背景:癌症恶病质是一种在营养支持下不能完全恢复的综合征,会导致食欲下降和体重减轻。它使患者的生活质量和预后恶化。在这项研究中,肺癌恶病质的流行病学,使用日本肺癌协会的国家数据库检查了其危险因素及其对化疗反应率和预后的影响.了解与癌症恶病质有关的这些事情对于克服肺癌患者的癌症恶病质很重要。
方法:2012年,来自日本314个机构的12.320名患者在全国注册数据库中注册(日本肺癌注册研究)。其中,有8489例患者的6个月内体重下降数据.我们定义了6个月内体重下降≥5%的患者,这是2011年癌症恶病质国际共识定义中列出的三个标准之一,在这项研究中表现为恶病质。
结果:8489名患者中约有20.4%患有癌症恶病质。性,年龄,吸烟史,肺气肿,性能状态,上腔静脉综合征,临床分期,转移部位,组织学,表皮生长因子受体(EGFR)突变状态,有恶病质和无恶病质患者的主要治疗方法和血清白蛋白水平有显著差异。Logistic分析表明,吸烟史,肺气肿,临床分期,转移部位,组织学,EGFR突变,血清钙和白蛋白水平与癌症恶病质显著相关。对初始治疗的反应,包括化疗,放化疗或放疗,恶病质患者比无恶病质患者明显更差(反应率:49.7%vs.41.5%,P<0.001)。在单变量和多变量分析中,恶病质患者的总生存期明显短于无恶病质患者(1年生存率:60.7%vs.37.6%,Cox比例风险模型,风险比:1.369,95%置信区间:1.274-1.470,P<0.001)。
结论:大约五分之一的肺癌患者出现癌症恶病质,并且与一些基线患者特征有关。它还与对初始治疗的反应不佳有关,导致预后不良。我们的研究结果可能有助于恶病质患者的早期识别和干预,这可能会改善他们对治疗的反应和预后。
Cancer cachexia is a syndrome that does not fully recover with nutritional support and causes appetite loss and body weight loss. It worsens a patient\'s quality of life and prognosis. In this
study, the epidemiology of cachexia in lung cancer, its risk factors and its impact on chemotherapy response rate and prognosis were examined using the national database of the Japan Lung Cancer Society. Understanding these things related to cancer cachexia is important as a starting point in overcoming cancer cachexia in patients with lung cancer.
In 2012, 12 320 patients from 314 institutions in Japan were registered in a nationwide registry database (Japanese Lung Cancer Registry
Study). Of these, data on body weight loss within 6 months were available for 8489 patients. We defined the patients with body weight loss ≥ 5% within 6 months, which is one of the three criteria listed in the 2011 international consensus definition of cancer cachexia, as cachectic in this
study.
Approximately 20.4% of the 8489 patients had cancer cachexia. Sex, age, smoking history, emphysema, performance status, superior vena cava syndrome, clinical stage, site of metastasis, histology, epidermal growth factor receptor (EGFR) mutation status, primary treatment method and serum albumin levels were significantly different between patients with and without cachexia. Logistic analyses showed that smoking history, emphysema, clinical stage, site of metastasis, histology, EGFR mutation, serum calcium and albumin levels were significantly associated with cancer cachexia. The response to initial therapy, including chemotherapy, chemoradiotherapy or radiotherapy, was significantly poorer in the patients with cachexia than in those without cachexia (response rate: 49.7% vs. 41.5%, P < 0.001). Overall survival was significantly shorter in the patients with cachexia than in those without cachexia in both univariate and multivariable analyses (1-year survival rate: 60.7% vs. 37.6%, Cox proportional hazards model, hazard ratio: 1.369, 95% confidence interval: 1.274-1.470, P < 0.001).
Cancer cachexia was seen in approximately one fifth of the lung cancer patients and was related to some baseline patient characteristics. It was also associated with a poor response to initial treatment, resulting in poor prognosis. The results of our
study may be useful for early identification and intervention in patients with cachexia, which may improve their response to treatment and their prognosis.