Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.
Department of Medicine, Liaquat National Hospital & Medical College, Karachi, Pakistan.
Cancer Control. 2024 Jan-Dec;31:10732748241292784. doi: 10.1177/10732748241292784.
Pancreatic cancer (PC) is a significant cause of cancer-related mortality, with limited curative options and high rates of cachexia, a debilitating syndrome associated with poor prognosis. While previous research has linked sarcopenia to poor outcomes in PC, the correlation between cachexia and treatment outcomes remains underexplored. This meta-analysis aims to investigate the association between cachexia and overall survival and time to treatment failure in advanced PC patients undergoing first-line chemotherapy.
A systematic search of electronic databases was conducted following PRISMA guidelines. Eligible studies compared cachexic and non-cachexic PC patients, reporting outcomes of observed survival or time to treatment failure. Data extraction and analysis were performed using Comprehensive Meta-Analysis Version 3.3, employing random-effects models and sensitivity analyses to assess heterogeneity and bias.
Seven observational studies involving 2834 PC patients were included. The incidence of cachexia was 45% (95% CI: 0.27-0.65), with a higher prevalence in East Asian populations. Cachexic patients experienced significantly earlier treatment failure (SDM: -2.22, 95% CI: -2.6 to -1.7, = 0.0001) and higher mortality risk (HR: 2.02, 95% CI: 1.17-3.48, = 0.011) compared to non-cachexic patients. Overall survival was lower in cachexic patients (SDM: -2.34, 95% CI: -3.7 to -0.90, = 0.001), with considerable heterogeneity across studies. Meta-regression analysis revealed significant differences between countries but insignificant correlations with age.
Cachexia is associated with reduced overall survival, early chemotherapy failure, and elevated mortality in advanced PC patients undergoing first-line chemotherapy. Recognition and management of cachexia are crucial for optimizing treatment outcomes and improving patient survival. Future research should focus on prospective studies to better understand the impact of cachexia on treatment response and develop tailored interventions to mitigate its adverse effects.
胰腺癌（PC）是癌症相关死亡的重要原因，治疗选择有限，且发生恶病质的概率较高，这是一种与预后不良相关的衰弱综合征。虽然之前的研究已经将肌肉减少症与 PC 的不良结局联系起来，但恶病质与治疗结局之间的相关性仍未得到充分探索。本荟萃分析旨在研究在接受一线化疗的晚期 PC 患者中，恶病质与总生存期和治疗失败时间之间的关系。
根据 PRISMA 指南对电子数据库进行了系统检索。符合条件的研究比较了恶病质和非恶病质的 PC 患者，报告了观察到的生存或治疗失败时间的结局。使用 Comprehensive Meta-Analysis Version 3.3 进行数据提取和分析，采用随机效应模型和敏感性分析来评估异质性和偏倚。
纳入了 7 项涉及 2834 例 PC 患者的观察性研究。恶病质的发生率为 45%（95%CI：0.27-0.65），东亚人群的发生率更高。与非恶病质患者相比，恶病质患者的治疗失败时间更早（SMD：-2.22，95%CI：-2.6 至-1.7， = 0.0001），且死亡风险更高（HR：2.02，95%CI：1.17-3.48， = 0.011）。与非恶病质患者相比，恶病质患者的总生存期更短（SMD：-2.34，95%CI：-3.7 至-0.90， = 0.001），但研究间存在较大异质性。元回归分析显示，国家之间存在显著差异，但与年龄无显著相关性。
恶病质与接受一线化疗的晚期 PC 患者的总生存期缩短、化疗早期失败和死亡率升高有关。识别和管理恶病质对于优化治疗结局和提高患者生存率至关重要。未来的研究应侧重于前瞻性研究，以更好地了解恶病质对治疗反应的影响，并制定针对性的干预措施来减轻其不良影响。
