悪液質スコア：CASCO

悪液質のスコアリング：CASCOに関する論文を紹介します。

Josep M. Argilés, Francisco J. López-Soriano, Míriam Toledo, Angelica Betancourt, Roberto Serpe, and Sílvia Busquets1. The cachexia score (CASCO): a new tool for staging cachectic cancer patients. Journal of Cachexia, Sarcopenia and Muscle DOI 10.1007/s13539-011-0027-5

下記のHPで全文PDFで見ることができます。

http://www.springerlink.com/content/y658m27p1lj0428g/fulltext.pdf

悪液質を前悪液質、悪液質、不応性悪液質の3段階に分類する論文はいくつかありますが、悪液質をスコアリングする論文は初めてみました。

CASCOは体重減少、炎症・代謝障害・免疫抑制、身体機能、食思不振、QOLの5項目で合計100点満点で点数をつけます。この得点が25点以下なら軽度、50点以下なら中等度、75点以下なら重度、75点以上ならターミナルと4段階に分類します。

悪液質を定量化したという点では評価できますが、臨床現場では正直使い勝手は悪いと思います。今後の研究でCASCOの妥当性が検証されたとしても、臨床研究のためのツールでしかないと私は考えます。私はEPCRCの定性的な分類を当面使用するつもりです。

Abstract

Background
According to a recent consensus, the cachectic syndrome is defined as: “… a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass. The prominent clinical feature of cachexia is weight loss in adults (corrected for fluid retention) or growth failure in children (excluding endocrine disorders). Anorexia, inflammation, insulin resistance, and increased muscle protein breakdown are frequently associated with cachexia.” Although this definition is accompanied by diagnostic criteria, it does not consider the problem of staging. Stratification of patients is important when considering therapy. The very first stage of the wasting syndrome does not necessarily involve body weight loss—a state known as pre-cachexia.

Methods and Results
The aim of the present score was to overcome the problem of patient staging in cancer. This score considers five main different factors: body weight and lean body mass loss; anorexia; inflammatory, immunological, and metabolic disturbances; physical performance; and quality of life. The scoring scale goes from 0 to 100: mild cachexia (less than 25), moderate (more than 26 and less than 50), severe (more than 51 and less than 75), and terminal phase (more than 76 and up to 100). The score also takes into consideration the condition known as pre-cachexia.

Conclusion
The present score will facilitate cachexia staging and will therefore allow for a more adequate therapy.

Electronic supplementary material The online version of this article (doi:10.1007/s13539-011-0027-5) contains supplementary material, which is available to authorized users.