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呼吁改进癌症相关性恶病质的编码。

Call to Improve Coding of Cancer-Associated Cachexia.

作者信息

Goncalves Marcus D, Dunne Richard F, Moore Amy C, Phillips Wendy, Heymsfield Steven B, Brown Justin C, Talbert Erin E, Janowitz Tobias

机构信息

NYU Langone Health, New York, NY.

University of Rochester Medical Center, Rochester, NY.

出版信息

JCO Oncol Pract. 2025 Jul;21(7):926-931. doi: 10.1200/OP-24-00781. Epub 2025 Jan 13.

DOI:10.1200/OP-24-00781
PMID:39805066
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12216636/
Abstract

Cachexia is a systemic wasting syndrome prevalent in patients with cancer that significantly affects quality of life, health care costs, and therapeutic outcomes. Despite its clinical importance, cachexia is rarely formally diagnosed. This deficiency presents a challenge for effective patient management and care, health care resource allocation, and the advancement of therapeutic approaches. Here, we highlight impedances to the diagnosis and coding of cachexia, including the absence of standardized therapy, a lack of incentives for accurate coding, and overlapping clinical features with other conditions. We differentiate cachexia from related conditions like unintentional weight loss, sarcopenia, frailty, and protein-calorie malnutrition, outlining their distinct clinical features and inter-relations. We propose an approach to enhance diagnostic accuracy and coding for cachexia. This effort will enable better prevalence data, translation of mechanism-based therapy development, patient identification and stratification, and ultimately advanced diagnostics and US Food and Drug Administration-approved treatments for cachexia.

摘要

恶病质是一种在癌症患者中普遍存在的全身性消耗综合征,严重影响生活质量、医疗成本和治疗效果。尽管其具有临床重要性,但恶病质很少被正式诊断。这种不足给有效的患者管理与护理、医疗资源分配以及治疗方法的进步带来了挑战。在此,我们强调恶病质诊断和编码方面的阻碍,包括缺乏标准化治疗、缺乏准确编码的激励措施以及与其他病症重叠的临床特征。我们将恶病质与非故意体重减轻、肌肉减少症、虚弱和蛋白质 - 热量营养不良等相关病症区分开来,概述它们独特的临床特征和相互关系。我们提出一种提高恶病质诊断准确性和编码的方法。这一努力将有助于获得更好的患病率数据、基于机制的治疗开发转化、患者识别与分层,并最终实现恶病质的先进诊断和美国食品药品监督管理局批准的治疗方法。

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引用本文的文献

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Cancer therapy and cachexia.癌症治疗与恶病质。
J Clin Invest. 2025 Aug 1;135(15). doi: 10.1172/JCI191934.

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Obesity-dependent selection of driver mutations in cancer.肥胖相关的癌症驱动突变选择。
Nat Genet. 2024 Nov;56(11):2318-2321. doi: 10.1038/s41588-024-01969-3. Epub 2024 Oct 28.
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Effectiveness of Combined Exercise and Nutrition Interventions in Preventing and Improving Sarcopenia in Frail or Healthy Older Adults: A Systematic Review.联合运动和营养干预预防和改善虚弱或健康老年人肌少症的效果:系统评价。
Res Gerontol Nurs. 2023 Nov-Dec;16(6):312-320. doi: 10.3928/19404921-20230817-03. Epub 2023 Aug 25.
3
Cancer Cachexia: ASCO Guideline Rapid Recommendation Update.癌症恶病质:美国临床肿瘤学会指南快速推荐更新
J Clin Oncol. 2023 Sep 1;41(25):4178-4179. doi: 10.1200/JCO.23.01280. Epub 2023 Jul 12.
4
Factors Associated With Practice of Multimodal Care for Cancer Cachexia Among Physicians and Nurses Engaging in Cancer Care.癌症相关医护人员对癌症恶病质实施多模式治疗的影响因素分析。
JCO Oncol Pract. 2023 Aug;19(8):602-609. doi: 10.1200/OP.23.00043. Epub 2023 May 15.
5
Cachexia: A systemic consequence of progressive, unresolved disease.恶病质:进行性、未解决疾病的全身性后果。
Cell. 2023 Apr 27;186(9):1824-1845. doi: 10.1016/j.cell.2023.03.028.
6
Body composition and lung cancer-associated cachexia in TRACERx.TRACERx 中的身体成分与肺癌相关性恶病质。
Nat Med. 2023 Apr;29(4):846-858. doi: 10.1038/s41591-023-02232-8. Epub 2023 Apr 12.
7
Overcoming barriers to timely recognition and treatment of cancer cachexia: Sharing Progress in Cancer Care Task Force Position Paper and Call to Action.克服癌症恶病质及时识别与治疗的障碍:分享癌症护理特别工作组立场文件及行动呼吁中的进展
Crit Rev Oncol Hematol. 2023 May;185:103965. doi: 10.1016/j.critrevonc.2023.103965. Epub 2023 Mar 15.
8
A preponderance of gastrointestinal cancer patients transition into cachexia syndrome.大量胃肠道癌患者发展为恶病质综合征。
J Cachexia Sarcopenia Muscle. 2022 Dec;13(6):2920-2931. doi: 10.1002/jcsm.13086. Epub 2022 Sep 27.
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Multidisciplinary approaches to cancer cachexia: current service models and future perspectives.多学科方法治疗癌症恶病质:当前服务模式和未来展望。
Expert Rev Anticancer Ther. 2022 Jul;22(7):737-749. doi: 10.1080/14737140.2022.2088516. Epub 2022 Jun 24.
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