Cancer-associated cachexia
Cancer-associated cachexia
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DOI：
10.1038/nrdp.2017.105
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发表时间：
2018-01-18
影响因子：
81.5
通讯作者：
Fearon, Kenneth C. H.
中科院分区：
文献类型：
--
作者：
Baracos, Vickie E.;Martin, Lisa;Fearon, Kenneth C. H.
癌症相关性恶病质是一种以体重减轻伴骨骼肌和脂肪组织特定损失为特征的疾病。恶病质是由食物摄入量减少和代谢变化的可变组合驱动的，包括能量消耗增加、过度catalysis和炎症。恶病质与胰腺癌、食道癌、胃癌、肺癌、肝癌和肠癌高度相关;这组恶性肿瘤占全球所有癌症死亡的一半。恶病质涉及来自肿瘤微环境中的癌细胞和细胞的多种介质，包括炎症和免疫细胞。此外，内分泌、代谢和中枢神经系统扰动与这些介质结合联合收割机，引起骨骼肌、心肌和脂肪组织的分解代谢变化。在组织水平，机制包括炎症激活、蛋白水解、自噬和脂解。恶病质与包括功能性、代谢性和免疫性疾病以及癌症治疗的加重毒性和并发症的多种发病率相关。患者的生活质量受损，身体，情感和社会福祉下降，医疗资源的使用增加。迄今为止，没有有效的医学干预完全逆转恶病质，也没有批准的药物治疗。足够的营养支持仍然是恶病质治疗的支柱，而针对分解代谢过程过度激活、细胞损伤和炎症的药物目前正在研究中。
Cancer-associated cachexia is a disorder characterized by loss of body weight with specific losses of skeletal muscle and adipose tissue. Cachexia is driven by a variable combination of reduced food intake and metabolic changes, including elevated energy expenditure, excess catabolism and inflammation. Cachexia is highly associated with cancers of the pancreas, oesophagus, stomach, lung, liver and bowel; this group of malignancies is responsible for half of all cancer deaths worldwide. Cachexia involves diverse mediators derived from the cancer cells and cells within the tumour microenvironment, including inflammatory and immune cells. In addition, endocrine, metabolic and central nervous system perturbations combine with these mediators to elicit catabolic changes in skeletal and cardiac muscle and adipose tissue. At the tissue level, mechanisms include activation of inflammation, proteolysis, autophagy and lipolysis. Cachexia associates with a multitude of morbidities encompassing functional, metabolic and immune disorders as well as aggravated toxicity and complications of cancer therapy. Patients experience impaired quality of life, reduced physical, emotional and social well-being and increased use of healthcare resources. To date, no effective medical intervention completely reverses cachexia and there are no approved drug therapies. Adequate nutritional support remains a mainstay of cachexia therapy, whereas drugs that target overactivation of catabolic processes, cell injury and inflammation are currently under investigation.