癌因性厌食诊疗中国专家共识

摘要/Abstract

摘要：

癌因性厌食是指因肿瘤本身和（或）其治疗所引发的食欲减退或丧失，其症状包括厌食、恶心、味觉改变、早饱或吞咽困难等，不仅影响患者的营养状态，还与生存期缩短、抗肿瘤治疗依从性降低、治疗相关不良反应增加、生命质量下降等多种严重不良事件紧密相关。癌因性厌食在肿瘤患者中普遍存在，在防治方面存在紧迫性，但医患对其认识和管理有待进一步深化和完善。因此，中国临床肿瘤学会肿瘤支持和康复专家委员会邀请我国相关领域专家，结合中国临床实践现状并基于现有的研究证据，总结了癌因性厌食的筛查和诊断标准，系统性地提出了综合管理策略。本共识将成为临床医生诊疗癌因性厌食的重要参考，可更好地规范癌因性厌食诊疗措施，做到积极筛查、早期干预和规范治疗，使更多患者获益。

关键词:厌食,诊断,治疗,综合管理,专家共识

Abstract:

Cancer-related anorexia refers to the loss or reduction of appetite caused by cancer itself and/or anticancer treatments. This condition encompasses a spectrum of symptoms， including anorexia， nausea， gustatory alteration， early satiety or dysphagia，etc. Cancer-related anorexia not only affects the nutritional status of patients， but is also closely associated with severe adverse outcomes， such as reduced survival， decreased compliance with anti-tumor treatment， increased treatment-related side effects， and diminished quality of life. Despite its widespread prevalence among patients and the urgency of its prevention and treatment， the understanding and management of both doctors and patients need to be further deepened and improved. Recognizing these challenges， Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee convened a panel of experts across relevant fields in China to summarize the screening and diagnosis criteria of cancer-related anorexia based on the current status of clinical practice and the existing research evidence， and to systematically propose a comprehensive management strategy. This consensus will become an important reference for clinicians in the diagnosis and treatment of cancer-related anorexia， which can better standardize the diagnosis and treatment measures for cancer-related anorexia， achieve active screening， early intervention and standardized treatment， so as to benefit more patients.

Key words:Anorexia,Diagnosis,Therapy,Comprehensive management,Expert consensus

中国临床肿瘤学会肿瘤支持与康复治疗专家委员会, 癌因性厌食诊疗中国专家共识工作组. 癌因性厌食诊疗中国专家共识[J]. 国际肿瘤学杂志, 2025, 52(2): 67-78.

Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee, Chinese Expert Consensus Working Group on Cancer-related Anorexia . Chinese expert consensus on the diagnosis and treatment of cancer-related anorexia[J]. Journal of International Oncology, 2025, 52(2): 67-78.

图/表13

图1

类别	水平	来源	专家共识度
1A	高	严谨的Meta分析、大型随机对照研究	一致共识（支持意见≥80%）
1B	高	严谨的Meta分析、大型随机对照研究	基本一致共识，争议小（支持意见60%~80%）
2A	稍低	一般质量的Meta分析、小型随机对照研究、设计良好的大型回顾性研究、病例对照研究	一致共识（支持意见≥80%）
2B	稍低	一般质量的Meta分析、小型随机对照研究、设计良好的大型回顾性研究、病例对照研究	基本一致共识，争议小（支持意见60%~80%）
3	低	非对照的单臂临床研究、病例报道、专家观点	无共识，且争议大（支持意见<60%）

表1

推荐等级	推荐标准
Ⅰ级推荐	1A类证据和部分2A类证据将1A类证据，以及部分专家共识度高且在中国可及性好的2A类证据作为Ⅰ级推荐
Ⅱ级推荐	1B 类证据和部分2A类证据将1B类证据，以及部分在中国可及性欠佳，但专家共识度较高的2A类证据，作为Ⅱ级推荐
Ⅲ级推荐	2B类证据和3类证据对于某些临床上习惯使用，或有探索价值的诊治措施，虽然循证医学证据相对不足，但专家组意见认为可以接受的，作为Ⅲ级推荐

表2

图2

图3

表3

厌食及恶病质功能评价量表"

在过去7天内出现的状况	没有	很少	有时	经常	很多
我的食欲很好	0	1	2	3	4
我摄入的食物量能满足我的需求	0	1	2	3	4
我担心我的体重下降	4	3	2	1	0
我觉得大多数食物味道不好	4	3	2	1	0
我担心自己看起来太瘦	4	3	2	1	0
每当进食时，我的食欲就会下降	4	3	2	1	0
我吃不下高热量或油腻的食物	4	3	2	1	0
我的家人及朋友很想让我吃东西	4	3	2	1	0
我有呕吐的症状	4	3	2	1	0
我吃东西时很快就饱了	4	3	2	1	0
我腹部感到疼痛	4	3	2	1	0
我的健康状况有改善	0	1	2	3	4

表3

评分	能量（kcal）	特征描述
1分	<300	三餐清流质，无肉、缺油
2分	300~<600	三餐半流质，无肉、缺油
3分	600~<900	一餐普食，两餐半流质，基本无肉、少油
4分	900~<1 200	两餐普食，一餐半流质，少肉、少油
5分	1 200~1 500	三餐普食，主食、肉蛋、油脂充足

表4

图4

表5

癌因性厌食治疗推荐等级及证据等级"

干预措施	推荐等级			证据等级
干预措施	Ⅰ级推荐	Ⅱ级推荐	Ⅲ级推荐	证据等级
药物治疗
促食欲药物
甲地孕酮	√			1A类
糖皮质激素		√		1B类
奥氮平		√		2A类
阿那莫林		√		2A类
沙利度胺			√	3类
促胃肠动力药物
甲氧氯普胺或多潘立酮		√		2A类
其他干预措施
营养干预	√			1A类
康复锻炼	√			2A类
心理干预		√		2A类
中医治疗			√	3类

表5

附表1

肿瘤患者食欲症状问卷"

问题	0分	1分	2分	3分	4分
食欲	非常差	差	一般	好	很好
进食时，何时感觉饱	什么也没吃	吃了几口	吃了1/3	吃了1/2	吃完整份
进食前的饥饿感	几乎没有	偶尔	有时	经常	总是
享受食物	几乎没有	偶尔	有时	经常	总是
目前食量	<1餐/d	1餐/d	2餐/d	3餐/d	≥3餐/d
加餐食量	0	1次/d	2次/d	3次/d	≥4次/d
与生病前相比，食物的味道	非常糟糕	糟糕	一般	更好	很好
目前味觉	没有味觉	严重改变	中等改变	轻微改变	没有改变
进食前或进食中恶心感	总是	经常	有时	偶尔	几乎没有
大多时候的心情	非常悲伤	悲伤	既不悲伤也不快乐	快乐	非常快乐
大多时候的精力	非常差	差	中等	好	很好
大多时候的疼痛	非常严重	严重	中等	轻微	非常轻微或几乎没有

附表1

附图1

不良反应	条目
味觉障碍	无法分辨咸味的敏感程度
	无法分辨咸、甜、酸这类味道的浓淡
	无法分辨咸、甜、酸这类简单味道
	尝出的味道不同于预期
	所有的食物都没有味道
	口腔内没有食物时也有苦味
口腔干燥	感觉口干
	口腔内有黏着感
	口腔内有发霉的感觉
	口腔内有龟裂的感觉
口腔黏膜炎	舌头和口腔黏膜有烧灼感
	食物进入口腔时有刺痛感
	口腔和口腔黏膜有持续刺痛感
	感觉疼痛且缺乏活动能力

附表2

附表3

癌因性厌食-恶病质核心在研项目"

靶点	药品名称	作用机制	研发机构	全球研发阶段	注册号
MC4R	PF-07258669	MC4R拮抗剂	Pfizer；Nxera Pharma	Ⅰ期临床	NCT06706869
	TCMCB07		Endevica	Ⅰ期临床	NCT05529849
	WO2024104452A1		长春金赛药业有限责任公司	临床前
GDF15	Ponsegromab	anti-GDF-15单抗	Pfizer	Ⅱ期临床	NCT05546476
	AV-380	anti-GDF-15单抗	AVEO Pharmaceuticals	Ⅰ期临床	NCT05865535
NPY5R；GHSR	WO2024003381	NPY5R激动剂；GHSR激动剂	Pephexia Therapeutics	临床前
GHSR	STC008	GHSR激动剂	北京阳光诺和药物研究股份有限公司	申报临床
	HM03		Helsinn Healthcare	临床前
	RQ-00433412		RaQualia Pharma	临床前
	STS002		北京阳光诺和药物研究股份有限公司	临床前
	STS004		北京阳光诺和药物研究股份有限公司	临床前

附表3

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