Verkoulen Koen C H A, Geenen Lars, Franssen Aimée J P M, Verzijl Anne M A, Vissers Yvonne L J, Hulsewé Karel W E, Degens Juliette H R J, van Dijk David P J, de Loos Erik R
Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
Department of Respiratory Medicine, Zuyderland Medical Center, Heerlen, The Netherlands.
Transl Lung Cancer Res. 2025 Aug 31;14(8):3183-3195. doi: 10.21037/tlcr-2025-511. Epub 2025 Aug 26.
Cancer cachexia, characterized by involuntary weight loss and extensive muscle and adipose tissue wasting, is a major contributor to morbidity and mortality in cancer patients. To date, no effective medical intervention can completely reverse this multifactorial syndrome, which is driven by different metabolic changes. Identification of cachectic patients is primarily based on alterations in body composition and the assessment of systemic metabolic and inflammatory changes. While these changes have been thoroughly described in patients with more advanced stages of lung cancer, their role in resectable lung cancer remains less explored. In this review, we summarize the different methods to assess body composition metrics such as skeletal muscle (SM) mass, fat distribution and overall body composition. As the dominant driver of cancer cachexia, we also describe the two most widely accepted acute phase proteins. Furthermore, we discuss the short and long-term clinical implications of cancer cachexia and the corresponding body composition and inflammatory changes in resectable lung cancer patients. Finally, we explore the possibility of identifying a specific host phenotype of cachectic lung cancer patients that predisposes to adverse outcomes of lung cancer surgery, which might enhance the predictive value for overall survival and aid in treatment decision-making in lung cancer patients in the future.
癌症恶病质的特征是体重非自愿减轻以及广泛的肌肉和脂肪组织消耗，是癌症患者发病和死亡的主要原因。迄今为止，尚无有效的医学干预措施能够完全逆转这种由不同代谢变化驱动的多因素综合征。恶病质患者的识别主要基于身体成分的改变以及全身代谢和炎症变化的评估。虽然这些变化在肺癌晚期患者中已有详尽描述，但其在可切除肺癌中的作用仍有待深入研究。在本综述中，我们总结了评估身体成分指标（如骨骼肌质量、脂肪分布和总体身体成分）的不同方法。作为癌症恶病质的主要驱动因素，我们还描述了两种最广泛认可的急性期蛋白。此外，我们讨论了癌症恶病质的短期和长期临床意义以及可切除肺癌患者相应的身体成分和炎症变化。最后，我们探讨了识别恶病质肺癌患者特定宿主表型的可能性，这种表型易导致肺癌手术不良预后，这可能会提高对总生存期的预测价值，并有助于未来肺癌患者的治疗决策。
