C. Fordy et al., Contribution of diet, tumour volume and patient-related factors to weight loss in patients with colorectal liver metastases, BR J SURG, 86(5), 1999, pp. 639-644
Background: One of the difficulties in assessing the contribution of tumour
-related factors to cancer cachexia is measurement of the extent of disease
where dissemination to multiple organ sites has occurred.
Methods: In this study the extent of tumour (both tumour volume and increas
e in marker levels), diet and patient-related factors (appetite, metabolic
hormones, immune activation, liver function and quality of life) were compa
red in patients with colorectal liver metastases who had lost at least 1 kg
in body-weight (weight loss) and patients who had not lost 1 kg in body we
ight (stable weight) during the preceding month.
Results: Forty patients (22 men; 14 with weight loss) were studied. Liver m
etastasis volume was significantly greater in patients who lost weight than
in those whose weight was stable (median (interquartile range) 1179 (245-1
517) versus 119 (23-523) ml; P = 0.003). The prevalence of patients with ra
ised levels of serum immune products was significantly greater in the weigh
t loss group for soluble interleukin (IL) 2 receptor alpha (sIL2r alpha) (P
= 0.03) and IL-6 (P = 0.05), but not for soluble tumour necrosis factor re
ceptor 1 (sTNFr1) or neopterin. There were significant correlations between
serum C-reactive protein and sIL2r alpha (r(s) = 0.68, P < 0.0001) and IL-
6 (r(s) = 0.46, P = 0.008) but not sTNFr1 or neopterin levels. Significant
differences in appetite, nausea, diet, energy intake, liver function tests
and serum levels of metabolic hormones were not detected.
Conclusion: Weight loss in patients with colorectal liver metastases was no
t explained by changes in diet, quality of life, or hormones, but activatio
n of the innate and incomplete activation of the acquired immune systems ma
y be involved. Agents that attenuate either the acute-phase inflammatory re
sponse or T lymphocyte IL-2 receptor upregulation might reduce weight loss
in patients with metastatic disease.