EPCRCのがん悪液質レビュー論文

EPCRCのがん悪液質レビュー論文を紹介します。

Blum D, Omlin A, Baracos VE, Solheim TS, Tan BH, Stone P, Kaasa S, Fearon K, Strasser F; European Palliative Care Research Collaborative. Cancer cachexia: A systematic literature review of items and domains associated with involuntary weight loss in cancer. Crit Rev Oncol Hematol. 2011 Jan 7. [Epub ahead of print]

EPCRCはEuropean Palliative Care Research Collaborativeの略です。ESPENの主要メンバーが参加しているそうですので、EPCRCの論文は読む価値ありと判断しています。

抄録だけ見ても実はそれほど参考にならないのですが、本文は30ページあるのでこれからゆっくり読みたいと思います。1項目だけで悪液質の有無を鑑別することは難しいようです。前悪液質の診断基準でも6カ月で5％以上の体重減少、全身炎症反応、食思不振の3項目と悪液質となる原疾患の存在が含まれていますので、この程度の項目数は悪液質の診断に必要だろうと思います。

食思不振や栄養摂取量減少と体重減少との関連が弱いというのは意外な気がしました。体重減少にはむしろ全身炎症による異化亢進の影響のほうが大きいのかもしれません。

悪液質と筋肉量、筋力に関する論文や、悪液質の身体機能、精神機能への影響に関する論文はあまりないそうです。このあたりが一番、リハ栄養に関連してくるところだと思うのですがこれからのようです。

Abstract
BACKGROUND: The concept of cancer-related anorexia/cachexia is evolving as its mechanisms are better understood. To support consensus processes towards an updated definition and classification system, we systematically reviewed the literature for items and domains associated with involuntary weight loss in cancer.

METHODS: Two search strings (cachexia, cancer) explored five databases from 1976 to 2007. Citations, abstracts and papers were included if they were original work, in English/German language, and explored an item to distinguish advanced cancer patients with variable degrees of involuntary weight loss. The items were grouped into the 5 domains proposed by formal expert meetings.

RESULTS: : Of 14,344 citations, 1275 abstracts and 585 papers reviewed, 71 papers were included (6325 patients; 40-50% gastrointestinal, 10-20% lung cancer). No single domain or item could consistently distinguish cancer patients with or without weight loss or having various degrees of weight loss. Anorexia and decreased nutritional intake were unexpectedly weakly related with weight loss. Explanations for this could be the imprecise measurement methods for nutritional intake, symptom interactions, and the importance of systemic inflammation as a catabolic drive. Data on muscle mass and strength is scarce and the impact of cachexia on physical and psychosocial function has not been widely assessed.

CONCLUSIONS: Current data support a modular concept of cancer cachexia with a variable combination of reduced nutritional intake and catabolic/hyper-metabolic changes. The heterogeneity in the literature revealed by this review underlines the importance of an agreed definition and classification of cancer cachexia.