Andreyev H J, Norman A R, Oates J, Cunningham D
Gastrointestinal Unit, Royal Marsden Hospital, Sutton, Surrey, U.K.
Eur J Cancer. 1998 Mar;34(4):503-9. doi: 10.1016/s0959-8049(97)10090-9.
The aim of this study was to examine whether weight loss at presentation, in patients who were to receive chemotherapy for gastrointestinal carcinomas, influences outcome and whether nutritional intervention would be worthwhile. This study was a retrospective review of prospectively gathered data. The outcomes of patients with or without weight loss and treated for locally advanced or metastatic tumours of the oesophagus, stomach, pancreas, colon or rectum were compared. In 1555 such consecutive patients treated over a 6-year period, weight loss at presentation was reported more commonly by men than women (51 versus 44%, P = 0.01). Although patients with weight loss received lower chemotherapy doses initially, they developed more frequent and more severe dose limiting toxicity--specifically plantar-palmar syndrome (P < 0.0001) and stomatitis (P < 0.0001)--than patients without weight loss. Consequently, patients with weight loss on average received 1 month (18%) less treatment (P < 0.0001). Weight loss correlated with shorter failure-free (P < 0.0001, hazard ratio = 1.25) and overall survival (P < 0.0001, hazard ratio = 1.63), decreased response (P = 0.006), quality of life (P < 0.0001) and performance status (P < 0.0001). Patients who stopped losing weight had better overall survival (P = 0.0004). Weight loss at presentation was an independent prognostic variable (hazard ratio = 1.43). The poorer outcome from treatment in patients with weight loss appears to occur because they receive significantly less chemotherapy and develop more toxicity rather than any specifically reduced tumour responsiveness to treatment. These findings provide a rationale for attempting randomised nutritional intervention studies in these patients.
本研究的目的是探讨接受胃肠道癌化疗的患者就诊时体重减轻是否会影响治疗结果，以及营养干预是否值得。本研究是对前瞻性收集的数据进行回顾性分析。比较了有或无体重减轻的、接受食管、胃、胰腺、结肠或直肠癌局部晚期或转移性肿瘤治疗的患者的治疗结果。在6年期间连续治疗的1555例此类患者中，男性就诊时体重减轻的报告率高于女性（51%对44%，P = 0.01）。虽然体重减轻的患者最初接受的化疗剂量较低，但与体重未减轻的患者相比，他们出现剂量限制毒性的频率更高、程度更严重，尤其是手足综合征（P < 0.0001）和口腔炎（P < 0.0001）。因此，体重减轻的患者平均接受的治疗时间少1个月（18%）（P < 0.0001）。体重减轻与无疾病进展生存期缩短（P < 0.0001，风险比 = 1.25）、总生存期缩短（P < 0.0001，风险比 = 1.63）、缓解率降低（P = 0.006）、生活质量下降（P < 0.0001）和体能状态下降（P < 0.0001）相关。停止体重减轻的患者总生存期更好（P = 0.0004）。就诊时体重减轻是一个独立的预后变量（风险比 = 1.43）。体重减轻的患者治疗结果较差似乎是因为他们接受的化疗显著减少且出现更多毒性，而非肿瘤对治疗的反应性有任何特异性降低。这些发现为在这些患者中尝试进行随机营养干预研究提供了理论依据。
