Variation by stage in the effects of prediagnosis weight loss on mortality in a prospective cohort of esophageal cancer patients.
Variation by stage in the effects of prediagnosis weight loss on mortality in a prospective cohort of esophageal cancer patients.
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前瞻性食管癌患者队列中诊断前体重减轻对死亡率影响的阶段变化。
DOI：
10.1093/dote/dox073
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Abrams,JA
中科院分区：
文献类型：
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作者：
Shen,S;Araujo,JL;Altorki,NK;Sonett,JR;Rodriguez,A;Sungur-Stasik,K;Spinelli,CF;Neugut,AI;Abrams,JA
癌症恶病质越来越被认为是各种肿瘤类型的不良预后标志物。食管癌患者的体重减轻是多因素的，因为体积较大的肿瘤患者的进食能力也会下降。我们的目的是研究食管癌诊断前体重减轻与死亡率之间的关系，并确定这些关系是否随肿瘤分期而变化。我们在两个三级中心对食管癌患者进行了前瞻性队列研究。我们记录了患者在诊断前一年的基线特征，包括药物、吸烟、体重指数和体重减轻，并收集了治疗和结果的数据。我们使用Cox回归模型来确定体重减轻百分比与结果之间的关系。主要结局为全因死亡率；次要终点是食管癌特异性死亡率和转移的发展。我们招募了134名受试者，其中大多数患有腺癌（82.1%）；体重减轻的中位数为4.7% （IQR: 0%-10.9%）。体重减轻百分比的增加与全因死亡率无关（p趋势= 0.36）。然而，有证据表明，肿瘤分期之间存在显著的相互作用（p = 0.02）。在T期1或2患者中，诊断前体重减轻与死亡率之间存在强烈且显著的关联（最高胎数与最低胎数的校正危险度为8.26,95%CI为1.11-61.5，p趋势= 0.03），但在T期3或4患者中没有相关性（p趋势= 0.32）。诊断前一年的体重指数与死亡率无关。仅在早期食管癌患者中，诊断前体重减轻与全因死亡率增加相关。这表明肿瘤相关的恶病质可以在食管癌早期发生，并且是预后不良的标志。
Cancer cachexia is increasingly recognized as a poor prognostic marker for various tumor types. Weight loss in esophageal cancer is multifactorial, as patients with bulky tumors also have reduced ability to eat. We aimed to investigate the relationship between prediagnosis weight loss and mortality in esophageal cancer and to determine whether these associations vary with tumor stage. We conducted a prospective cohort study of esophageal cancer patients at two tertiary centers. We recorded baseline patient characteristics including medications, smoking, body mass index, and weight loss in the year prior to diagnosis, and collected data on treatment and outcomes. We used Cox regression modeling to determine the associations between percent weight loss and outcomes. The main outcome of interest was all-cause mortality; secondary endpoints were esophageal cancer-specific mortality and development of metastases. We enrolled 134 subjects, the majority of whom had adenocarcinoma (82.1%); median percent weight loss was 4.7% (IQR: 0%–10.9%). Increasing percent weight loss was not associated with all-cause mortality (ptrend = 0.36). However, there was evidence of significant interaction by tumor stage (p = 0.02). There was a strong and significant association between prediagnosis weight loss and mortality in patients with T stages 1 or 2 (adjusted HR 8.26 for highest versus lowest tertile, 95%CI 1.11–61.5, ptrend = 0.03) but not for T stages 3 or 4 (ptrend = 0.32). Body mass index one year prior to diagnosis was not associated with mortality. Prediagnosis weight loss was associated with increased all-cause mortality only in patients with early stage esophageal cancer. This suggests that tumor-related cachexia can occur early in esophageal cancer and represents a poor prognostic marker.