非小細胞肺がんの悪液質と予後

非小細胞肺がんStage3患者における悪液質の有病割合と予後に関する研究です。

Barbara S. van der Meij, et al: The prevalence and prognostic value of cachexia in patients with stage III NSCLC

非小細胞肺がん患者で診断時にStage3であった40人について、悪液質の有無をFearonらとEvansの診断基準を使用して比較しています。

結果です。Fearonらの診断基準では、前悪液質9人、悪液質7人、悪液質に非該当24人でした。3群間で生存期間には有意差を認めませんでしたが、悪液質群でQOLが有意に低いという結果でした。

Evansの診断基準では、悪液質11人、悪液質に非該当29人でした。悪液質群では生存期間が有意に短く、炎症マーカー（CRP、IL-6）が高値で、ヘモグロビンと悪液質が低値でした。悪液質群ではQOLが低い傾向にありました。

結論ですが、非小細胞肺がん患者Stage3診断時に悪液質を認めることはありますが、Fearonらの診断基準とEvansの診断基準で異なります。悪液質は生存期間とQOLに関連していると思われますが、さらなる研究が必要です。

どちらの診断基準を使えばよいかは迷うところですが、Fearonらの診断基準はがん悪液質、Evansの診断基準はがん以外の疾患も含めた悪液質ですので、がん悪液質ならFearonら、がん以外の疾患の悪液質ならEvansがよいかもしれません。私は診断が簡単なFearonらの診断基準を好みますが。

Background and aims: Cachexia frequently occurs in patients with lung cancer, and is associated with reduced physical function, intolerance to anti-cancer therapy and shorter survival. Our aim was to study the prevalence and the prognostic value of cachexia and to explore parameters associated with cachexia in patients with stage III non-small cell lung carcinoma (NSCLC).

Methods: In 40 patients at diagnosis of stage III NSCLC, weight loss, FFM, handgrip strength, anorexia, nutritional intake and serum biochemistry were assessed. The ESPEN SIG and Fearon criteria were used to define pre-cachexia and cachexia, respectively. Cachexia was also defined by the Evans criteria. Additionally, quality of life was assessed by the EORTC-QLQC30 questionnaire. Differences between groups were analysed by independent t tests and ANOVA, and survival by Cox regression, adjusted for sex and tumour stage (IIIa/IIIb).

Results: According to the SIG and Fearon criteria, pre-cachexia was present in 9 (23%), cachexia in 7 (18%), and no cachexia in 24 (60%) patients. Survival between these groups was not significantly different, but patients with cachexia reported a lower quality of life (p = 0.03). According to the Evans criteria, cachexia was present in 11 (28%) patients and no cachexia in 29 (72%) patients. The cachexia group showed a significantly shorter survival than the no-cachexia group (HR = 4.4, p = 0.001). Patients with cachexia had higher levels of CRP and IL-6, and lower Hb and serum albumin than patients without cachexia (p < 0.01), and all inflammatory parameters were significantly correlated (Pearson r: 0.5–0.7, p < 0.01). Patients with cachexia tended to report a lower quality of life (p = 0.08).

Conclusions: Pre-cachexia and cachexia are prevalent at diagnosis of stage III NSCLC, but criteria find different prevalences. Cachexia seems to be associated with shorter survival and a lower quality of life. Further studies are warranted to more extensively explore these new criteria in cancer patients.