Cachexia worsens prognosis in patients with resectable pancreatic cancer
Cachexia worsens prognosis in patients with resectable pancreatic cancer
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DOI：
10.1007/s11605-008-0505-z
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发表时间：
2008-07-01
影响因子：
3.2
通讯作者：
Martignoni, Marc E.
中科院分区：
文献类型：
--
作者：
Bachmann, Jeannine;Heiligensetzer, Mathias;Martignoni, Marc E.
胰腺癌是西方国家癌症相关死亡的第四大原因，预后不良（5年生存率，肿瘤切除术后辅助治疗的患者为25%;总体而言，5年生存率约为4%; Jemal等人，CA Cancer J Clin，55：10-30，2005）。许多患者在疾病进展过程中出现恶病质状态，这种综合征占晚期胰腺癌患者死亡的80%。值得注意的是，只有少数数据可用于恶病质的影响，胰腺癌患者安排肿瘤切除术。材料和方法因此，在这项研究中，227例连续的胰腺导管腺癌患者在18- 20年内被记录在案，关于恶病质的患病率及其对围手术期发病率和死亡率的影响，特别关注术后体重增加，结果40.5%的患者在手术时已存在恶病质。恶病质患者的营养状况确实较差，表现为蛋白质、白蛋白和血红蛋白水平较低。尽管肿瘤大小、淋巴结状态和CA 19 -9水平无显著差异，但由于恶病质患者的转移性疾病发生率较高，因此恶病质患者的切除率降低（77.8% vs. 48.9%）。住院期间的发病率和死亡率无显著性差异。但有和无恶病质的患者术后体重均下降，且体重增加直到术后6个月才开始。恶病质患者的生存率显着降低肿瘤切除患者以及姑息治疗patients.Conclusion恶病质有显着影响的生存和性能状态姑息患者以及在胰腺癌患者手术。但肿瘤相关恶病质并不一定取决于肿瘤大小或负荷，肿瘤的转移性去分化可能是肿瘤相关恶病质发展的关键步骤。
Introduction Pancreatic cancer is the fourth leading cause of cancer-related death in Western countries with a poor prognosis (5-year survival rates, 25% in patients after tumor resection with adjuvant treatment; overall, the 5-year survival rate is about 4%; Jemal et al., CA Cancer J Clin, 55:10-30, 2005). Many patients develop a cachectic status during the progression of the disease, and this syndrome accounts for up to 80% of deaths in patients with advanced pancreatic cancer. Remarkably, there are only a few data available on the impact of cachexia in patients with pancreatic cancer scheduled for tumor resection.Material and Methods Therefore, in this study, 227 consecutive patients with ductal adenocarcinoma of the pancreas were documented over an 18-month period regarding the prevalence of cachexia and its influence on perioperative morbidity and mortality with a special interest to postoperative weight gain and survival in a prospectively designed database and followed up.Results In 40.5% of the patients, cachexia was already present at the time of operation. The cachectic patients did present in a worse nutritional status, represented by lower protein, albumins, and hemoglobin levels. Despite no significant differences in tumor size, lymph node status, and CA19-9 levels, the resection rate in patients with cachexia was reduced (77.8% vs. 48.9%) due to a higher rate of metastatic disease in patients with cachexia. The morbidity and in-hospital mortality revealed no significant difference. However, patients with and without cachexia lost weight after operation, and the weight gain started not until 6 months after operation. The survival in patients with cachexia was significantly reduced in patients undergoing tumor resection as well as in palliative treated patients.Conclusion Cachexia has a significant impact on survival and performance status in palliative patients as well as in patients operated for pancreatic cancer. But tumor-related cachexia is not necessarily dependent on tumor size or load and that metastatic dedifferentiation of the tumor might be a critical step in the development of tumor-associated cachexia.