Central tenet of cancer cachexia therapy: do patients with advanced cancer have exploitable anabolic potential?
Central tenet of cancer cachexia therapy: do patients with advanced cancer have exploitable anabolic potential?
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DOI：
10.3945/ajcn.113.060228
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发表时间：
2013-10-01
影响因子：
7.1
通讯作者：
Baracos, Vickie E.
中科院分区：
文献类型：
--
作者：
Prado, Carla M.;Sawyer, Michael B.;Baracos, Vickie E.
背景资料：骨骼肌萎缩被认为是恶病质的中心特征，但骨骼肌萎缩在晚期癌症患者中的潜力尚未得到证实。目的：我们研究了晚期癌症骨骼肌萎缩的临床过程和可能的肌肉萎缩窗口。设计：我们对人群中肌肉的损失和增加进行了计算机断层扫描（CT）图像的定量分析，结果：晚期癌症患者（n = 368;中位生存期：196 d）在其疾病过程中共有1279个CT图像。考虑到所有时间点，在任何2次扫描之间的39%的间隔中发生肌肉损失。然而，肌肉增加的总体频率为15.4%，并且在任何2次扫描之间的45.6%的间隔中肌肉是稳定的，这使得肌肉的维持或增加成为主要行为。多项logistic回归分析显示，死亡后90 d内（与>90 d相比）是肌肉损失的主要危险因素（OR：2.67; 95% CI：1.45，4.94; P = 0.002），此时肌肉增加的可能性相应较小（OR：0.37; 95% CI：0.20，0.69; P = 0.002）。性别，年龄，体重指数，肿瘤组没有显着的预测肌肉损失或gain.Conclusions：一个窗口的合成代谢潜力存在于定义的早期阶段的疾病轨迹（>90天生存），创造了一个机会，营养干预，停止或扭转恶病质。死亡后90天内的癌症患者合成代谢潜力的可能性很低。
Background: Skeletal muscle wasting is considered the central feature of cachexia, but the potential for skeletal muscle anabolism in patients with advanced cancer is unproven.Objective: We investigated the clinical course of skeletal muscle wasting in advanced cancer and the window of possible muscle anabolism.Design: We conducted a quantitative analysis of computed tomography (CT) images for the loss and gain of muscle in population-based cohorts of advanced cancer patients (lung, colorectal, and pancreas cancer and cholangiocarcinoma) in a longitudinal observational study.Results: Advanced-cancer patients (n = 368; median survival: 196 d) had a total of 1279 CT images over the course of their disease. With consideration of all time points, muscle loss occurred in 39% of intervals between any 2 scans. However, the overall frequency of muscle gain was 15.4%, and muscle was stable in 45.6% of intervals between any 2 scans, which made the maintenance or gain of muscle the predominant behavior. Multinomial logistic regression revealed that being within 90 d (compared with >90 d) from death was the principal risk factor for muscle loss (OR: 2.67; 95% CI: 1.45, 4.94; P = 0.002), and muscle gain was correspondingly less likely (OR: 0.37; 95% CI: 0.20, 0.69; P = 0.002) at this time. Sex, age, BMI, and tumor group were not significant predictors of muscle loss or gain.Conclusions: A window of anabolic potential exists at defined early phases of the disease trajectory (>90 d survival), creating an opportunity for nutritional intervention to stop or reverse cachexia. Cancer patients within 90 d of death have a low likelihood of anabolic potential.