Abstract:
Cachexia is associated with lower overall survival (OS) in patients with cancer; however, the relationship between the two is reported to differ according to the definitive criteria for diagnosing cachexia. We aimed to investigate 1) the difference in the prevalence of cachexia in patients with cancer and 2) the association between cachexia and OS, depending on the definitive criteria for diagnosing cachexia in patients with cancer. We searched PubMed and Web of Science from their inception until July 31, 2023, to identify eligible studies. We conducted a systematic review of the prevalence of cachexia in patients with cancer and performed a meta-analysis to investigate its relationship with OS. A total of 125 articles comprising 137,960 patients were included in the systematic review, and 26 articles consisting of 11,118 patients underwent meta-analysis. The overall prevalence of cachexia in patients with cancer was 33.0% (95% confidence interval [CI]: 32.8, 33.3); however, it varied according to the definitive criteria for diagnosing cachexia (13.9%-56.5%). According to the Fearon 2011 criteria, the prevalence of cachexia was associated with a high hazard ratio (HR) for OS compared with that of noncachexia [HR: 1.58 (95% CI: 1.45, 1.73)]; according to the other criteria, the HR was 2.78 (95% CI: 1.88, 4.11), indicating significant subgroup differences (P = 0.006). The dose-response curve indicated that the HR for OS plateaued at a cachexia prevalence range of 40%-50% (l-shaped relationship). The prevalence of cachexia in patients with cancer may vary depending on the definitive criteria used to diagnose cachexia. The HR for OS was higher for low cachexia prevalence. The definitive criteria should be carefully considered when assessing cachexia in patients with cancer. This trial was registered at the PROSPERO as CRD42023435474.
摘要:
背景:恶病质与癌症患者总生存率降低相关;然而,据报道,根据诊断恶病质的最终标准,两者之间的关系有所不同。
目的:我们的目的是调查(1)癌症患者恶病质患病率的差异和(2)恶病质与总生存率之间的关系,取决于癌症患者恶病质的明确诊断标准。
方法:我们从PubMed和WebofScience开始到2023年7月31日进行搜索,以确定符合条件的研究。我们对癌症患者恶病质的患病率进行了系统评价,并进行了荟萃分析以研究其与总生存期的关系。
结果:系统综述共纳入125篇文章,包括137,960名患者,和由11,118例患者组成的26篇文章进行了荟萃分析。癌症患者恶病质的总体患病率为33.0%(95%置信区间[CI],32.8-33.3);然而,根据诊断恶病质的明确标准(13.9-56.5%)而有所不同。根据Fearon2011标准,与非恶病质相比,恶病质的患病率与总生存率的高危险比(HR:1.58[95%CI,1.45-1.73])相关;根据其他标准,HR为2.78(95%CI,1.88-4.11),表明亚组差异显著(p=0.006)。剂量-反应曲线表明,总存活的HR在恶病质患病率范围为40-50%时趋于稳定(L形关系)。
结论:癌症患者恶病质的患病率可能因诊断恶病质的确定标准而异。低恶病质患病率的总生存率HR较高。在评估癌症患者的恶病质时,应仔细考虑确定的标准。本研究在PROSPERO注册为CRD42023435474。
结论:这项研究为临床实践中癌症恶病质的鉴别诊断标准的预后影响提供了重要的见解。我们提供定量和定性证据,证明恶病质的总体生存率和患病率存在显着差异,取决于癌症患者恶病质的明确诊断标准。