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Zhou J, Luo L, Xie L, Hu S, Tan L, Lei X, Luo X, Yang M. Sarcopenic obesity by the ESPEN/EASO criteria for predicting mortality in advanced non-small cell lung cancer. Clin Nutr 2023; 42:817-824. [PMID: 37084468 DOI: 10.1016/j.clnu.2023.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recently released the first international consensus on the diagnostic criteria for sarcopenic obesity (SO), which recommended skeletal muscle mass adjusted for body weight (SMM/W) to determine low muscle mass. SMM adjusted for body mass index (SMM/BMI) appeared to be better associated with physical performance than SMM/W. Thus, we modified the ESPEN/EASO criteria by using SMM/BMI. We aimed (1) to evaluate the agreement of the ESPEN/EASO-defined SO (SOESPEN) and the modified ESPEN/EASO-defined SO (SOESPEN-M) with other commonly used SO definitions, and (2) to compare different SO definitions for predicting mortality in a prospective cohort with advanced non-small cell lung cancer (NSCLC). METHODS This prospective study included patients with advanced NSCLC. We defined SO according to five different diagnostic criteria: SOESPEN, SOESPEN-M, Asian Working Group for Sarcopenia (AWGS)-determined sarcopenia with BMI-determined obesity (SOAWGS), computed tomography-derived sarcopenia with BMI-determined obesity (SOCT), and fat mass to fat-free mass ratio >0.8 (SOFM). The outcome was all-cause mortality. RESULTS Of the 639 participants (mean age 58.6 years, 229 women) we studied, 488 (76.4%) died during the median follow-up period of 25 months. SMM/BMI was significantly lower in the death group than in the survivor group (men: p = 0.001, women: p < 0.001), but SMM/W was not. Only 3 (0.47%) participants met all five SO diagnostic criteria. SOESPEN showed an excellent agreement with SOESPEN-M (Cohen's kappa = 0.896), a moderate agreement with SOAWGS (Cohen's kappa = 0.415), but poor agreements with SOCT and SOFM (Cohen's kappa = 0.078 and 0.092, respectively). After full adjustment for potential confounders, SOESPEN (HR 1.54, 95% CI 1.26-1.89), SOESPEN-M (HR 1.56, 95% CI 1.26-1.92), and SOAWGS (HR 1.43, 95% CI 1.14-1.78) were significantly associated with mortality. However, SOCT (HR 1.17, 95% CI 0.87-1.58) and SOFM (HR 1.15, 95% CI 0.90-1.46) showed no significant association with mortality. CONCLUSIONS SOESPEN showed an excellent agreement with SOESPEN-M, a moderate agreement with SOAWGS, but poor agreements with SOCT and SOFM. SOESPEN, SOESPEN-M, and SOAWGS were independent prognostic factors for mortality in our study population, but SOCT and SOFM were not. Although SMM/BMI was better associated with survival than SMM/W, SOESPEN-M did not show an advantage in predicting survival over SOESPEN.
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Affiliation(s)
- Jinqiu Zhou
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Li Luo
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Lingling Xie
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China; Department of Oncology, Shangjin Nanfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Song Hu
- Department of Radiology, Shangjin Nanfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingling Tan
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Xiaozhen Lei
- Department of Oncology, Shangjin Nanfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaozhen Luo
- Department of Oncology, Shangjin Nanfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China; Precision Medicine Research Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China; National Clinical Research Center for Geriatric Diseases at West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China.
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Ueshima J, Maeda K, Shimizu A, Nagano A, Ishida Y, Takeuchi T, Nonogaki T, Matsuyama R, Yamanaka Y, Murotani K, Mori N. Cachexia staging score predicts survival in patients with cancer who receive palliative care. Nutrition 2023; 106:111880. [PMID: 36436335 DOI: 10.1016/j.nut.2022.111880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to validate the cachexia staging score (CSS), a multidimensional, item-based diagnostic method of cachexia severity, for patients with advanced cancer receiving palliative care. METHODS Eligible patients were those with cancer who received palliative care during hospitalization between May 2019 and April 2020. All data were collected retrospectively from medical records. Cachexia was graded into four levels according to the CSS. Kaplan-Meier curves were constructed with or without death as the outcome, comparing prognoses among different levels of cachexia with Bonferroni correction. Cox proportional hazards regression analysis was performed to identify factors affecting mortality. RESULTS The mean age of the 196 patients was 65.8 ± 14 y. Men made up 42% of the study population. Lower body mass index, increased rate of weight loss, increased strength, assistance walking, rising from a chair, climbing stairs, and falls (SARC-F) points, decline in activities of daily living, appetite loss, and abnormal blood biomarkers were significantly more common with increasing severity of cachexia, and survival was shorter (P < 0.001). The hazard ratio (HR) increased with worsening severity of cachexia according to CSS classification (precachexia: HR, 2.78; 95% confidence interval [CI], 0.62-12.46, P = 0.182; cachexia: HR, 4.77; 95% CI, 1.09-20.80; P = 0.038; and refractory cachexia: HR, 11.00; 95% CI, 2.37-51.07; P = 0.002). CONCLUSIONS The CSS predicted life expectancy in a population of patients receiving palliative care and had excellent prognostic discriminative power to classify patients at different stages of cachexia.
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Affiliation(s)
- Junko Ueshima
- Department of Nutrition Service, NTT Medical Center Tokyo, Tokyo, Japan; Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan
| | - Keisuke Maeda
- Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan.
| | - Akio Shimizu
- Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan; Department of Health Science, Faculty of Health and Human Development, University of Nagano, Nagano, Japan
| | - Ayano Nagano
- Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan; Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Hyogo, Japan
| | - Yuria Ishida
- Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan; Department of Nutrition, Aichi Medical University Hospital, Aichi, Japan
| | - Tomoko Takeuchi
- Department of Nutrition, Aichi Medical University Hospital, Aichi, Japan
| | - Tomoyuki Nonogaki
- Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan; Department of Pharmacy, Aichi Medical University Hospital, Aichi, Japan
| | - Remi Matsuyama
- Department of Dentistry and Oral Surgery, Aichi Medical University, Aichi, Japan
| | - Yosuke Yamanaka
- Department of Dentistry and Oral Surgery, Aichi Medical University, Aichi, Japan
| | | | - Naoharu Mori
- Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan
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Mori N, Maeda K, Fukami Y, Matsuyama R, Nonogaki T, Kato R, Ishida Y, Shimizu A, Ueshima J, Nagano A. High SARC-F score predicts poor survival of patients with cancer receiving palliative care. Support Care Cancer 2022; 30:4065-4072. [PMID: 35064824 DOI: 10.1007/s00520-022-06845-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/18/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE A high score determined by SARC-F, a simple screening questionnaire for sarcopenia, has been reportedly associated with worse medical outcomes. However, information regarding whether high SARC-F scores are associated with a poor prognosis in patients with advanced cancer remains limited. We clarified whether a SARC-F score ≥ 4 predicts poor prognosis in patients with cancer receiving palliative care. METHODS We conducted a retrospective cohort study of patients with cancer who received palliative care at a university hospital between May 2019 and April 2020. Patient characteristics including age, sex, height, weight, cancer type, serum albumin level, C-reactive protein level, presence of edema, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), SARC-F score, history of anticancer therapy, and clinical outcomes were collected from electronic medical records. RESULTS Of 304 patients, 188 had a SARC-F score < 4, and 116 patients had a SARC-F score ≥ 4. The overall survival of patients with a SARC-F score ≥ 4 was 40 days (95% CI 29-47), which was significantly worse than 121 days (95% CI 95-156) for patients with a SARC-F score < 4 (p < 0.001). SARC-F score ≥ 4 (hazard ratio: HR 1.56), edema (HR 1.94), head and neck cancer (HR 0.51), C-reactive protein (HR 1.05), ECOG-PS ≥ 3 (HR 1.47), and radiotherapy (HR 0.52) were associated with overall survival. The ability to climb stairs was a SARC-F sub-item significantly associated with mortality (HR 1.59). CONCLUSION The SARC-F questionnaire is a useful predictor of prognosis for patients with cancer receiving palliative care because a SARC-F ≥ 4 score predicts worse overall survival.
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Affiliation(s)
- Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Yasuyuki Fukami
- Department of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tomoyuki Nonogaki
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Ryoko Kato
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Clinical Nutrition and Food Services, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Ayano Nagano
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
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Olaechea S, Gannavarapu BS, Gilmore A, Alvarez C, Iyengar P, Infante R. The influence of tumour fluorodeoxyglucose avidity and cachexia development on patient survival in oesophageal or gastroesophageal junction cancer. JCSM CLINICAL REPORTS 2021; 6:128-136. [DOI: 10.1002/crt2.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Santiago Olaechea
- Center for Human Nutrition UT Southwestern Medical Center Dallas TX 75390 USA
| | | | - Anne Gilmore
- Center for Human Nutrition UT Southwestern Medical Center Dallas TX 75390 USA
| | - Christian Alvarez
- Center for Human Nutrition UT Southwestern Medical Center Dallas TX 75390 USA
| | - Puneeth Iyengar
- Center for Human Nutrition UT Southwestern Medical Center Dallas TX 75390 USA
- Department of Radiation Oncology UT Southwestern Medical Center Dallas TX USA
| | - Rodney Infante
- Center for Human Nutrition UT Southwestern Medical Center Dallas TX 75390 USA
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