乳がん化学療法を受ける患者のレジメン別にみた体重増加への影響要因

Weight Gain Patterns and Factors Associated with the Regimen Type for Breast Cancer Patients Receiving Chemotherapy

要旨

　【目的】本研究は，乳がんで化学療法を受けた患者の治療後体重増加に関して，レジメン別にみた影響要因の相違を明らかにすることを目的とした．

　【方法】FEC療法，TC療法，DOC療法，およびPTX療法の各レジメンで治療を受けた乳がん患者93名を対象とした．治療前後に体成分分析装置により測定した体脂肪量，体脂肪率および体水分量と，診療記録から収集した個人特性，体重，BMI，および血液検査結果をデータとして用い，統計的に分析した．

　【結果】FEC群とPTX群においては，治療前後の体重に有意な差はなかったが，体重増加率と体脂肪量の増加率についてはFEC群（ρ＝0.787，p＜.000），DOC群（ρ＝.722，p＝.004）ともに有意な相関が認められた．治療後の血清総コレステロールはFEC群のみで有意な上昇がみられた（z＝−4.202，p＜.000）．TC群では，治療後の体重は治療前と比較して2.30kg（z＝−3.074，p＝.002），DOC群では3.25kg（z＝−2.945，p＝.003）の有意な増加が認められた．TC群では治療後に細胞外水分量の有意な増加（z＝−3.152，p＝.002）と血清総タンパクの有意な低下（z＝−3.728，p＜.000）が，DOC群でも細胞外水分量の有意な増加（z＝−2.746，p＝.006）と血清総タンパクの有意な低下（z＝−2.242，p＝.025）がみられた．この両群の体重増加率は3〜4％であり，細胞外水分の増加率は5〜6％であった．

　【結論】FEC療法を受けた患者ではsarcopenic obesityが疑われる体脂肪の蓄積が，TC療法とDOC療法を受けた患者についてはfluid retention syndromeが起こりやすい特徴があると考えられた．これらの特徴に応じ，レジメン別に異なるアプローチの必要性が示唆された．

Abstract

　PURPOSE: Weight gain is a remarkable side effect of chemotherapy for breast cancer patients. This study aimed to identify weight gain patterns and factors among women receiving several major types of chemotherapy regimen.

　PATIENTS AND METHODS: Data were collected on 93 Japanese women receiving chemotherapy with FEC, TC, DOC or PTX for breast cancer. We prospectively evaluated weight, body mass index(BMI), body composition, serum protein and serum cholesterol before(baseline)and after treatment(post-treatment).

　RESULTS: There was no significant change in weight/BMI from baseline to the post-treatment in either the FEC group or the PTX group. The rate of weight increase correlated significantly with the body fat mass in both the FEC group(p＜0.000)and DOC group(p=0.004). Participants in the FEC group only showed a significant increase in serum cholesterol after treatment(p＜0.000). The median change in weight was＋2.30 kg in the TC group(p=0.002)and＋3.25 kg in the DOC group (p=0.003). There was a significant increase in extracellular water(p=0.002)and a decrease in serum protein(p ＜0.000)in the TC group, similar to those seen in the DOC group(p=0.006/p= 0.025). The mean increase rates were 3.4% for body weight and 5.6% for extracellular water.

　CONCLUSIONS: Although no significant change in weight gain was seen in women receiving the FEC regimen, there would be some possibility of sarcopenic obesity from weight increase associated with body fat mass. The weight gain in patients receiving either the TC or DOC regimen was possibly owing to Docetaxel-induced fluid retention. Therefore, weight management during chemotherapy for breast cancer patients would be expected according to the features associated with the regimen type.