1
|
Xie H, Wei L, Ruan G, Zhang H, Shi J, Lin S, Liu C, Liu X, Zheng X, Chen Y, Shi H. Performance of anthropometry-based and bio-electrical impedance-based muscle-mass indicators in the Global Leadership Initiative on Malnutrition criteria for predicting prognosis in patients with cancer. Clin Nutr 2024; 43:1791-1799. [PMID: 38865763 DOI: 10.1016/j.clnu.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Reduced muscle mass is a criterion for diagnosing malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria; however, the choice of muscle-mass indicators within the GLIM criteria remains contentious. This study aimed to establish muscle-measurement-based GLIM criteria using data from bio-electrical impedance analysis (BIA) and anthropometric evaluations and evaluate their ability to predict overall survival (OS), short-term outcomes, and healthcare burden in patients with cancer. METHODS This was a multicenter, prospective study that commenced in 2013 and enrolled participants from various clinical centers across China. We constructed GLIM criteria based on various muscle measurements, including fat-free mass index (FFMI), skeletal muscle index (SMI), calf circumference (CC), midarm circumference (MAC), midarm muscle circumference (MAMC), and midarm muscle area (MAMA). Survival was estimated using the Kaplan-Meier method and survival curves were compared using the log-rank test. Cox proportional hazards regression was used to assess the independent association between the GLIM criteria and OS. The discriminatory performance of different muscle-measurement-based GLIM criteria for mortality was evaluated using Harrell's concordance index (C-index). Logistic regression was used to evaluate the association of the GLIM criteria with short-term outcomes and healthcare burden. RESULTS A total of 4769 patients were included in the analysis, of whom 1659 (34.8%) died during the study period. The Kaplan-Meier curves demonstrated that all muscle-measurement-based GLIM criteria significantly predicted survival in patients with cancer (all p < 0.001). The survival rate of malnourished patients was approximately 10% lower than that of non-malnourished patients. Cox proportional hazards regression showed that all the muscle-measurement-based GLIM could independently predict the OS of patients (all p < 0.001). The prognostic discrimination was as follows: MAMC (Chi-square: 79.61) > MAMA (Chi-square: 79.10) > MAC (Chi-square: 64.09) > FFMI (Chi-square: 62.33) > CC (Chi-square: 58.62) > ASMI (Chi-square: 57.29). In comparison to the FFMI-based GLIM criteria, the ASMI-based criteria (-0.002, 95% CI: -0.006 to 0.002, p = 0.334) and CC-based criteria (-0.003, 95% CI: -0.007 to 0.002, p = 0.227) did not exhibit a significant advantage. However, the MAC-based criteria (0.001, 95% CI: -0.003 to 0.004, p = 0.776), MAMA-based criteria (0.004, 95% CI: 0.000-0.007, p = 0.035), and MAMC-based criteria (0.005, 95% CI: 0.000-0.007, p = 0.030) outperformed the FFMI-based GLIM criteria. Logistic regression showed that muscle measurement-based GLIM criteria predicted short-term outcomes and length of hospital stay in patients with cancer. CONCLUSION All muscle measurement-based GLIM criteria can effectively predict OS, short-term outcomes, and healthcare burden in patients with cancer. Anthropometric measurement-based GLIM criteria have potential for clinical application as an alternative to BIA-based measurement.
Collapse
Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Lishuang Wei
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Heyang Zhang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Jinyu Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Shiqi Lin
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Chenan Liu
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Xin Zheng
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Yue Chen
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Hanping Shi
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China; Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
| |
Collapse
|
2
|
Xie H, Jia P, Wei L, Ruan G, Zhang H, Ge Y, Lin S, Song M, Wang Z, Liu C, Shi J, Liu X, Yang M, Zheng X, Chen Y, Zhang X, Shi H. Evaluation and validation of neutrophil to albumin ratio as a promising prognostic marker for all-cause mortality in patients with cancer: a multicenter cohort study. Nutrition 2024; 121:112365. [PMID: 38377700 DOI: 10.1016/j.nut.2024.112365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/31/2023] [Accepted: 01/21/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The practicality and effectiveness of using the prognostic value of the neutrophil-to-albumin ratio (NAR) in evaluating patients with cancer remain unclear, and research is needed to fully understand its potential application in the cancer population. METHODS The Kaplan-Meier method was used for survival analysis, and the log-rank test was employed for comparison. Univariate and multivariate Cox proportional hazards models were used to determine the prognostic biomarkers, and Logistic regression analysis was conducted to investigate the relationship between NAR and 90-day outcomes and cachexia. RESULTS The study included 14 682 patients with cancer, divided into discovery (6592 patients), internal validation (2820 patients), and external validation groups (5270 patients). Patients with high NAR had higher all-cause mortality than those with low NAR in the discovery (50.15% versus 69.29%, P < 0.001), internal validation (54.18% versus 70.91%, P < 0.001), and external validation cohorts (40.60% versus 66.68%, P < 0.001). In the discovery cohort, high NAR was observed to be independently associated with all-cause mortality in patients (HR 1.16, 95% CI 1.12-1.19; P < 0.001). Moreover, we validated the promising prognostic value of NAR as a predictor of survival in patients with cancer through internal validation (HR 1.21, 95% CI 1.16-1.27, P < 0.001) and external validation cohorts (HR 1.27, 95% CI 1.21-1.34, P < 0.001). Additionally, in the subgroup analysis by tumor type, high NAR was identified as a risk factor for most cancers, except for breast cancer. CONCLUSIONS This study showed that NAR is a feasible and promising biomarker for predicting prognosis and cancer cachexia in cancer patients.
Collapse
Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Pingping Jia
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Lishuang Wei
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Heyang Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Shiqi Lin
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Mengmeng Song
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Ziwen Wang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Chenan Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Jinyu Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Ming Yang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xin Zheng
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Yue Chen
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiaowei Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
| |
Collapse
|
3
|
Yang J, Xie H, Wei L, Ruan G, Zhang H, Shi J, Shi H. Phase angle: A robust predictor of malnutrition and poor prognosis in gastrointestinal cancer. Nutrition 2024; 125:112468. [PMID: 38781749 DOI: 10.1016/j.nut.2024.112468] [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: 02/28/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship among phase angle (PA), malnutrition, and prognosis in patients with gastrointestinal cancer. METHODS In total, 870 patients with gastrointestinal cancer were enrolled. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate the association between PA and survival risk. Restricted cubic spline regression was used for flexibility analysis to explore sex-specific associations between PA and survival. Logistic regression was used to assess the relationships among PA, malnutrition, and cachexia. RESULTS Low PA was closely associated with poor physical conditions, diminished quality of life, and malnutrition. Patients with low PA had a significantly worse prognosis than those with high PA (60.6% versus 72.8%; log-rank P < 0.001). PA was suitable for the prognostic assessment of patients with advanced-stage tumors. Regardless of sex, patients with lower PA showed significantly poorer survival rates. Cox proportional hazards models identified PA as an independent predictor of prognosis in patients with gastrointestinal cancer (hazard ratio (HR)=0.534; 95% confidence interval (CI)=0.409-0.696, P < 0.001). Subgroup analysis indicated that a high PA was an independent risk factor affecting the prognoses of patients with esophageal, liver, and intrahepatic bile duct cancers. Interestingly, variations in PA had a more significant prognostic effect on survival in men than in women. The logistic regression model confirmed that PA is a valuable indicator for assessing malnutrition and cachexia in patients with gastrointestinal cancer. Among all body composition indicators, PA demonstrated the highest accuracy for prognostic prediction. CONCLUSIONS PA was identified as a robust predictor of malnutrition and poor prognosis in patients with gastrointestinal cancer.
Collapse
Affiliation(s)
- Jiajun Yang
- Department of Colorectal and Anal Surgery, Huizhou Central People's Hospital, Huizhou, China
| | - Hailun Xie
- Department of Gastrointestinal Gland Surgery, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China; Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Lishuang Wei
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Heyang Zhang
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Jinyu Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
| |
Collapse
|
4
|
Chen L, Chen Y, Wang M, Lai L, Zheng L, Lu H. Ursolic acid alleviates cancer cachexia by inhibiting STAT3 signaling pathways in C2C12 myotube and CT26 tumor-bearing mouse model. Eur J Pharmacol 2024; 969:176429. [PMID: 38423241 DOI: 10.1016/j.ejphar.2024.176429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Cancer cachexia, a multi-organ disorder resulting from tumor and immune system interactions, prominently features muscle wasting and affects the survival of patients with cancer. Ursolic acid (UA) is known for its antioxidant, anti-inflammatory, and anticancer properties. However, its impact on cancer cachexia remains unexplored. This study aimed to assess the efficacy of UA in addressing muscle atrophy and organ dysfunction in cancer cachexia and reveal the mechanisms involved. UA dose-dependently ameliorated C2C12 myotube atrophy. Mechanistically, it inhibited the expression of muscle-specific RING finger containing protein 1 (MURF1) and the phosphorylation of signal transducer and activator of transcription 3 (STAT3), and upregulated the mRNA or protein levels of myogenic differentiation antigen and myogenin in cultured C2C12 myotubes treated with conditioned medium. In vivo, UA protected CT26 tumor-bearing mice against loss of body weight, as well as increased skeletal muscle and epididymal fat without affecting tumor growth. Additionally, UA increased food intake in CT26 tumor-bearing mice. The mRNA expression of tumor necrosis-α and interleukin 6 was significantly downregulated in the intestine, gastrocnemius, and heart tissues following 38 d UA administration. UA treatment reversed the levels of myocardial function indicators, including creatine kinase, creatine kinase-MB, lactate dehydrogenase, car-dial troponin T, and glutathione. Finally, UA treatment significantly inhibited the expression of MURF1, the phosphorylation of nuclear factor kappa-B p65, and STAT3 in the gastrocnemius muscle and heart tissues of cachexic mice. Our findings suggest that UA is a promising natural compound for developing dietary supplements for cancer cachexia therapy owing to its anti-catabolic effects.
Collapse
Affiliation(s)
- Li Chen
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China.
| | - Yan Chen
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Mengxia Wang
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Linglin Lai
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Linbo Zheng
- Department Traditional Chinese Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Huiqin Lu
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| |
Collapse
|
5
|
Zhang X, Huang JX, Tang M, Zhang Q, Deng L, Song CH, Li W, Shi HP, Cong MH. Modified Controlling Nutritional Status (mCONUT) serves as a promising prognostic factor in patients with cancer cachexia. Nutrition 2024; 117:112229. [PMID: 37922740 DOI: 10.1016/j.nut.2023.112229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/03/2023] [Accepted: 09/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Malnutrition and systemic inflammation are considered 2 hallmarks of cancer cachexia. Our study aimed to construct a modified Controlling Nutritional Status by introducing C-reactive protein as an inflammatory parameter and investigate its prognostic value in patients with cancer cachexia. METHODS This multicenter cohort study included 5221 patients with cancer, among whom 1719 were diagnosed with cachexia. Concordance index and receiver operating characteristic curves were used to compare prognostic values between the 2 systems. The primary outcome was overall survival, and comprehensive survival analyses were performed. The secondary outcomes were short-term survival, malnutrition, and quality of life. RESULTS During the median follow-up of 17.47 mo, 813 deaths were recorded. The modified Controlling Nutritional Status was more accurate than Controlling Nutritional Status in predicting survival in patients with cancer cachexia. Patients in the high Controlling Nutritional Status/modified Controlling Nutritional Status group had a significantly shorter overall survival. Multivariate Cox analysis confirmed high Controlling Nutritional Status (hazard ratio = 1.34, 95% CI, 1.13-1.58; P < 0.001) and modified Controlling Nutritional Status (hazard ratio = 1.46; 95% CI, 1.26-1.69; P < 0.001) were independent risk factors for survival, adjusting for confounders. In subgroup analyses, a high modified Controlling Nutritional Status score had a significantly negative effect on survival in cachexia patients with upper gastrointestinal and colorectal cancer, especially for advanced-stage (stages III and IV) patients. The risk of short-term mortality and experiencing malnutrition rose to 1.48 and 1.13 times, respectively, in the high modified Controlling Nutritional Status group, as well as that for poorer life quality. CONCLUSION The modified Controlling Nutritional Status group comprehensively reflects nutritional, immune, and inflammatory status and serves as a powerful prognostic scoring system in patients with cancer cachexia.
Collapse
Affiliation(s)
- Xi Zhang
- Department of Comprehensive Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Jia-Xin Huang
- Department of Comprehensive Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Cancer Center of The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Meng Tang
- Department of Comprehensive Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Qi Zhang
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China; Department of Gastrointestinal Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Li Deng
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China; Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chun-Hua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wei Li
- Cancer Center of The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Han-Ping Shi
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China; Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ming-Hua Cong
- Department of Comprehensive Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
6
|
Xie H, Zhang H, Ruan G, Wei L, Ge Y, Lin S, Song M, Wang Z, Liu C, Shi J, Liu X, Yang M, Zheng X, Chen Y, Zhang X, Shi H. Individualized threshold of the involuntary weight loss in prognostic assessment of cancer. J Cachexia Sarcopenia Muscle 2023; 14:2948-2958. [PMID: 37994288 PMCID: PMC10751427 DOI: 10.1002/jcsm.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/04/2023] [Accepted: 10/03/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Involuntary weight loss (WL) is a common symptom in cancer patients and is associated with poor outcomes. However, there is no standardized definition of WL, and it is unclear what magnitude of weight loss should be considered significant for prognostic purposes. This study aimed to determine an individualized threshold for WL that can be used for prognostic assessment in cancer patients. METHODS Univariate and multivariate analyses of overall survival (OS) were performed using Cox proportional hazard models. The Kaplan-Meier method was performed to estimate the survival distribution of different WL levels. Logistic regression analysis was used to determine the relationship between WL and 90-day outcomes. Restricted cubic splines with three knots were used to examine the effects of WL on survival under different body mass index (BMI) conditions. RESULTS Among the 8806 enrolled patients with cancer, median survival time declined as WL increased, from 25.1 to 20.1, 17.8 and 16.4 months at <2%, 2-5%, 5-10% and ≥10% WL, respectively (P < 0.001). Multivariate adjusted Cox regression analysis showed that the risk of adverse prognosis increased by 18.1% based on the SD of WL (5.45 U) (HR: 1.181, 95% CI: 1.144-1.219, P < 0.001). Similarly, categorical WL was independently associated with OS in patients with cancer. With the worsening of WL, the risk of a poor prognosis in patients increases stepwise. Compared with <2% WL, all-cause mortalities were 15.1%, 37% and 64.2% higher in 2-5%, 5-10%, and ≥10% WL, respectively. WL can effectively stratify the prognosis of both overall and site-specific cancers. The clinical prognostic thresholds for WL based on different BMI levels were 4.21% (underweight), 5.03% (normal), 6.33% (overweight), and 7.60% (obese). Multivariate logistic regression analysis showed that WL was independently associated with 90-day outcomes in patients with cancer. Compared with patients with <2% WL, those with ≥10% WL had more than twice the risk of 90-day outcomes (OR: 3.277, 95% CI: 2.287-4.694, P < 0.001). Systemic inflammation was a cause of WL deterioration. WL mediates 6.3-10.3% of the overall association between systemic inflammation and poor prognoses in patients with cancer. CONCLUSIONS An individualized threshold for WL based on baseline BMI can be used for prognostic assessment in cancer patients. WL and BMI should be evaluated simultaneously in treatment decision-making, nutritional intervention, and prognosis discussions of patients with cancer.
Collapse
Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Heyang Zhang
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Lishuang Wei
- Department of Respiratory and Critical Care MedicineBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Shiqi Lin
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Mengmeng Song
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Ziwen Wang
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Chenan Liu
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Jinyu Shi
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Ming Yang
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Xin Zheng
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Yue Chen
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Xiaowei Zhang
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
- Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina
| |
Collapse
|
7
|
Pan X, Zhang G, Wei K, Gu X, Dan J, Zhao Y, Liu X, Cheng C, Zhang X. Carnosol analogue WK-63 alleviated cancer cachexia by inhibiting NF-κB and activating AKT pathways in muscle while inhibiting NF-κB and AMPK pathways in adipocyte. Toxicol Appl Pharmacol 2023; 479:116729. [PMID: 37863360 DOI: 10.1016/j.taap.2023.116729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
Cancer cachexia is a systemic metabolic disorder syndrome characterized by severe wasting of muscle and adipose tissues while is lack of effective therapeutic approaches. Carnosol (CS) was found in our previous study to exhibit ameliorating effects on cancer cachexia. In the present study, we designed and synthesized 49 CS analogues by structural modification of CS. Results of activity screening revealed that, among the analogues, WK-63 exhibited better effects than CS in ameliorating atrophy of C2C12 myotubes induced by conditioned medium of C26 tumor cells. WK-63 could also dose-dependently alleviate adipocyte lipolysis of mature 3 T3-L1 cells induced by C26 tumor cell conditioned medium. WK-63 alleviated myotube atrophy by inhibiting Nuclear Factor kappa-B (NF-κB) and activating the Protein Kinase B (AKT) signaling pathway, and also alleviated fat loss by inhibiting NF-κB and Adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) signaling pathways. Results of pharmacokinetic (PK) assay showed that, compared with other analogues, WK-63 exhibited longer half-life (T1/2) and mean residence time (MRTs), as well as a larger concentration curve area (AUC0-t). These findings suggested that WK-63 might exert optimal effects in vivo. In the C26 tumor-bearing mice model, administration of WK-63 ameliorated the body weight loss and also improved the weight loss of epididymal adipose tissue. WK-63 is expected to be a novel therapeutic option for the treatment of cancer cachexia.
Collapse
Affiliation(s)
- Xiaojuan Pan
- Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, PR China
| | - Gang Zhang
- Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, PR China
| | - Kun Wei
- College of Chemical Engineering, Key Laboratory of Green Chemistry of Sichuan Institutes of Higher Education, Sichuan University of Science & Engineering, Zigong 643000, Sichuan, PR China
| | - Xiaofan Gu
- Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, PR China
| | - Jiahuan Dan
- College of Chemical Engineering, Key Laboratory of Green Chemistry of Sichuan Institutes of Higher Education, Sichuan University of Science & Engineering, Zigong 643000, Sichuan, PR China
| | - Yun Zhao
- Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, PR China
| | - Xuan Liu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201003, China.
| | - Chunru Cheng
- College of Chemical Engineering, Key Laboratory of Green Chemistry of Sichuan Institutes of Higher Education, Sichuan University of Science & Engineering, Zigong 643000, Sichuan, PR China.
| | - Xiongwen Zhang
- Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, PR China.
| |
Collapse
|
8
|
Xie H, Yuan K, Ruan G, Wei L, Zhang H, Ge Y, Lin S, Song M, Wang Z, Liu C, Shi J, Liu X, Yang M, Zheng X, Chen Y, Zhang X, Shi H. Improving the assessment of malnutrition in cancer: Using systemic inflammation markers as a supplement to the inflammation items of the GLIM criteria. Clin Nutr 2023; 42:2036-2044. [PMID: 37672850 DOI: 10.1016/j.clnu.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND & AIMS Systemic inflammation is a key pathogenic criterion for diagnosing malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Although cancer is commonly considered as a chronic inflammation-related disease, the inflammatory burden may vary depending on the type and stage of cancer. Therefore, a more precise definition of inflammation criteria could facilitate the identification of malnutrition in cancer. METHODS This prospective multicenter study included 1683 cancer patients screened via NRS2002 for malnutrition risk. The inflammatory burden index (IBI), C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and albumin (ALB) level were used to assess the inflammatory burden. Kaplan-Meier and Cox regression analyses were used to determine the relationship between the GLIM criteria and overall survival. Harrell's concordance index (C-index) was used to compare the discriminative performance of the original, IBI-based, CRP-based, NLR-based, and ALB-based GLIM criteria for survival. Logistic regression models were used to assess the association between GLIM criteria and short-term outcomes, length of hospital stay, and hospitalization costs. RESULTS Compared to the original GLIM criteria, the IBI/CRP/NLR/ALB-based GLIM criteria better predicted the long-term outcomes of patients with cancer (chi-square: 1.316 vs. 78.321 vs. 74.740 vs. 88.719 vs. 100.921). The C-index revealed that the inflammation marker-based GLIM criteria showed significantly better prognostic accuracy than the original GLIM criteria. The ALB-based GLIM criteria exhibited the best prognostic accuracy. The inflammation marker-based GLIM criteria were independent predictive factors for the long-term prognosis of cancer. Patients with malnutrition had a 45% higher risk of adverse long-term prognoses than those without malnutrition. The inflammation marker-based GLIM criteria had good prognostic ability to predict outcomes at 3, 6, and 12 months. The stepwise effect of the grading of severity via the IBI-based GLIM criteria and CRP-based GLIM criteria was notable. The inflammation marker-based GLIM criteria are useful for predicting short-term outcomes, length of hospitalization, and hospitalization costs. CONCLUSION The inflammation marker-based GLIM criteria have a stronger predictive value than the original GLIM criteria in evaluating both the short- and long-term prognoses of cancer patients. It is recommended to use the inflammation marker-based GLIM criteria for nutritional evaluation of cancer patients.
Collapse
Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Kaitao Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Lishuang Wei
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, China
| | - Heyang Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Shiqi Lin
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Mengmeng Song
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Ziwen Wang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Chenan Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Jinyu Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Ming Yang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xin Zheng
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Yue Chen
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiaowei Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
| |
Collapse
|
9
|
Yoon SL, Grundmann O. Relevance of Dietary Supplement Use in Gastrointestinal-Cancer-Associated Cachexia. Nutrients 2023; 15:3391. [PMID: 37571328 PMCID: PMC10421404 DOI: 10.3390/nu15153391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Cancer cachexia is a multi-organ syndrome with unintentional weight loss, sarcopenia, and systemic inflammation. Gastrointestinal (GI) cancer patients are more susceptible to cachexia development due to impaired nutrient absorption and digestion. Given the widespread availability and relatively low cost of dietary supplements, we examined the evidence and effects of fish oil (omega-3 fatty acids), melatonin, probiotics, and green tea for managing symptoms of GI cancer cachexia. A literature review of four specific supplements was conducted using PubMed, Google Scholar, and CINAHL without a date restriction. Of 4621 available literature references, 26 articles were eligible for review. Fish oil decreased C-reactive protein and maintained CD4+ cell count, while melatonin indicated inconsistent findings on managing cachexia, but was well-tolerated. Probiotics decreased serum pro-inflammatory biomarkers and increased the tolerability of chemotherapy by reducing side effects. Green tea preparations and extracts showed a decreased risk of developing various cancers and did not impact tumor growth, survival, or adverse effects. Among these four supplements, probiotics are most promising for further research in preventing systemic inflammation and maintaining adequate absorption of nutrients to prevent the progression of cancer cachexia. Supplements may benefit treatment outcomes in cancer cachexia without side effects while supporting nutritional and therapeutic needs.
Collapse
Affiliation(s)
- Saunjoo L. Yoon
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL 32610, USA;
| | - Oliver Grundmann
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL 32610, USA;
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| |
Collapse
|
10
|
Kadakia KC, Hamilton-Reeves JM, Baracos VE. Current Therapeutic Targets in Cancer Cachexia: A Pathophysiologic Approach. Am Soc Clin Oncol Educ Book 2023; 43:e389942. [PMID: 37290034 PMCID: PMC11019847 DOI: 10.1200/edbk_389942] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Significant progress in our understanding of cancer cachexia has occurred in recent years. Despite these advances, no pharmacologic agent has achieved US Food and Drug Administration approval for this common and highly morbid syndrome. Fortunately, improved understanding of the molecular basis of cancer cachexia has led to novel targeted approaches that are in varying stages of drug development. This article reviews two major thematic areas that are driving these pharmacologic strategies, including those targeting signal mediators at the level of the CNS and skeletal muscle. Additionally, pharmacologic strategies are being tested in combination with targeted nutrients, nutrition therapy, and exercise to treat cancer cachexia. To this end, we highlight recently published and ongoing trials evaluating cancer cachexia therapies in these specific areas.
Collapse
Affiliation(s)
- Kunal C. Kadakia
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Jill M. Hamilton-Reeves
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
11
|
Shen XD, Wang X, Zheng ZJ, Chen YH, Tan CL, Liu XB, Ke NW. The differential effects of sarcopenia and cachexia on overall survival for pancreatic ductal adenocarcinoma patients following pancreatectomy: A retrospective study based on a large population. Cancer Med 2023; 12:10438-10448. [PMID: 36938648 DOI: 10.1002/cam4.5779] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVES Both cachexia and sarcopenia have been considered adverse predictors for prognosis in patients with pancreatic cancer; although sarcopenia and cachexia share some similarities, they are still defined as distinct nutritional conditions. We aimed to explore the differential impacts of sarcopenia and cachexia on prognosis for pancreatic ductal adenocarcinoma (PDAC) patients following radical excision. METHODS From January 2015 to May 2022, 614 patients undergoing surgery for PDAC were retrospectively included. Sarcopenia was defined as the L3 total skeletal muscle index below 52.4 cm2 /m2 (men) and 38.5 cm2 /m2 (women). Cachexia was classified according to the following criteria: involuntary weight loss >5% over the past 6 months, or weight loss >2% and BMI <20 kg/m2 , or weight loss >2% and sarcopenia. RESULTS Of the 614 patients included in the analysis, 62% and 48% were diagnosed with sarcopenia and cachexia, respectively. Kaplan-Meier analysis showed that sarcopenia and/or cachexia were significantly associated with worse overall survival (OS) rather than worse recurrence-free survival (RFS). Moreover, Cox regression analysis revealed that cachexia rather than sarcopenia was an adverse factor for OS in all PDAC patients. For poorly differentiated PDAC, both cachexia and sarcopenia were significantly associated with shorter OS. However, for moderately/well-differentiated PADC, cachexia was an independent factor for adverse OS, but not sarcopenia. CONCLUSIONS Sarcopenia and cachexia have different effects on OS for PDAC patients undergoing radical excision. This difference may provide some important information for preoperative management.
Collapse
Affiliation(s)
- Xiao-Ding Shen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xing Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen-Jiang Zheng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-Hua Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chun-Lu Tan
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xu-Bao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Neng-Wen Ke
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
12
|
Loosen SH, Jördens MS, Schoon B, Antoch G, Luedde T, Minko P, Loberg C, Roderburg C. Sarcopenia indicate poor survival in patients undergoing transarterial chemoembolization (TACE) for hepatic malignancies. J Cancer Res Clin Oncol 2023:10.1007/s00432-022-04519-8. [PMID: 36689060 PMCID: PMC10356883 DOI: 10.1007/s00432-022-04519-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/03/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patient selection for transarterial chemoembolization (TACE) has remained challenging. Currently used markers mainly reflect liver function and turned out as less reliable in larger clinical trials. The patients´ body composition has been linked with patient outcome in different cancers. Now, we analyzed the function of different parameters of the patient's body composition as prognostic and/ or predictive parameters in patients that received TACE. METHODS CT scans were used to assess five parameters of the individual body composition (skeletal muscle index (SMI), median muscular attenuation (MMA), bone mineral density (BMD) as well as the visceral and subcutaneous fat area) in 89 patients undergoing TACE. Results were correlated with tumor response to TACE and outcome of patients. RESULTS SMI and visceral fat area were significantly higher in male patients and among patients undergoing TACE for HCC compared to patients with liver metastases. While all parameters of the body composition did not predict response to TACE, patients with an SMI below the ideal cutoff value of 37.76 cm2/m2 had a significantly reduced long-term outcome with a median overall survival of 404 days compared to 1321 days for patients with a high SMI. Moreover, the pre-interventional SMI turned out as an independent prognostic factor in a multivariate Cox regression model including clinicopathological parameters and laboratory markers of organ dysfunction and systemic inflammation (HR: 0.899, 95% CI 0.827-0.979, p = 0.014). CONCLUSION The pre-interventional SMI represents an independent prognostic factor for overall survival following TACE. Assessment of the individual body composition using routine CT scan might help to identify the ideal patients for TACE.
Collapse
Affiliation(s)
- Sven H Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Markus S Jördens
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Berenike Schoon
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christina Loberg
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| |
Collapse
|
13
|
Bai G, Zhou Y, Rong Q, Qiao S, Mao H, Liu P. Development of Nomogram Models Based on Peripheral Blood Score and Clinicopathological Parameters to Predict Preoperative Advanced Stage and Prognosis for Epithelial Ovarian Cancer Patients. J Inflamm Res 2023; 16:1227-1241. [PMID: 37006810 PMCID: PMC10064492 DOI: 10.2147/jir.s401451] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/02/2023] [Indexed: 04/04/2023] Open
Abstract
Purpose Nutritional and inflammatory states are crucial in cancer development. The purpose of this study is to construct a scoring system grounded on peripheral blood parameters associated with nutrition and inflammation and explore its value in stage, overall survival (OS), and progression-free survival (PFS) prediction for epithelial ovarian cancer (EOC) patients. Patients and Methods Four hundred and fifty-three EOC patients were retrospectively identified and their clinical data and relevant peripheral blood parameters were collected. The ratio of neutrophil to lymphocyte, lymphocyte to monocyte, fibrinogen to lymphocyte, total cholesterol to lymphocyte and albumin level were calculated and dichotomized. A scoring system named peripheral blood score (PBS) was constructed. Univariate and multivariate Logistic or Cox regression analyses were used to select independent factors; these factors were then used to develop nomogram models of advanced stage and OS, PFS, respectively. The internal validation and DCA analysis were performed to evaluate models. Results Lower PBS indicated a better prognosis and higher PBS indicated inferior. High PBS is associated with advanced stage, high CA125, serous histological type, poor differentiation, and accompanied ascites. The logistic regression showed age, CA125, and PBS were independent factors for the FIGO III-IV stage. The nomogram models for advanced FIGO stage based on these factors showed good efficiency. FIGO stage, residual disease, and PBS were independent factors affecting OS and PFS, the nomogram models composed of these factors had good performance. DCA curves revealed the models augmented net benefits. Conclusion PBS can be a noninvasive biomarker for EOC patients' prognosis. The related nomogram models could be powerful, cost-effective tools to provide information of advanced stage, OS, and PFS for EOC patients.
Collapse
Affiliation(s)
- Gaigai Bai
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Yue Zhou
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Qing Rong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Sijing Qiao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Hongluan Mao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Correspondence: Hongluan Mao; Peishu Liu, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People’s Republic of China, Tel +86-18560081988; +86-18560082027, Email ;
| | - Peishu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| |
Collapse
|