2020-12-05 がんの発症前の歩行速度低下 JAMA Netw Open . 2020 May 1;3(5):e204783. doi: 10.1001/jamanetworkopen.2020.4783. Assessment of Sarcopenia Measures, Survival, and Disability in Older Adults Before and After Diagnosis With Cancer Grant R Williams 1, Yanjun Chen 1, Kelly M Kenzik 1, Andrew McDonald 1, Shlomit S Shachar 2 3, Heidi D Klepin 4, Stephen Kritchevsky 4, Smita Bhatia 1 70-79歳の地域住民3075名(男性1491名・平均年齢74.1±2.9歳)が対象で17年追跡 年に1度、四肢の除脂肪量(ALM)・握力・歩行速度を測定し、 がんの発症者(515名)の診断前と診断後の減少率を、がん未発症者(1030名と比較。 対象者の背景； Table 1. Patient Characteristicsa Characteristic No. (%) Total sample (N = 3075) Patients with cancer (n = 515) Matched controls (n = 1030) Age, mean (SD), ya 74.1 (2.9) 74.4 (2.9) 74.4 (2.9) Male 1491 (48.5) 323 (62.7) 646 (62.7) Race White 1794 (58.3) 279 (54.2) 565 (54.9) Black 1281 (41.7) 236 (45.8) 465 (45.2) Site Pittsburgh, Pennsylvania 1548 (50.3) 264 (51.7) 507 (49.2) Memphis, Tennessee 1527 (49.7) 251 (48.7) 523 (50.8) Incident cancer site of origin Prostate NA 117 (23.2) NA Colorectal NA 63 (12.5) NA Lung NA 61 (12.1) NA Breast NA 61 (12.1) NA Other NA 213 (42.2) NA Cancer stage Limited NA 293 (56.9) NA Metastatic NA 165 (32.0) NA Unknown NA 57 (11.1) NA Abbreviation: NA, not applicable. aVariables presented are baseline values at enrollment in the study. がんの種類； 前立腺がん：23.2% 大腸がん：12.5% 肺がん：12.1% 乳がん：12.1% 32.0%はがんの転移も認められた。 発症者と未発症者の比較； 診断前の減少率は、歩行速度が低下、ALMや握力は差はなし。 診断後の減少率は、ALMが低下、握力と歩行速度に差はなし。 歩行速度が遅いと死亡率が44％増加(HR：1.44、95%CI1.05-1.98) Table 3. Difference in Sarcopenia Indices Between the Participants With Cancer and Matched Controls Without Cancer Before and After Cancer Diagnosisa Index Appendicular lean mass Hand grip strength Gait speed Estimate, β (95% CI) P value Estimate, β (95% CI) P value Estimate, β (95% CI) P value All cancer vs none Before diagnosis −0.02 (−0.07 to 0.04) .49 −0.21 (−0.43 to 0) .05 −0.02 (−0.03 to −0.01) <.001 After diagnosis −0.14 (−0.23 to −0.05) <.001 −0.02 (−0.37 to 0.33) .92 0 (−0.01 to 0.02) .51 Prostate cancer vs none Before diagnosis 0.03 (−0.09 to 0.16) .60 −0.58 (−1.09 to −0.06) .03 −0.02 (−0.04 to −0.01) .002 After diagnosis −0.12 (−0.27 to 0.03) .13 0.07 (−0.57 to 0.71) .83 0 (−0.02 to 0.02) .87 Colorectal vs none Before diagnosis −0.09 (−0.23 to 0.06) .25 −0.65 (−1.24 to −0.05) .03 −0.01 (−0.03 to 0.01) .50 After diagnosis −0.15 (−0.40 to 0.09) .22 −0.06 (−1.08 to 0.95) .90 0.01 (−0.03 to 0.05) .63 Lung cancer vs none Before diagnosis 0 (−0.16 to 0.16) .99 −0.46 (−1.07 to 0.15) .14 −0.02 (−0.04 to 0) .04 After diagnosis −0.23 (−0.65 to 0.20) .30 −0.30 (−2.02 to 1.42) .73 0.03 (−0.03 to 0.08) .33 Breast cancer vs none Before diagnosis −0.01 (−0.14 to 0.11) .82 0.07 (−0.35 to 0.48) .75 −0.02 (−0.04 to 0) .06 After diagnosis −0.11 (−0.31 to 0.09) .27 −0.02 (−0.72 to 0.68) .96 0.01 (−0.02 to 0.04) .49 Other cancer vs none Before diagnosis −0.04 (−0.13 to 0.04) .28 0.10 (−0.21 to 0.42) .51 −0.03 (−0.04 to −0.01) <.001 After diagnosis −0.12 (−0.27 to 0.02) .10 −0.08 (−0.67 to 0.50) .78 0 (−0.02 to 0.02) .85 Metastatic vs none Before diagnosis −0.05 (−0.14 to 0.04) .30 −0.39 (−0.76 to −0.02) .04 −0.03 (−0.04 to −0.02) <.001 After diagnosis −0.32 (−0.53 to −0.10) .003 −0.39 (−1.24 to 0.46) .37 0.01 (−0.02 to 0.04) .44 急に歩行速度が低下しだしたら、がんを発症しているかもしれません。 もちろんそれ以外のこともありますが、精査を促すきっかけにはなるかもしれません。 死亡率とは関連しないようですが、ALMや握力が、診断後は低下するようです。 食事や運動の仕方を考える必要があるかもしれません。
