Pancreatic cancer related cachexia: influence on metabolism and correlation to weight loss and pulmonary function.
Pancreatic cancer related cachexia: influence on metabolism and correlation to weight loss and pulmonary function.
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DOI：
10.1186/1471-2407-9-255
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发表时间：
2009-07-28
期刊：
影响因子：
3.8
通讯作者：
Martignoni ME
中科院分区：
文献类型：
--
作者：
Bachmann J;Ketterer K;Marsch C;Fechtner K;Krakowski-Roosen H;Büchler MW;Friess H;Martignoni ME
剧烈的体重减轻是胰腺癌患者经常被低估的症状。恶病质-定义为稳定体重的意外损失超过10% -存在于高达80%的上消化道癌症患者中，并且对生存有显著影响。该研究的目的是显示胰腺癌患者恶病质的多种全身效应，包括切除率、对肺功能的影响、脂肪和肌肉组织的量以及实验室参数的变化。在胰腺癌患者中，记录临床表现，包括体重减轻的量。评估实验室参数和肺功能测试，并通过计算机断层扫描测量肌肉和脂肪组织的厚度。使用SPSS软件进行统计分析，包括多变量分析。使用Kaplan-Meier分析和对数秩检验计算生存曲线。为了检验检查组之间的显著差异，我们使用Student t检验和Mann-Whitney U检验。显著性定义为p < 0.05。在198例胰腺导管腺癌患者中，70%的患者在接受手术时体重减轻，40%的患者体重减轻超过稳定体重的10%。在恶病质患者中，转移瘤的诊断率明显更高（47%对24%，P < 0.001），导致这些患者的切除率明显降低。恶病质患者的脂肪组织量显著减少。因此，胰腺癌患者体重的急剧下降可能是肿瘤进展或更具侵袭性的暗示。伴有恶病质的胰腺癌患者有更高的肿瘤分期进展率和更差的营养状况。此外，恶病质患者的肺功能受损，脂肪组织减少。胰腺癌和恶病质患者的生存率显著降低。如果体重减轻超过5%，则可以检测到切除率显着降低，但如果体重减轻10%或以上，则变化显着更大。我们建议，体重减轻10%被定义为胰腺癌的显着。
Dramatic weight loss is an often underestimated symptom in pancreatic cancer patients. Cachexia- defined as an unintended loss of stable weight exceeding 10% – is present in up to 80% of patients with cancer of the upper gastrointestinal tract, and has a significant influence on survival. The aim of the study was to show the multiple systemic effects of cachexia in pancreatic cancer patients, in terms of resection rate, effects on pulmonary function, amount of fat and muscle tissue, as well as changes in laboratory parameters. In patients with pancreatic cancer, clinical appearance was documented, including the amount of weight loss. Laboratory parameters and lung-function tests were evaluated, and the thickness of muscle and fat tissue was measured with computed tomography scans. Statistical analysis, including multivariate analysis, was performed using SPSS software. Survival curves were calculated using Kaplan-Meier analysis and the log-rank test. To test for significant differences between the examined groups we used Student's t-test and the Mann-Whitney U test. Significance was defined as p < 0.05. Of 198 patients with a ductal adenocarcinoma of the pancreas, 70% were suffering from weight loss when they presented for operation, and in 40% weight loss exceeded 10% of the stable weight. In patients with cachexia, metastases were diagnosed significantly more often (47% vs. 24%, P < 0.001), leading to a significantly reduced resection rate in these patients. Patients with cachexia had significantly reduced fat tissue amounts. Hence, dramatic weight loss in a patient with pancreatic cancer may be a hint of a more progressed or more aggressive tumour. Pancreatic cancer patients with cachexia had a higher rate of more progressed tumour stages and a worse nutritional status. Furthermore, patients with cachexia had an impaired lung function and a reduction in fat tissue. Patients with pancreatic cancer and cachexia had significantly reduced survival. If weight loss exceeded 5% there was a significantly reduced resection rate to detect, but the changes were significantly more substantial if weight loss was 10% or more. We propose that a weight loss of 10% be defined as significant in pancreatic cancer.