がん悪液質の診断基準とQOL・予後

がん悪液質の診断基準と、QOL、運動能力、生命予後との関連を緩和けあ患者で調査した論文を紹介します。

Wallengren O, Lundholm K, Bosaeus I. Diagnostic criteria of cancer cachexia: relation to quality of life, exercise capacity and survival in unselected palliative care patients. Support Care Cancer. 2013 Jan 13. [Epub ahead of print]

悪液質の診断基準は3つ使用しています（Fearonら2006年：10%以上の体重減少、1日エネルギー摂取量1500kcal以下、CRP1mg/dl以上、Enansら2008年、Fearonら2011年）。

結果ですが、2%以上の体重減少、BMI20未満、CRP1mg/dl以上はQOL低下と関連していました。疲労、握力低下、全身炎症は歩行距離低下と関連を認めました。2%以上の体重減少、疲労、CRP1mg/dl以上、アルブミン3.2g/dl未満は生命予後不良と関連していました。

悪液質の有病割合は12～85％と診断基準によって大きく異なりました。以上より、体重減少、疲労、全身炎症がもっともQOL低下、運動能力低下、生命予後と関連していました。悪液質の有病割合は診断基準で大きく異なり、さらなる研究が必要という結論です。

ただ、現状では前悪液質、悪液質不応性、悪液質というステージ分類を導入したのは、Fearonらの2011年の診断基準だけですので、現状ではこれを用いるのがベストではと感じています。

Abstract

PURPOSE:

Cachexia is associated with adverse outcomes. There is limited information on the impact of different diagnostic criteria of cachexia on patient centered outcomes.

METHODS:

We compared the prevalence of reduced quality of life (QoL), physical function and survival in palliative care cancer patients classified by different cachexia criteria. Four hundred and five patients with advanced cancer were included. Cachexia criteria were BMI, weight loss, fatigue, Karnofsky performance score, low handgrip strength, lean tissue depletion (DXA or arm muscle circumference) and abnormal biochemistry (inflammation, anemia or low serum albumin). QoL was assessed with a cancer specific questionnaire (EORTC QLQ-C30) and classified by cluster analysis. Dietary intake was obtained from a 4-day food record. Physical function was measured on a treadmill.

RESULTS:

Weight loss >2 %, BMI <20 and="and" crp="crp" fatigue="fatigue">10 mg/L were associated with adverse QoL, function and symptoms (odds ratios: 2.1, 2.9, 4.0 and 3.1 respectively, P < 0.05 for all). Fatigue, low grip strength and markers of systemic inflammation were associated with short walking distance (P < 0.05). Weight loss > 2 %, fatigue, CRP > 10 mg/L and S-albumin < 32 g/L were associated with shorter survival (hazard ratios: 1.4, 1.6, 2.2 and 2.0 respectively, P < 0.05 for all). The prevalence of cachexia diagnosis varied from 12 to 85 % using different definitions.

CONCLUSIONS:

Weight loss, fatigue and markers of systemic inflammation were most strongly and consistently associated with adverse QoL, reduced functional abilities, more symptoms and shorter survival. The prevalence of cachexia using different definitions varied widely; indicating a need to further explore and validate diagnostic criteria for cancer cachexia.