Dolan Ross D, Pennel Kathryn, Thompson Joshua, McKenzie Molly, Alexander Peter, Richards Colin, Black Douglas, Abbass Tanvir, Maka Noori, McGovern Josh, Roseweir Antonia, McSorley Stephen T, Horgan Paul G, Roxburgh Campbell, McMillan Donald C, Edwards Joanne
Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
School of Cancer Sciences, University of Glasgow, Glasgow, UK.
BJC Rep. 2025 Feb 5;3(1):7. doi: 10.1038/s44276-024-00119-w.
In cancer cachexia the relationship between the tumour, its environment and the systemic inflammatory response is not clear. This study aims to examine this relationship in greater detail.
Host characteristics included the presence of a Systemic Inflammatory Response (SIR) as measured by Systemic Inflammatory Grade (SIG), sarcopenia (SMI) and myosteatosis (SMD) were measured. Categorical variables were analysed using χ test for linear-by-linear association, or χ test for 2 by 2 tables. Survival analysis was carried out using univariate and multivariate Cox regression.
A total of 473 patients were included. Of these, 70.4% were over 65 years of age, 54.8% were male and 49.8% had an ASA grade of 1 or 2. Pathological examination showed that the majority of patients had a T3 (53.7%) or a T4 (34.0%) cancer and 73.0% had evidence of necrosis. A SIG score of 0 or 1 was present in 57.7% of patients. Tumour necrosis was associated with age (p < 0.01), tumour location (p < 0.01), T-stage (p < 0.001), margin involvement (p < 0.05), SIG (p < 0.001), SMI (p < 0.01), SMD (p < 0.05) and 5-year survival (p < 0.001). On multivariate survival analysis in patients with T3 cancers age (HR: 1.45 95% CI 1.13-1.86 p < 0.01), ASA grade (HR: 1.50 95% CI 1.15-1.95 p < 0.01) and SIG (HR: 1.28 95% CI 1.11-1.48 p < 0.001) remained independently associated with survival.
These results suggest that tumour necrosis and the subsequent SIR could result in profound changes in body composition and survival. Further pre-clinical and clinical work is required to prove causation.
在癌症恶病质中，肿瘤、其周围环境与全身炎症反应之间的关系尚不清楚。本研究旨在更详细地探讨这种关系。
测量宿主特征，包括通过全身炎症分级（SIG）测量的全身炎症反应（SIR）的存在情况、肌肉减少症（SMI）和肌脂肪变性（SMD）。分类变量使用线性趋势χ检验或2×2列联表χ检验进行分析。生存分析采用单因素和多因素Cox回归。
共纳入473例患者。其中，70.4%的患者年龄超过65岁，54.8%为男性，49.8%的患者美国麻醉医师协会（ASA）分级为1或2级。病理检查显示，大多数患者患有T3期（53.7%）或T4期（34.0%）癌症，73.0%有坏死证据。57.7%的患者SIG评分为0或1。肿瘤坏死与年龄（p<0.01）、肿瘤位置（p<0.01）、T分期（p<0.001）、切缘受累情况（p<0.05）、SIG（p<0.001）、SMI（p<0.01）、SMD（p<0.05）和5年生存率（p<0.001）相关。在T3期癌症患者的多因素生存分析中，年龄（风险比：1.45，95%置信区间1.13 - 1.86，p<0.01）、ASA分级（风险比：1.50，95%置信区间1.15 - 1.95，p<0.01）和SIG（风险比：1.28，95%置信区间1.11 - 1.48，p<0.001）仍然与生存独立相关。
这些结果表明，肿瘤坏死及随后的全身炎症反应可能导致身体组成和生存的深刻变化。需要进一步的临床前和临床研究来证实因果关系。
