Yabe Michitoshi, Naito Tateaki, Matsuda Suguru, Morita Meiko, Sekikawa Motoki, Miura Keita, Kodama Hiroaki, Fujisaki Toshiya, Mamesaya Nobuaki, Kobayashi Haruki, Ko Ryo, Wakuda Kazushige, Ono Akira, Kenmotsu Hirotsugu, Murakami Haruyasu, Takahashi Toshiaki
Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Thorac Cancer. 2025 Jun;16(12):e70104. doi: 10.1111/1759-7714.70104.
Cachexia is a syndrome in patients with cancer that reduces life quality and prognosis, characterized by severe weight loss, muscle atrophy, and anorexia. How cachexia adversely affects older patients with small cell lung cancer (SCLC) remains uncertain. This study aimed to determine the effect of cachexia on prognosis, treatment delivery, and efficacy in older patients with advanced SCLC receiving first-line platinum-based chemotherapy.
We retrospectively analyzed older patients (≥ 70 years) with advanced SCLC treated with carboplatin and etoposide between January 2015 and June 2020 at the Shizuoka Cancer Center. Cachexia was diagnosed based on the % weight loss and body mass index. After excluding patients with no documented weight change and those who relapsed after radiotherapy, we examined the effect of cachexia on treatment delivery, progression-free survival (PFS), and overall survival (OS).
Cachexia was identified in 57% (28 of 49) of patients. The cachexia group experienced more frequent treatment interruptions and dose reductions than the non-cachexia group (46% vs. 10% for dose reductions, p < 0.05; 61% vs. 90% for completion of four chemotherapy courses, p < 0.05). Median PFS and OS were significantly shorter in the cachexia group compared to those in the non-cachexia group (PFS: 3.3 vs. 5.4 months; OS: 6.3 vs. 15.1 months).
Older patients with advanced SCLC and cachexia undergoing carboplatin and etoposide therapy exhibited shorter PFS and OS than those without cachexia. Treatment delivery was less effective in the cachexia group than in the non-cachexia group, suggesting that their vulnerabilities affected treatment efficacy.
恶病质是癌症患者中一种会降低生活质量和预后的综合征，其特征为严重体重减轻、肌肉萎缩和厌食。恶病质如何对老年小细胞肺癌（SCLC）患者产生不利影响仍不确定。本研究旨在确定恶病质对接受一线铂类化疗的老年晚期SCLC患者的预后、治疗实施及疗效的影响。
我们回顾性分析了2015年1月至2020年6月在静冈癌症中心接受卡铂和依托泊苷治疗的老年（≥70岁）晚期SCLC患者。根据体重减轻百分比和体重指数诊断恶病质。在排除无体重变化记录的患者以及放疗后复发的患者后，我们研究了恶病质对治疗实施、无进展生存期（PFS）和总生存期（OS）的影响。
49例患者中有57%（28例）被确定为恶病质。恶病质组比非恶病质组经历了更频繁的治疗中断和剂量减少（剂量减少：46%对10%，p<0.05；完成四个化疗疗程：61%对90%，p<0.05）。与非恶病质组相比，恶病质组的中位PFS和OS显著缩短（PFS：3.3个月对5.4个月；OS：6.3个月对15.1个月）。
接受卡铂和依托泊苷治疗的老年晚期SCLC合并恶病质患者的PFS和OS比无恶病质患者短。恶病质组的治疗实施效果不如非恶病质组，表明他们的脆弱性影响了治疗效果。
