Zdziarski Przemyslaw, Sroka Zbigniew
Lower Silesian Center, 53-413 Wroclaw, Poland.
PRION Private Research Institute of Nature, 50-385 Wroclaw, Poland.
Biomedicines. 2024 Nov 28;12(12):2722. doi: 10.3390/biomedicines12122722.
Critical and progressive cachexia may be observed in numerous medical disciplines, but in patients with various diseases, several pathways overlap (endocrine, inflammatory and kidney diseases, heart failure, cancer). Unlike numerous cohort studies that examine thyroid cancer and risk factors, a different method was used to avoid bias and analyze the sequence of events, i.e., the pathway. A case-control analysis is presented on patients with initial immune-mediated thyroiditis complicated by cachexia, presenting pulmonary pathology coexisting with opportunistic infection, and ultimately diagnosed with cancer (TC-thyroid cancer, misdiagnosed as lung cancer). Contrary to other patients with lung cancer, the presented patients were not active smokers and exclusively women who developed cachexia with existing autoimmune processes in the first phase. Furthermore, the coexistence of short overall survival without cancer progression in the most seriously ill patients, as well as correlation with sex (contrary to history of smoking) and predisposition to mycobacterial disease, are very suggestive. Although we describe three different autoimmune conditions (de Quervain's, Graves', and atrophic thyroiditis), disturbances in calcium and metabolic homeostasis, under the influence of hormonal and inflammatory changes, are crucial factors of cachexia and prognosis. The unique sequence sheds light on immune-mediated thyroid disease as a subclinical paraneoplastic process modified by various therapeutic regimens. However, it is also associated with cachexia, systemic consequences, and atypical sequelae, which require a holistic approach. The differential diagnosis of severe cachexia, adenocarcinoma with pulmonary localization, and tuberculosis reactivation requires an analysis of immunological and genetic backgrounds. Contrary to highly specialized teams (e.g., lung cancer units), immunotherapy and general medicine in aging populations require a multidisciplinary, holistic, and inquiring approach. The lack of differentiation, confusing biases, and discrepancies in the literature are the main obstacles to statistical research, limiting findings to correlations of common factors only. Time-lapse case studies such as this one may be among the first to build evidence of a pathway and an association between inflammatory and endocrine imbalances in cancer cachexia.
在众多医学学科中都可能观察到严重且进行性的恶病质，但在患有各种疾病的患者中，有几种途径相互重叠（内分泌、炎症和肾脏疾病、心力衰竭、癌症）。与众多研究甲状腺癌及其危险因素的队列研究不同，本研究采用了一种不同的方法来避免偏差并分析事件序列，即途径。本文呈现了一项病例对照分析，对象是最初患有免疫介导性甲状腺炎并伴有恶病质、存在肺部病变并伴有机会性感染、最终被诊断为癌症（TC-甲状腺癌，误诊为肺癌）的患者。与其他肺癌患者不同，本文所呈现的患者并非主动吸烟者，且均为女性，她们在第一阶段就因现有的自身免疫过程而出现恶病质。此外，病情最严重的患者总体生存期短且无癌症进展，以及与性别（与吸烟史相反）和分枝杆菌病易感性的相关性，都极具启发性。尽管我们描述了三种不同的自身免疫性疾病（亚急性甲状腺炎、格雷夫斯病和萎缩性甲状腺炎），但在激素和炎症变化的影响下，钙和代谢稳态的紊乱是恶病质和预后的关键因素。这一独特的序列揭示了免疫介导的甲状腺疾病是一种由各种治疗方案改变的亚临床副肿瘤过程。然而，它也与恶病质、全身后果和非典型后遗症相关，这需要一种整体的方法。对严重恶病质、肺定位腺癌和结核复发的鉴别诊断需要分析免疫和遗传背景。与高度专业化的团队（如肺癌科室）不同，老年人群的免疫治疗和普通医学需要多学科、整体和探究性的方法。缺乏区分、令人困惑的偏差以及文献中的差异是统计研究的主要障碍，仅将研究结果局限于常见因素的相关性。像这样的延时病例研究可能是最早建立癌症恶病质中炎症和内分泌失衡途径及关联证据的研究之一。
