Background & Aims

Cancer cachexia is a wasting syndrome associated with functional impairment and reduced survival that impacts up to 50% of patients with gastrointestinal cancers. However, data are limited on the prevalence and clinical significance of cachexia in patients with hepatocellular carcinoma (HCC).

Methods

We performed a retrospective cohort study of patients diagnosed with HCC at 2 United States health systems between 2008 and 2018. Patient weights were recorded 6 months prior to and at time of HCC diagnosis. Cachexia was defined as >5% weight loss (or >2% weight loss if body mass index <20 kg/m²), and precachexia was defined as 2% to 5% weight loss. We used multivariable logistic regression models to identify correlates of cachexia and multivariable Cox proportional hazard models to identify factors associated with overall survival.

Results

Of 604 patients with HCC, 201 (33.3%) had precachexia and 143 (23.7%) had cachexia at diagnosis, including 19.0%, 23.5%, 34.7%, and 34.0% of patients with Barcelona Clinic Liver Cancer stages 0/A, B, C, and D, respectively. Patients with cachexia were less likely to receive HCC treatment (odds ratio, 0.38; 95% confidence interval, 0.21–0.71) and had worse survival than those with precachexia or stable weight (11.3 vs 20.4 vs 23.5 months, respectively; P < .001). Cachexia remained independently associated with worse survival (hazard ratio, 1.43; 95% confidence interval, 1.11–1.84) after adjusting for age, sex, race, ethnicity, Child Pugh class, alpha-fetoprotein, Barcelona Clinic Liver Cancer stage, and HCC treatment.

Conclusions

Nearly 1 in 4 patients with HCC present with cachexia, including many with compensated cirrhosis or early stage tumors. The presence of cancer-associated weight loss appears to be an early and independent predictor of worse outcomes in patients with HCC.

中文翻译：

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恶病质在肝细胞癌患者中很普遍，并且与较差的预后相关

背景与目标

癌症恶病质是一种与功能障碍和生存率降低相关的消耗综合征，影响多达 50% 的胃肠道癌症患者。然而，关于肝细胞癌 (HCC) 患者恶病质的患病率和临床意义的数据有限。

方法

我们对 2008 年至 2018 年间在美国 2 个卫生系统诊断为 HCC 的患者进行了一项回顾性队列研究。在 HCC 诊断前 6 个月和诊断时记录患者体重。恶病质定义为体重减轻>5%（如果体重指数<20 kg/m ²则体重减轻>2% ），恶病质前定义为体重减轻2%至5%。我们使用多变量逻辑回归模型来识别恶病质的相关因素，并使用多变量 Cox 比例风险模型来识别与总体生存相关的因素。

结果

在 604 名 HCC 患者中，201 名 (33.3%) 有恶病质前期，143 名 (23.7%) 在诊断时有恶病质，包括 19.0%、23.5%、34.7% 和 34.0% 的巴塞罗那临床肝癌 0/A、B 期患者、C 和 D。恶病质患者接受 HCC 治疗的可能性较小（比值比 0.38；95% 置信区间 0.21–0.71）并且生存率低于恶病质前期或体重稳定的患者（分别为 11.3 vs 20.4 vs 23.5 个月；P < .001 ). 在调整年龄、性别、种族、民族、Child Pugh 分级、甲胎蛋白、巴塞罗那临床肝癌分期和 HCC 治疗后，恶病质仍然与较差的生存率独立相关（风险比，1.43；95% 置信区间，1.11–1.84） .

结论

近四分之一的 HCC 患者存在恶病质，包括许多代偿性肝硬化或早期肿瘤。癌症相关体重减轻似乎是 HCC 患者预后较差的早期独立预测指标。