Background: Cachexia is common in patients with oesophagogastric cancer. The syndrome is characterised by tissue wasting (muscle and fat), anorexia, and reduced physical function, which result from complex interactions between the tumour and its host. Heterogeneity in the diagnostic criteria used for cachexia has hindered their clinical utilisation. This study aimed to compare the two established cachexia definitions (Fearon’s consensus definition and the Global Leadership Initiative on Malnutrition [GLIM] criteria) and their relationships with survival in patients with oesophagogastric cancer. Methods: Consecutive patients newly diagnosed with oesophagogastric cancer (January 2019 to December 2020) were identified from a prospective regional database. Involuntary weight loss, BMI, CT body composition analyses, and neutrophil–lymphocyte ratios were recorded at clinical staging. These data were used to assess patients for cachexia according to Fearon and GLIM diagnostic criteria. The primary outcome of interest was overall survival. Results: Overall, 465 patients (66.9% male, median 71 years) were diagnosed with oesophagogastric cancer during the 2-year study period. Cachectic proportions differed between definitions (Fearon: 59.1% vs. GLIM: 44.1%), and only 49.1% of the 322 patients who met one set of diagnostic criteria were cachectic according to both. Patients who met the GLIM criteria were significantly more comorbid and had a poorer performance status; however, no such difference was evident when using the Fearon definition. Those patients who met either set of diagnostic criteria had shorter survival than those who met neither (p< 0.001). Following adjustment for confounders, GLIM-defined cachexia was more strongly associated with reduced survival (aHR: 1.57 [95% CI: 1.25–1.96],p< 0.001) than Fearon-defined cachexia (aHR: 1.41 [95% CI: 1.13–1.76],p= 0.002). Patients who only met the Fearon diagnostic criteria had prolonged survival (median: 363 days) when compared to those who met only GLIM (median: 158 days) or both definitions (median: 120 days). A secondary analysis of those patients who met the GLIM diagnostic criteria (n= 205) compared the three potential phenotypical criteria used in this definition. Only reduced muscle mass, and not low BMI or weight loss, was associated with poorer survival (aHR: 1.88 [95% CI: 1.15–3.07],p= 0.012) in this group. Conclusions: Cancer cachexia is strongly associated with shortened survival in patients with oesophagogastric cancer. Classification using the GLIM criteria provides more effective prognostication and this definition should be utilised in multidisciplinary patient care.
背景：恶病质在食管胃结合部癌患者中较为常见。该综合征以组织消耗（肌肉与脂肪）、厌食及身体功能下降为特征，由肿瘤与宿主间复杂的相互作用所致。诊断标准的不统一阻碍了其在临床中的应用。本研究旨在比较两种已确立的恶病质定义（Fearon共识定义与全球营养不良领导倡议[GLIM]标准）及其与食管胃结合部癌患者生存期的关联。 方法：从区域性前瞻性数据库中连续纳入2019年1月至2020年12月期间新确诊的食管胃结合部癌患者。在临床分期阶段记录非自愿性体重减轻、体重指数、CT身体成分分析及中性粒细胞-淋巴细胞比值。依据Fearon和GLIM诊断标准，使用这些数据评估患者的恶病质状况。主要观察终点为总生存期。 结果：在两年研究期间，共465例患者（男性占66.9%，中位年龄71岁）确诊为食管胃结合部癌。不同定义下的恶病质比例存在差异（Fearon标准：59.1% vs GLIM标准：44.1%），且322例符合任一组诊断标准的患者中，仅49.1%同时符合两组标准。符合GLIM标准的患者合并症显著更多、体能状态更差；而使用Fearon标准时未发现此类差异。符合任一组诊断标准的患者生存期均短于两组标准均不符合者（p<0.001）。校正混杂因素后，GLIM定义的恶病质与生存期缩短的关联强度（校正风险比：1.57[95%置信区间：1.25–1.96]，p<0.001）高于Fearon定义（校正风险比：1.41[95%置信区间：1.13–1.76]，p=0.002）。与仅符合GLIM标准（中位生存期：158天）或同时符合两组标准（中位生存期：120天）的患者相比，仅符合Fearon诊断标准的患者生存期更长（中位生存期：363天）。对符合GLIM诊断标准的205例患者进行亚组分析，比较该定义中三种潜在表型标准。仅肌肉质量下降（而非低体重指数或体重减轻）与该亚组患者较差的生存期相关（校正风险比：1.88[95%置信区间：1.15–3.07]，p=0.012）。 结论：癌症恶病质与食管胃结合部癌患者生存期缩短密切相关。采用GLIM标准进行分类能提供更有效的预后评估，该定义应在多学科患者护理中推广应用。
肿瘤(癌症)患者之家