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癌症恶病质是由晚期恶性肿瘤造成的食欲减退、体重减轻、极度消瘦、乏力、贫血和全身严重衰竭状态，其病理生理学特征为营养素代谢异常和肌肉萎缩，可能给患者的临床结局带来不利影响。不过，还有一种特殊情况，即身高、体重、体型或体重指数基本正常，看似不瘦，但是肌肉的重量、体积或密度减少而脂肪增加，形成一种特殊的肌肉减少型肥胖或脂肪过多型瘦弱，俗称“虚胖”。既往研究已经证实，肌肉减少或脂肪过多，与晚期乳腺癌患者死亡率风险相关，2018年《美国医学会杂志》肿瘤学分册发表的研究还发现，肌肉减少或脂肪过多，与早期乳腺癌患者死亡率风险也密切相关，值得警惕。 相关链接 2020年5月20日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表美国哈佛大学麻省总医院、贝斯以色列医院和新英格兰女执事医院、美国临床肿瘤学会、德克萨斯大学MD安德森癌症中心、弗吉尼亚联邦大学、坎比亚医疗集团、罗斯威尔帕克综合癌症中心、德尤维尔学院、旧金山加利福尼亚大学、霍普金斯大学医学中心、梅奥医学中心、加拿大艾伯塔大学、卡尔加里大学、英国爱丁堡大学、丹麦哥本哈根大学联合起草的癌症恶病质指南，为成年晚期癌症患者恶病质临床管理提供了循证指导意见。 美国临床肿瘤学会首先通过美国国家医学图书馆数据库和英国考科蓝循证医学数据库，对1966年～2019年10月17日发表的随机对照研究进行检索和系统分析，收集癌症恶病质营养、药物以及运动等其他干预措施的研究证据。随后，召集专家小组对研究证据进行评审并提出推荐意见。 结果，20项系统回顾以及系统回顾未纳入的13项随机对照研究符合要求。少数研究结果表明，饮食咨询±口服营养补充都可增加体重，但是研究证据仍然不足。改善食欲和（或）体重的相关药物干预措施包括甲地孕酮等孕酮（黄体酮）类似物和地塞米松或氟羟甲酮等皮质类固醇。其他被评估的干预措施未获益或获益证据不足，无法得出疗效结论。上述研究证据的局限性包括晚期癌症所致退出率或失访率高，以及不同研究的关注结局和结局评定方法各不相同。 因此，该指南主要推荐意见如下：
J Clin Oncol. 2020 May 20. [Epub ahead of print] Management of Cancer Cachexia: ASCO Guideline. Roeland EJ, Bohlke K, Baracos VE, Bruera E, Del Fabbro E, Dixon S, Fallon M, Herrstedt J, Lau H, Platek M, Rugo HS, Schnipper HH, Smith TJ, Tan W, Loprinzi CL. Massachusetts General Hospital Cancer Center, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; University of Alberta, Edmonton, Alberta, Canada; MD Anderson Cancer Center, Houston, TX; Virginia Commonwealth University, Richmond, VA; Cambia Health Solutions, Portland, OR; University of Edinburgh, UK; University of Copenhagen, Denmark; University of Calgary, Calgary, Alberta, Canada; Roswell Park Comprehensive Cancer Center and D'Youville College, Buffalo, NY; University of California San Francisco, San Francisco, CA; Beth Israel Deaconess Medical Center, Boston, MA; Johns Hopkins Medicine, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN. PURPOSE: To provide evidence-based guidance on the clinical management of cancer cachexia in adult patients with advanced cancer. METHODS: A systematic review of the literature collected evidence regarding nutritional, pharmacologic, and other interventions, such as exercise, for cancer cachexia. PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and systematic reviews of RCTs published from 1966 through October 17, 2019. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS: The review included 20 systematic reviews and 13 additional RCTs. Dietary counseling, with or without oral nutritional supplements, was reported to increase body weight in some trials, but evidence remains limited. Pharmacologic interventions associated with improvements in appetite and/or body weight include progesterone analogs and corticosteroids. The other evaluated interventions either had no benefit or insufficient evidence of benefit to draw conclusions on efficacy. Limitations of the evidence include high drop-out rates, consistent with advanced cancer, as well as variability across studies in outcomes of interest and methods for outcome assessment. RECOMMENDATIONS: Dietary counseling may be offered with the goals of providing patients and caregivers with advice for the management of cachexia. Enteral feeding tubes and parenteral nutrition should not be used routinely. In the absence of more robust evidence, no specific pharmacological intervention can be recommended as the standard of care; therefore, clinicians may choose not to prescribe medications specifically for the treatment of cancer cachexia. Nonetheless, when it is decided to trial a drug to improve appetite and/or improve weight gain, currently available pharmacologic interventions that may be used include progesterone analogs and short-term (weeks) corticosteroids. PMID: 32432946 DOI: 10.1200/JCO.20.00611
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