criteria was significantly higher in patients with cachexia than in those without cachexia: a BMI of <21 kg/m (65% vs. 15%, P < 0.001), a weight loss of >2% in 6 months (87% vs. 14%, P < 0.001), anorexia (75% vs. 47%, P < 0.001), a grip strength of <28 kg in male individuals (63% vs. 28%, P < 0.001) and CRP level of >5 mg/L (85% vs. 56%, P < 0.001). Overall survival was significantly shorter in patients with cachexia than in those without cachexia (MST 157 days, 95% CI 108-226 days vs. MST 423 days, 95% CI 245 days to not available, P = 0.0023). The Cox proportional hazards analysis showed that best supportive care (hazard ratio [HR] 2.91, P ≤ 0.001), lung cancer (HR 1.67, P = 0.0046), an Eastern Cooperative Oncology Group Performance Status score of ≥3 (HR 1.58, P = 0.016), AWGC-defined cachexia (HR 1.56, P = 0.015), an age of ≥70 years (HR 1.53, P = 0.0070), oedema (HR 1.31, P = 0.022) and head/neck cancer (HR 0.44, P = 0.023) were found to be the significant predictors for mortality.
CONCLUSIONS
We demonstrated that AWGC-defined cachexia has a significant prognostic value in advanced cancer.
背景
最近，亚洲恶病质工作组（AWGC）发布了亚洲恶病质诊断标准的共识声明。我们旨在验证该标准在日本晚期癌症患者中的适用性。
方法
我们进行了一项单机构回顾性队列研究，时间为 2021 年 4 月至 2022 年 10 月。AWGC 标准包括慢性合并症以及体重在 3-6 个月内下降>2%或 BMI<21kg/m 。此外，还需要满足以下任何一项标准：主观症状为厌食症，客观测量为握力下降，生物标志物为 C 反应蛋白（CRP）水平升高。我们使用男性/女性个体的握力截断值为 28/18kg 和 CRP 水平为 5mg/L。
结果
在连续的 449 例患者中，由于生命末期或难治性症状（n=41）或缺失数据（n=44）而无法评估的 85 例患者被排除在主要分析之外。AWGC 定义的恶病质患病率为 76%（n=277），所有患者的中位生存时间（MST）为 215（95%置信区间[CI]145-270）天。患有恶病质的患者以下标准的患病率明显高于无恶病质的患者：BMI<21kg/m （65% vs. 15%，P<0.001），6 个月内体重下降>2%（87% vs. 14%，P<0.001），厌食症（75% vs. 47%，P<0.001），男性个体的握力<28kg（63% vs. 28%，P<0.001）和 CRP 水平>5mg/L（85% vs. 56%，P<0.001）。患有恶病质的患者总生存时间明显短于无恶病质的患者（MST 157 天，95%CI 108-226 天 vs. MST 423 天，95%CI 245 天至无法评估，P=0.0023）。Cox 比例风险分析显示，最佳支持治疗（风险比[HR]2.91，P≤0.001）、肺癌（HR 1.67，P=0.0046）、东部合作肿瘤组表现状态评分≥3（HR 1.58，P=0.016）、AWGC 定义的恶病质（HR 1.56，P=0.015）、年龄≥70 岁（HR 1.53，P=0.0070）、水肿（HR 1.31，P=0.022）和头颈部癌症（HR 0.44，P=0.023）是死亡的显著预测因素。
结论
我们证明了 AWGC 定义的恶病质在晚期癌症中具有显著的预后价值。
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