title: Relation between hypermetabolism, cachexia, and survival in cancer patients: a prospective study in 390 cancer patients before initiation of anticancer therapy.
abstract: Background:Cachexia is a major cause of death in cancer patients. The role of hypermetabolism in cancer cachexia remains unclear.Objective:We studied the relation between resting energy expenditure (REE), the estimated energy balance, clinical and biological markers of cachexia, and survival.Design:REE was measured with the use of indirect calorimetry in cancer patients before the initiation of anticancer therapies. Hypermetabolic, normometabolic, and hypometabolic patients were identified with the use of Boothby's standard. Weight loss, performance status (PS), C-reactive protein (CRP), albumin, the nutritional risk index, daily energy intake, energy balance (equal to daily energy intakes minus the REE), and survival were recorded.Results:Of 390 enrolled patients, 49% of subjects were hypermetabolic, 30% of subjects were normometabolic, and 21% of subjects were hypometabolic. Mean daily energy intakes did not differ significantly between the 3 groups. Hypermetabolic patients, compared with normometabolic patients, were more likely to have a negative energy balance [45% compared with 32%, respectively; OR: 1.74 (95% CI: 1.05, 2.91);P= 0.024], weight loss >5% [48% compared with 34%, respectively; OR: 1.83 (95% CI: 1.11, 3.04);P= 0.013], PS ≥2 [40% compared with 29%, respectively; OR: 1.70 (95% CI: 1.01, 2.88);P= 0.038], and CRP concentrations ≥10 mg/L [52% compared with 33%, respectively; OR: 2.2 (95% CI: 1.33, 3.66);P= 0.001]. In metastatic patients, compared with normometabolism, hypermetabolism was associated with a reduced median survival [14.6 compared with 21.4 mo, respectively; OR: 1.48 (95% CI: 1.01, 2.17);P= 0.044].Conclusions:Hypermetabolism is correlated with clinical and biological markers of cancer cachexia and is associated with a shorter survival in metastatic cancer patients. The development of therapeutic strategies that aim to blunt hypermetabolism appears warranted. This trial was registered at www.controlled-trials.com as ISRCTN46152275.
authors.affiliation: Medical Oncology, Cochin Teaching Hospital, AP-HP, and cl.vazeille@gmail.com.
authors.forename: Clara
authors.initials: C
authors.lastname: Vazeille
authors.affiliation: Medical Oncology, Cochin Teaching Hospital, AP-HP, and.
authors.forename: Anne
authors.initials: A
authors.lastname: Jouinot
authors.affiliation: Medical Oncology, Cochin Teaching Hospital, AP-HP, and.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Durand
authors.affiliation: Clinical Biochemistry, Cochin Teaching Hospital, GH HUPC, AP-HP, and.|Laboratory of Biological Nutrition EA 4466, Pharmacy University, Paris Descartes University, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Neveux
authors.affiliation: Medical Oncology, Cochin Teaching Hospital, AP-HP, and.
authors.forename: Pascaline
authors.initials: P
authors.lastname: Boudou-Rouquette
authors.affiliation: Medical Oncology, Cochin Teaching Hospital, AP-HP, and.
authors.forename: Olivier
authors.initials: O
authors.lastname: Huillard
authors.affiliation: Medical Oncology, Cochin Teaching Hospital, AP-HP, and.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Alexandre
authors.affiliation: Clinical Biochemistry, Cochin Teaching Hospital, GH HUPC, AP-HP, and.|Laboratory of Biological Nutrition EA 4466, Pharmacy University, Paris Descartes University, Paris, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Cynober
authors.affiliation: Medical Oncology, Cochin Teaching Hospital, AP-HP, and.
authors.forename: François
authors.initials: F
authors.lastname: Goldwasser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001481:Basal Metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002100:Cachexia / Q000209:etiology / Q000378:metabolism*; D002153:Calorimetry, Indirect; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D016017:Odds Ratio; D011446:Prospective Studies; D012146:Rest; D017741:Survivors; D015431:Weight Loss; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: cachexia; cancer; hypermetabolism; resting energy expenditure; survival; weight loss