肿瘤患者的体重丢失与管理

陈奕博; 谢海伦; 徐诺; 钟沛; 王舒瑶; 徐昌鸿; 林斯宇; 石汉平

doi:10.16689/j.cnki.cn11-9349/r.2026.02.018

PDF(1677 KB)

肿瘤代谢与营养电子杂志 ›› 2026, Vol. 13 ›› Issue (2) : 310-319. DOI: 10.16689/j.cnki.cn11-9349/r.2026.02.018

综述

肿瘤患者的体重丢失与管理

¹陈奕博, ¹谢海伦, ¹徐诺, ¹钟沛, ¹王舒瑶, ¹徐昌鸿, ¹林斯宇, ²石汉平

作者信息 +

Weight loss and management in cancer patients

¹Chen Yibo, ¹Xie Hailun, ¹Xu Nuo, ¹Zhong Pei, ¹Wang Shuyao, ¹Xu Changhong, ¹Lin Siyu, ¹Shi Hanping

Author information +

文章历史 +

摘要

恶性肿瘤患者体重丢失是恶性肿瘤相关营养不良和恶液质的重要表型,贯穿诊断、治疗与康复全过程,并与治疗耐受性下降、生活质量受损及生存缩短密切相关。本文围绕恶性肿瘤患者体重丢失的临床界定、发生机制、评估方法与管理策略进行综述。首先,从临床角度概述非意愿性体重丢失的判定意义及疾病驱动、治疗相关驱动因素;其次,系统梳理炎症—代谢—食欲调控失衡、肠道微生态异常、骨骼肌与脂肪组织分解重构,以及不同恶性肿瘤类型和治疗方式所致特异性机制,强调体重丢失本质上是多通路耦合、相互放大的恶性循环。进一步结合筛查工具、体成分评估、功能评估和实验室指标,阐述从营养风险识别到多维表型分层的临床评估路径。在管理方面,本文总结了以营养治疗为基础,联合运动康复、药物干预、症状控制、心理支持及多学科协作的全程综合管理模式。总体而言,恶性肿瘤患者体重丢失的管理应强调早筛查、早评估、早干预和个体化决策,在改善营养状态与功能储备的同时,提高抗肿瘤治疗完成率与患者结局。未来仍需进一步完善筛查分层工具,强化高质量临床证据,并推动精准化、连续化管理策略的建立。

Abstract

Weight loss in patients with cancer is a major manifestation of cancer-related malnutrition and cachexia. It runs through the entire course of diagnosis, treatment, and rehabilitation, and is closely associated with reduced treatment tolerance, impaired quality of life, and shortened survival. This article reviews the clinical definition, underlying mechanisms, assessment methods, and management strategies of weight loss in cancer patients. First, from a clinical perspective, it outlines the significance of identifying unintentional weight loss, as well as disease-related and treatment-related driving factors. Second, it systematically summarizes the imbalance in inflammation, metabolism, and appetite regulation, alterations in the gut microbiota, and the catabolic remodeling of skeletal muscle and adipose tissue, together with the specific mechanisms associated with different tumor types and treatment modalities, emphasizing that cancer-related weight loss is essentially a vicious cycle driven by multiple interrelated pathways. Furthermore, by integrating screening tools, body composition assessment, functional evaluation, and laboratory indicators, this review illustrates a clinical assessment pathway from nutritional risk identification to multidimensional phenotypic stratification. In terms of management, it summarizes a comprehensive, whole-course care model based on nutritional therapy and combined with exercise rehabilitation, pharmacological intervention, symptom control, psychological support, and multidisciplinary collaboration. Overall, the management of weight loss in cancer patients should emphasize early screening, early assessment, early intervention, and individualized decision-making, so as to improve nutritional status and functional reserve while enhancing treatment completion and clinical outcomes. Future efforts should focus on refining screening and stratification tools, strengthening high-quality clinical evidence, and promoting the development of precise and continuous management strategies.

导出引用

陈奕博, 谢海伦, 徐诺, 钟沛, 王舒瑶, 徐昌鸿, 林斯宇, 石汉平. 肿瘤患者的体重丢失与管理[J]. 肿瘤代谢与营养电子杂志. 2026, 13(2): 310-319 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.02.018

Chen Yibo, Xie Hailun, Xu Nuo, Zhong Pei, Wang Shuyao, Xu Changhong, Lin Siyu, Shi Hanping. Weight loss and management in cancer patients[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2026, 13(2): 310-319 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.02.018

参考文献

[1] RENARD J, DURAND J P, DE PERCIN S, et al. Early nutritional and inflammation assessment predicts prognosis in patients with cancer across tumor origin and metastatic status[J]. Clin Nutr,2025,52:313-322.
[2] THAKIR T M, WANG A R, DECKER-FARRELL A R, et al. Cancer therapy and cachexia[J]. J Clin Invest, 2025, 135(15).
[3] ARENDS J. Malnutrition in cancer patients: Causes, consequences and treatment options[J]. Eur J Surg Oncol,2024,50(5):107074.
[4] GILMORE L A, OLAECHEA S, GILMORE B W, et al. A preponderance of gastrointestinal cancer patients transition into cachexia syndrome[J]. J Cachexia Sarcopenia Muscle,2022,13(6):2920-2931.
[5] ARENDS J, STRASSER F, GONELLA S, et al. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines[J]. ESMO Open,2021,6(3):100092.
[6] BROWN L R, THOMSON G G, GARDNER E, et al. Cachexia index for prognostication in surgical patients with locally advanced oesophageal or gastric cancer: multicentre cohort study[J]. Br J Surg, 2024, 111(4):znae098.
[7] KORDES M, LARSSON L, ENGSTRAND L, et al. Pancreatic cancer cachexia: three dimensions of a complex syndrome[J]. Br J Cancer,2021,124(10):1623-1636.
[8] HUO Z, CHONG F, LI N, et al. Diagnostic criteria for cancer-associated cachexia: insights from a multicentre cohort Study[J]. J Cachexia Sarcopenia Muscle, 2025, 16(1): e13703.
[9] ZHANG G, ZHANG C, FIDA S, et al. Impact of weight change on the prognosis of cancer patients: A multicenter, prospective study[J]. Clin Nutr ESPEN,2025,70:69-76.
[10] MUSCARITOLI M, ARENDS J, BACHMANN P, et al. ESPEN practical guideline: clinical nutrition in cancer[J]. Clin Nutr,2021,40(5):2898-2913.
[11] HUSTAD K S, KOTENG L H, URRIZOLA A, et al. Practical cancer nutrition, from guidelines to clinical practice: a digital solution to patient-centred care[J]. ESMO Open,2025,10(4):104529.
[12] DE FELICE F, MALERBA S, NARDONE V, et al. Progress and challenges in integrating nutritional care into oncology practice: results from a national survey on behalf of the nutrionc research group[J]. Nutrients, 2025, 17(1):188.
[13] XIE H, ZHANG H, RUAN G, et al. Individualized threshold of the involuntary weight loss in prognostic assessment of cancer[J]. J Cachexia Sarcopenia Muscle,2023,14(6):2948-2958.
[14] KOUTNIK A P, POFF A M, WARD N P, et al. Ketone bodies attenuate wasting in models of atrophy[J]. J Cachexia Sarcopenia Muscle,2020,11(4):973-996.
[15] NAKAMURA K, TONOUCHI H, SASAYAMA A, et al. A ketogenic formula prevents tumor progression and cancer cachexia by attenuating systemic inflammation in colon 26 tumor-bearing mice[J]. Nutrients, 2018, 10(2):206.
[16] YANG Y H, HAO Y M, LIU X F, et al. Docosahexaenoic acid-enriched phospholipids and eicosapentaenoic acid-enriched phospholipids inhibit tumor necrosis factor-alpha-induced lipolysis in 3T3-L1 adipocytes by activating sirtuin 1 pathways[J]. Food Funct,2021,12(11):4783-4796.
[17] HUISMAN C, NORGARD M A, LEVASSEUR P R, et al. Critical changes in hypothalamic gene networks in response to pancreatic cancer as found by single-cell RNA sequencing[J]. Mol Metab,2022,58:101441.
[18] BOZZETTI F. Chemotherapy-induced sarcopenia[J]. Curr Treat Options Oncol,2020,21(1):7.
[19] NOLDEN A A, HWANG L D, BOLTONG A, et al. Chemosensory changes from cancer treatment and their effects on patients' food behavior: a scoping review[J]. Nutrients, 2019, 11(10):2285.
[20] ZHANG Y, CHEN J, LIU H, et al. The incidence of immune-related adverse events (irAEs) and their association with clinical outcomes in advanced renal cell carcinoma and urothelial carcinoma patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis[J]. Cancer Treat Rev,2024,129:102787.
[21] STROJAN P, HUTCHESON K A, EISBRUCH A, et al. Treatment of late sequelae after radiotherapy for head and neck cancer[J]. Cancer Treat Rev,2017,59:79-92.
[22] KIM J Y, GIL T H, LEE H G, et al. Plasma extracellular vesicles biomarkers linked to lower muscle mass, function and physical performance in sarcopenia[J]. J Cachexia Sarcopenia Muscle, 2025, 16(2): e13784.
[23] PROPPER D J, BALKWILL F R. Harnessing cytokines and chemokines for cancer therapy[J]. Nat Rev Clin Oncol,2022,19(4):237-253.
[24] BARACOS V E, MARTIN L, KORC M, et al. Cancer-associated cachexia[J]. Nat Rev Dis Primers,2018,4:17105.
[25] ROBINSON T P, HAMIDI T, COUNTS B, et al. The impact of inflammation and acute phase activation in cancer cachexia[J]. Front Immunol,2023,14:1207746.
[26] SCHAKMAN O, DEHOUX M, BOUCHUARI S, et al. Role of IGF-I and the TNFα/NF-κB pathway in the induction of muscle atrogenes by acute inflammation[J]. Am J Physiol Endocrinol Metab, 2012, 303(6): E729-E739.
[27] JOHNSON D E, O'KEEFE R A, GRANDIS J R. Targeting the IL-6/JAK/STAT3 signalling axis in cancer[J]. Nat Rev Clin Oncol,2018,15(4):234-248.
[28] AGUSTSSON T, RYDéN M, HOFFSTEDT J, et al. Mechanism of increased lipolysis in cancer cachexia[J]. Cancer Res,2007,67(11):5531-5537.
[29] RICH T, INNOMINATO P F, BOERNER J, et al. Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer[J]. Clin Cancer Res,2005,11(5):1757-1764.
[30] SUN Q, VAN DE LISDONK D, FERRER M, et al. Area postrema neurons mediate interleukin-6 function in cancer cachexia[J]. Nat Commun,2024,15(1):4682.
[31] HU Y, LIU L, CHEN Y, et al. Cancer-cell-secreted miR-204-5p induces leptin signalling pathway in white adipose tissue to promote cancer-associated cachexia[J]. Nat Commun,2023,14(1):5179.
[32] CHOPIN L K, SEIM I, WALPOLE C M, et al. The ghrelin axis--does it have an appetite for cancer progression?[J]. Endocr Rev,2012,33(6):849-891.
[33] LAVIANO A, ROSSI FANELLI F, MEGUID M M. Serotonin and cancer anorexia: myths or facts?[J]. J Clin Oncol,2005,23(9):2111-2112.
[34] DAVIS M P, DREICER R, WALSH D, et al. Appetite and cancer-associated anorexia: a review[J]. J Clin Oncol,2004,22(8):1510-1517.
[35] SUZUKI H, ASAKAWA A, AMITANI H, et al. Cancer cachexia--pathophysiology and management[J]. J Gastroenterol,2013,48(5):574-594.
[36] WANG T, CAI G, QIU Y, et al. Structural segregation of gut microbiota between colorectal cancer patients and healthy volunteers[J]. ISME J,2012,6(2):320-329.
[37] XAVIER J B. Ecological management of the microbiota in patients with cancer[J]. Nat Rev Clin Oncol,2025,22(9):627-639.
[38] STALEY C, WEINGARDEN A R, KHORUTS A, et al. Interaction of gut microbiota with bile acid metabolism and its influence on disease states[J]. Appl Microbiol Biotechnol,2017,101(1):47-64.
[39] TILG H, ADOLPH T E, GERNER R R, et al. The intestinal microbiota in colorectal cancer[J]. Cancer Cell,2018,33(6):954-964.
[40] MCSHANE E, FURNESS K, HANNA L, et al. Assessing the impact of an intensive dietitian-led telehealth intervention focusing on nutritional adequacy, symptom control and optional supplemental jejunal feeding, on quality of life in patients with pancreatic cancer: a randomised controlled trial protocol[J]. Nutr J,2025,24(1):54.
[41] PÖTGENS S A, LECOP S, HAVELANGE V, et al. Gut microbiota alterations induced by intensive chemotherapy in acute myeloid leukaemia patients are associated with gut barrier dysfunction and body weight loss[J]. Clin Nutr,2023,42(11):2214-2228.
[42] BOSSI P, ANTONUZZO A, CHERNY N I, et al. Diarrhoea in adult cancer patients: ESMO Clinical Practice Guidelines[J]. Ann Oncol, 2018, 29(Suppl 4): iv126-iv142.
[43] LEUNG E, GLADWISH A P, DAVIDSON M, et al. Quality-of-life outcomes and toxic effects among patients with cancers of the uterus treated with stereotactic pelvic adjuvant radiation therapy: The SPARTACUS phase 1/2 nonrandomized controlled trial[J]. JAMA Oncol,2022,8(6):1-9.
[44] BRUNO G, ZACCARI P, ROCCO G, et al. Proton pump inhibitors and dysbiosis: Current knowledge and aspects to be clarified[J]. World J Gastroenterol,2019,25(22):2706-2719.
[45] FEARON K C. Cancer cachexia and fat-muscle physiology[J]. N Engl J Med,2011,365(6):565-567.
[46] SAYER A A, COOPER R, ARAI H, et al. Sarcopenia[J]. Nat Rev Dis Primers,2024,10(1):68.
[47] CUI Q, LI S, LIU X, et al. MIF-ACKR3 causes irreversible fat loss by impairing adipogenesis in cancer cachexia[J]. Cell Metab,2025,37(4):954-970.e958.
[48] PATEL H J, PATEL B M. TNF-α and cancer cachexia: Molecular insights and clinical implications[J]. Life Sci,2017,170:56-63.
[49] TISDALE M J. Molecular pathways leading to cancer cachexia[J]. Physiology (Bethesda),2005,20:340-348.
[50] BILODEAU P A, COYNE E S, WING S S. The ubiquitin proteasome system in atrophying skeletal muscle: roles and regulation[J]. Am J Physiol Cell Physiol, 2016, 311(3): C392-C403.
[51] RODRIGUEZ J, VERNUS B, CHELH I, et al. Myostatin and the skeletal muscle atrophy and hypertrophy signaling pathways[J]. Cell Mol Life Sci,2014,71(22):4361-4371.
[52] DAS S K, EDER S, SCHAUER S, et al. Adipose triglyceride lipase contributes to cancer-associated cachexia[J]. Science,2011,333(6039):233-238.
[53] ARNER P. Medicine. Lipases in cachexia[J]. Science,2011,333(6039):163-164.
[54] DOLLY A, LECOMTE T, TABCHOURI N, et al. Pectoralis major muscle atrophy is associated with mitochondrial energy wasting in cachectic patients with gastrointestinal cancer[J]. J Cachexia Sarcopenia Muscle,2022,13(3):1837-1849.
[55] AWAD A, ABDUL KARIM N. Dysregulation of mitochondrial function in cancer cells[J]. Int J Mol Sci, 2025, 26(14).
[56] TOTH M J, CALLAHAN D M, MILLER M S, et al. Skeletal muscle fiber size and fiber type distribution in human cancer: Effects of weight loss and relationship to physical function[J]. Clin Nutr,2016,35(6):1359-1365.
[57] LI X, HU C, ZHANG Q, et al. Cancer cachexia statistics in China[J]. Precision Nutrition,2022,1(1):10.
[58] KANG M K, LEE H J. Impact of malnutrition and nutritional support after gastrectomy in patients with gastric cancer[J]. Ann Gastroenterol Surg,2024,8(4):534-552.
[59] KOTWAL A, PERLMAN J E, GOLDNER W S, et al. Endocrine dysfunction from immune checkpoint inhibitors: pearls and pitfalls in evaluation and management[J]. JCO Oncol Pract,2023,19(7):395-402.
[60] ELTING L S, KEEFE D M, SONIS S T, et al. Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life[J]. Cancer,2008,113(10):2704-2713.
[61] VERGAUWEN A, BAUDELET M, VAN DEN STEEN L, et al. Exploratory research: patient-reported factors contributing to decreased oral intake during radiotherapy in head and neck cancer[J]. Head Neck,2025,47(6):1717-1725.
[62] ANANDAVIDELAN P, LAGERGREN P. Cachexia in patients with oesophageal cancer[J]. Nat Rev Clin Oncol,2016,13(3):185-198.
[63] TENDERENDA K, GIERCZAK A, PANCZYK M, et al. Nutritional status as a prognostic factor for survival in palliative care: a retrospective observational analysis of home parenteral nutrition in cancer patients with inoperable malignant bowel obstruction[J]. Nutrients, 2024, 16(11):1569.
[64] SIKKENS E C, CAHEN D L, DE WIT J, et al. A prospective assessment of the natural course of the exocrine pancreatic function in patients with a pancreatic head tumor[J]. J Clin Gastroenterol, 2014, 48(5): e43-e46.
[65] MORRIS-STIFF G. Exocrine pancreatic insufficiency and fat malabsorption related to pancreatectomy and other gastrointestinal surgery: A narrative review[J]. Nutr Clin Pract, 2024, 39(Suppl 1): S35-S45.
[66] AHMADIEH H, SALTI I. Tyrosine kinase inhibitors induced thyroid dysfunction: a review of its incidence, pathophysiology, clinical relevance, and treatment[J]. Biomed Res Int,2013,2013:725410.
[67] SPAIN L, DIEM S, LARKIN J. Management of toxicities of immune checkpoint inhibitors[J]. Cancer Treat Rev,2016,44:51-60.
[68] HERRSTEDT J, CLARK-SNOW R, RUHLMANN C H, et al. 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting[J]. ESMO Open,2024,9(2):102195.
[69] HERSBERGER L, BARGETZI L, BARGETZI A, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial[J]. Clin Nutr,2020,39(9):2720-2729.
[70] CHEUNG H H T, JOYNT G M, LEE A. Diagnostic test accuracy of preoperative nutritional screening tools in adults for malnutrition: a systematic review and network meta-analysis[J]. Int J Surg,2024,110(2):1090-1098.
[71] GE Y Z, FU Z M, ZHANG Q, et al. AIWW: a new nutrition-screening tool for the oncologic population[J]. Sci China Life Sci,2023,66(8):1831-1840.
[72] CEDERHOLM T, JENSEN G L, CORREIA M, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community[J]. J Cachexia Sarcopenia Muscle,2019,10(1):207-217.
[73] SONG M, ZHANG Q, LIU T, et al. Efficacy of Global Leadership Initiative on Malnutrition as potential cachexia screening tool for patients with solid cancer[J]. Nutr J,2022,21(1):73.
[74] HUO Z, CHONG F, YIN L, et al. Comparison of the performance of the GLIM criteria, PG-SGA and mPG-SGA in diagnosing malnutrition and predicting survival among lung cancer patients: A multicenter study[J]. Clin Nutr,2023,42(6):1048-1058.
[75] HAN J, HARRISON L, PATZELT L, et al. Imaging modalities for diagnosis and monitoring of cancer cachexia[J]. EJNMMI Res,2021,11(1):94.
[76] BROWN L R, SOUSA M S, YULE M S, et al. Body weight and composition endpoints in cancer cachexia clinical trials: Systematic Review 4 of the cachexia endpoints series[J]. J Cachexia Sarcopenia Muscle,2024,15(3):816-852.
[77] RINNINELLA E, CINTONI M, RAOUL P, et al. Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis[J]. Clin Nutr,2020,39(7):2045-2045.
[78] WATANABE J, MATSUI R, SASANUMA H, et al. Body composition assessment and sarcopenia in patients with biliary tract cancer: A systematic review and meta-analysis[J]. Clin Nutr,2022,41(2):321-328.
[79] CASEY P, ALASMAR M, MCLAUGHLIN J, et al. The current use of ultrasound to measure skeletal muscle and its ability to predict clinical outcomes: a systematic review[J]. J Cachexia Sarcopenia Muscle,2022,13(5):2298-2309.
[80] FERNÁNDEZ-JIMÉNEZ R, GARCÍA-REY S, ROQUE-CUÉLLAR M C, et al. Ultrasound muscle evaluation for predicting the prognosis of patients with head and neck cancer: a large-scale and multicenter prospective study[J]. Nutrients, 2024, 16(3):387.
[81] FARON A, SPRINKART A M, KUETTING D L R, et al. Body composition analysis using CT and MRI: intra-individual intermodal comparison of muscle mass and myosteatosis[J]. Sci Rep,2020,10(1):11765.
[82] WU W, LIU M, ZENG Q, et al. Research progress on evaluation methods for skeletal muscle mass assessment in sarcopenia (Review)[J]. Oncol Lett,2025,30(3):423.
[83] BRANCO M G, MATEUS C, CAPELAS M L, et al. Bioelectrical impedance analysis (bia) for the assessment of body composition in oncology: a scoping review[J]. Nutrients, 2023, 15(22):4792.
[84] MESSINA C, ALBANO D, GITTO S, et al. Body composition with dual energy X-ray absorptiometry: from basics to new tools[J]. Quant Imaging Med Surg,2020,10(8):1687-1698.
[85] MCDONALD J, SAYERS J, ANKER S D, et al. Physical function endpoints in cancer cachexia clinical trials: Systematic Review 1 of the cachexia endpoints series[J]. J Cachexia Sarcopenia Muscle,2023,14(5):1932-1948.
[86] NIGHTINGALE G, BATTISTI N M L, LOH K P, et al. Perspectives on functional status in older adults with cancer: An interprofessional report from the International Society of Geriatric Oncology (SIOG) nursing and allied health interest group and young SIOG[J]. J Geriatr Oncol,2021,12(4):658-665.
[87] BOBOS P, NAZARI G, LU Z, et al. Measurement properties of the hand grip strength assessment: a systematic review with meta-analysis[J]. Arch Phys Med Rehabil,2020,101(3):553-565.
[88] COBBING S, ALIBHAI S M H, JIN R, et al. Impairments in geriatric assessment and their associations with different grip strength cutoffs and components of the Short Physical Performance Battery among older adults with cancer[J]. J Geriatr Oncol,2025,16(3):102201.
[89] OSAWA Y, CHILES SHAFFER N, SHARDWELL M D, et al. Changes in knee extension peak torque and body composition and their relationship with change in gait speed[J]. J Cachexia Sarcopenia Muscle,2019,10(5):1000-1008.
[90] CULAKOVA E, MOHAMED M, FLANNERY M, et al. Relationships between patient-reported and clinician-rated toxicities and daily functioning in older adults with advanced cancer undergoing systemic therapy[J]. Cancer, 2025, 131(4): e35766.
[91] HENDRIKS S, HUISMAN M G, GHIGNONE F, et al. Timed up and go test and long-term survival in older adults after oncologic surgery[J]. BMC Geriatr,2022,22(1):934.
[92] POOLE-WILSON P A. The 6-minute walk. A simple test with clinical application[J]. Eur Heart J,2000,21(7):507-508.
[93] BARBER A, WILLBANKS A, ABPLANALP K, et al. Six-minute walk test is superior to grip strength as a marker of functional recovery during cancer cachexia rehabilitation[J]. J Cachexia Sarcopenia Muscle, 2025, 16(4): e70024.
[94] STEFFENS D, POCOVI N C, BARTYN J, et al. Feasibility, reliability, and safety of remote five times sit to stand test in patients with gastrointestinal cancer[J]. Cancers (Basel), 2023, 15(9):2434.
[95] YULE M S, THOMPSON J, LEESAHATSAWAT K, et al. Biomarker endpoints in cancer cachexia clinical trials: systematic review 5 of the cachexia endpoint series[J]. J Cachexia Sarcopenia Muscle,2024,15(3):853-867.
[96] GEPPERT J, ROHM M. Cancer cachexia: biomarkers and the influence of age[J]. Mol Oncol,2024,18(9):2070-2086.
[97] PUMTAKO C, DOLAN R D, FALLON M, et al. The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study[J]. Clin Nutr ESPEN,2025,67:344-352.
[98] VAGNILDHAUG O M, HABBERSTAD R H, SALVESEN Ø, et al. A comparison of inflammatory markers' potential to predict weight loss in advanced cancer: a prospective observational study[J]. J Circ Biomark,2025,14:12-20.
[99] THOMPSON J J, MACLEOD N, WILL S, et al. The prognostic value of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin in patients with advanced lung cancer[J]. BMC Cancer,2025,25(1):543.
[100] TRAN S D, FORREST N J, GUGGILLA V, et al. Weight and blood-based markers of cachexia predict disability, hospitalization and worse survival in cancer immunotherapy patients[J]. J Cachexia Sarcopenia Muscle, 2025, 16(1): e13685.
[101] BERGER M M, SHENKIN A, DIZDAR O S, et al. ESPEN practical short micronutrient guideline[J]. Clin Nutr,2024,43(3):825-857.
[102] GROARKE J D, CRAWFORD J, COLLINS S M, et al. Ponsegromab for the treatment of cancer cachexia[J]. N Engl J Med,2024,391(24):2291-2303.
[103] HÜLLWEGEN M, KLEINERT M, VON HAEHLING S, et al. GDF15: from biomarker to target in cancer cachexia[J]. Trends Cancer,2025,11(11):1093-1105.
[104] WANG L, CONG M, CUI J, et al. General rules for treating cancer-related malnutrition[J]. Precision Nutrition, 2022, 1(3): e00024.
[105] ZENG S, XUE Y, ZHAO J, et al. Total parenteral nutrition versus early enteral nutrition after cystectomy: a meta-analysis of postoperative outcomes[J]. Int Urol Nephrol,2019,51(1):1-7.
[106] MAZAKI T, EBISAWA K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature[J]. J Gastrointest Surg,2008,12(4):739-755.
[107] WEIMANN A, BEZMAREVIC M, BRAGA M, et al. ESPEN guideline on clinical nutrition in surgery - Update 2025[J]. Clin Nutr,2025,53:222-261.
[108] ORSSO C E, CARETERO A, POLTRONIERI T S, et al. Effects of high-protein supplementation during cancer therapy: a systematic review and meta-analysis[J]. Am J Clin Nutr,2024,120(6):1311-1324.
[109] BETTIGA A, FIORIO F, LIGUORI F, et al. The impact of a mediterranean-like diet with controlled protein intake on the onco-nephrological scenario: time for a new perspective[J]. Nutrients, 2022, 14(23):5193.
[110] HABIBI S, TALEBI S, KHOSRAVINIA D, et al. Oral nutritional supplementation in cancer patients: A systematic review and dose-response meta-analysis[J]. Clin Nutr,2025,47:28-39.
[111] WANG Y, LIU R, CHANG M, et al. Does omega-3 PUFA-enriched oral nutritional intervention benefit cancer patients receiving chemo (radio) therapy? A systematic review and meta-analysis of randomized controlled trials[J]. Crit Rev Food Sci Nutr,2023,63(18):3081-3096.
[112] SA-NGUANSAI S, PINTASIRI P, TIENCHAIANANDA P. Efficacy of oral nutritional supplement in cancer patients receiving chemotherapy: a systematic review and meta-analysis of randomized controlled trials[J]. Ann Palliat Med,2024,13(2):260-272.
[113] MCLUSKIE A, BOWERS M, BAYLY J, et al. Nutritional interventions in randomised clinical trials for people with incurable solid cancer: A systematic review[J]. Clin Nutr,2025,44:201-219.
[114] AVANCINI A, BORSATI A, TONIOLO L, et al. Physical activity guidelines in oncology: A systematic review of the current recommendations[J]. Crit Rev Oncol Hematol,2025,210:104718.
[115] CAMPBELL K L, WINTERS-STONE K M, WISKEMANN J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable[J]. Med Sci Sports Exerc,2019,51(11):2375-2390.
[116] PEYRACHON R, LIÈVRE A, RÉBILLARD A. The role of aerobic and resistance exercise for cancer cachexia management - a systematic scoping review[J]. Asia Pac J Oncol Nurs,2025,12:100748.
[117] KEMPIN S, BUCHNER A, BROSE S F, et al. The effect of resistance and/or aerobic training on quality of life, fitness, and body composition in prostate cancer patients-a systematic review and meta-analysis[J]. Cancers (Basel), 2024, 16(24):4286.
[118] KANG D W, DAWSON J K, BARNES O, et al. Resistance exercise and skeletal muscle-related outcomes in patients with cancer: a systematic review[J]. Med Sci Sports Exerc,2024,56(9):1747-1758.
[119] MURRAY J, BENNETT H, SELVA-NAYAGAM S, et al. Impact of aerobic training on cardiovascular function, fitness, and patient reported outcomes during anthracycline chemotherapy: a case series in women with breast cancer[J]. Integr Cancer Ther,2023,22:15347354231210874.
[120] MKITIE A A, ALABI R O, ORELL H, et al. Managing cachexia in head and neck cancer: a systematic scoping review[J]. Adv Ther,2022,39(4):1502-1523.
[121] GLOVER E I, PHILLIPS S M. Resistance exercise and appropriate nutrition to counteract muscle wasting and promote muscle hypertrophy[J]. Curr Opin Clin Nutr Metab Care,2010,13(6):630-634.
[122] ANTOUN S, RAYNARD B. Muscle protein anabolism in advanced cancer patients: response to protein and amino acids support, and to physical activity[J]. Ann Oncol, 2018, 29(Suppl 2): ii10-ii17.
[123] CORMIE P, NEWTON R U, SPRY N, et al. Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases[J]. Prostate Cancer Prostatic Dis,2013,16(4):328-335.
[124] SHEILL G, GUINAN E M, PEAT N, et al. Considerations for exercise prescription in patients with bone metastases: a comprehensive narrative review[J]. PM R,2018,10(8):843-864.
[125] SPENCE R R, HEECH K C, BROWN W J. Exercise and cancer rehabilitation: a systematic review[J]. Cancer Treat Rev,2010,36(2):185-194.
[126] HUSSEY C, HANBRIDGE M, DOWLING M, et al. Cancer survivorship: understanding the patients' journey and perspectives on post-treatment needs[J]. BMC Sports Sci Med Rehabil,2024,16(1):82.
[127] ROELAND E J, BOHLKE K, BARACOS V E, et al. Management of cancer cachexia: ASCO Guideline[J]. J Clin Oncol,2020,38(21):2438-2453.
[128] YAVUZSEN T, DAVIS M P, WALSH D, et al. Systematic review of the treatment of cancer-associated anorexia and weight loss[J]. J Clin Oncol,2005,23(33):8500-8511.
[129] RUIZ GARCIA V, LóPEZ-BRIZ E, CARBONELL SANCHIS R, et al. Megestrol acetate for treatment of anorexia-cachexia syndrome[J]. Cochrane Database Syst Rev, 2013(3): CD004310.
[130] REID J, HUGHES C M, MURRAY L J, et al. Non-steroidal anti-inflammatory drugs for the treatment of cancer cachexia: a systematic review[J]. Palliat Med,2013,27(4):295-303.
[131] BERGER M M, SHENKIN A, SCHWEINLIN A, et al. ESPEN micronutrient guideline[J]. Clin Nutr,2022,41(6):1357-1424.
[132] ZHU W, LIU C, YAO K, et al. Micronutrient deficiency detected by liquid chromatography-tandem mass spectrometry and its association with clinical outcome of cancer patients-a prospective cohort study[J]. BMC Med,2025,23(1):539.
[133] BLAND K A, HARRISON M, ZOPF E M, et al. Quality of life and symptom burden improve in patients attending a multidisciplinary clinical service for cancer cachexia: a retrospective observational review[J]. J Pain Symptom Manage, 2021, 62(3): e164-e176.
[134] REID J, BLAIR C, DEMPSTER M, et al. Multimodal interventions for cachexia management[J]. Cochrane Database Syst Rev, 2025(3): CD015749.
[135] BOWERS M, PETRASSO C, MCLUSKIE A, et al. Multicomponent interventions for adults with cancer cachexia: a systematic review[J]. J Cachexia Sarcopenia Muscle, 2025, 16(2): e13716.
[136] GAUTAM P, SHANKAR A. Management of cancer cachexia towards optimizing care delivery and patient outcomes[J]. Asia Pac J Oncol Nurs,2023,10(Suppl 1):100322.
[137] ZHAO Y, PANG D, LU Y. The role of nurse in the multidisciplinary management of cancer cachexia[J]. Asia Pac J Oncol Nurs,2021,8(5):487-497.
[138] SÁNCHEZ-TORRALVO F J, CONTRERAS-BOLÍVAR V, RUIZ-VICO M, et al. Relationship between malnutrition and the presence of symptoms of anxiety and depression in hospitalized cancer patients[J]. Support Care Cancer,2022,30(2):1607-1613.
[139] ZION S R, TAUB C J, HEATHCOTE L C, et al. Effects of a cognitive behavioral digital therapeutic on anxiety and depression symptoms in patients with cancer: a randomized controlled trial[J]. JCO Oncol Pract,2023,19(12):1179-1189.
[140] MA Z, SHI Y, YAO S, et al. Effectiveness of telemedicine-based psychosocial intervention for breast cancer patients: a systematic review and meta-analysis[J]. Support Care Cancer,2023,31(10):595.
[141] BOWERS M, HIGGINSON I J, MADDOCKS M. Patient and carer experiences of cancer cachexia and its management[J]. Curr Opin Support Palliat Care,2024,18(3):132-137.
[142] CHOW R, DRKULEC H, IM J H B, et al. The use of wearable devices in oncology patients: a systematic review[J]. Oncologist, 2024, 29(4): e419-e430.
[143] CHUNG K C W, TAKEMURA N, LAM W W T, et al. Efficacy of mobile app-based dietary interventions among cancer survivors: systematic review and meta-analysis[J]. JMIR mHealth uHealth, 2025, 13: e65505.
[144] HALL C C, SKIPWORTH R J E, BLACKWOOD H, et al. A randomized, feasibility trial of an exercise and nutrition-based rehabilitation programme (ENeRgy) in people with cancer[J]. J Cachexia Sarcopenia Muscle,2021,12(6):2034-2044.