脂肪组织和血浆磷脂类减少与晚期癌症患者生存率的相关性

　　背景与目的：脂肪组织大量丢失是癌症恶病质的主要表现。晚期癌症患者还表现为血浆磷脂类水平低下。这些表现是否与癌症病程具有相关性尚未可知，与生存率的关系也未可知。本研究观察了死亡前500天内脂肪组织和血浆磷脂类变化特征及对预后影响的重要性。
　　方法：死亡前500天至少进行2次以上CT扫描的结直肠癌和肺癌患者（108例）回顾性分析观察脂肪组织率变化。相似转移癌患者（72例）采用前瞻性方法测量血浆磷脂脂肪酸水平。
　　结果：死亡前7个月脂肪组织开始加速丢失，至死亡前2个月平均丢失量达到总量的29%。接近死亡患者的血浆磷脂脂肪酸水平较生存时间大于8个月的患者低35%。磷脂脂肪酸水平下降与脂肪组织丢失同时发生，可以预测存活时间。
　　结论：血浆磷脂类水平下降提示外周必需脂肪酸缺乏，可能与脂肪组织丢失有关。

Clin Nutr. 2010 Aug;29(4):482-487.
Loss of adipose tissue and plasma phospholipids: Relationship to survival in advanced cancer patients.

Murphy RA, Wilke MS, Perrine M, Pawlowicz M, Mourtzakis M, Lieffers JR, Maneshgar M, Bruera E, Clandinin MT, Baracos VE, Mazurak VC.

Alberta Institute for Human Nutrition, University of Alberta, 4-10 Agriculture/Forestry Centre Edmonton, Alberta, T6G 2P5, Canada.

BACKGROUND & AIMS: Extensive loss of adipose tissue is a key feature of cancer cachexia. Advanced cancer patients also exhibit low plasma phospholipids. It is not known whether these processes coincide across the cancer trajectory nor has their relationship with survival been defined. Changes in adipose tissue mass and plasma phospholipids were characterized within 500days prior to death and prognostic significance assessed. METHODS: Adipose tissue rate of change was determined in a retrospective cohort of patients who died of colorectal and lung cancers (n=108) and who underwent >2 computed tomography scans in the last 500days of life. Plasma phospholipid fatty acids were measured prospectively in a similar cohort of patients with metastatic cancer (n=72). RESULTS: Accelerated loss of adipose tissue begins at 7months from death reaching an average loss of 29% of total AT 2months from death. Plasma phospholipid fatty acids were 35% lower in patients closest to death versus those surviving >8months. Losses of phospholipid fatty acids and adipose tissue occur in tandem and are predictive of survival. CONCLUSIONS: Depletion of plasma phospholipids likely indicates a deficit of essential fatty acids in the periphery which may contribute to loss of adipose tissue.