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Xu X, Tian M, Ding CC, Xu H, Wang H, Jin X. Skeletal Muscle Index-Based Cachexia Index as a Predictor of Prognosis in Patients With Cancer: A Meta-Analysis and Systematic Review. Nutr Rev 2024:nuae094. [PMID: 39001797 DOI: 10.1093/nutrit/nuae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024] Open
Abstract
CONTEXT Cachexia is associated with poor survival rates. In the clinical setting, the diagnosis of cancer cachexia is challenging. The cachexia index (CXI), a new index for predicting survival time, is a promising tool for diagnosing cancer cachexia; however, its efficacy in predicting patient survival has not been validated. OBJECTIVE This meta-analysis and systematic review aimed to explore the CXI's prognostic value in patients with cancer. DATA SOURCES The PubMed, Embase, MEDLINE, and Cochrane Library databases were searched for relevant studies to determine the association between CXI findings and prognosis. DATA EXTRACTION The outcomes were overall survival (OS), progression-, disease-, and recurrence-free survival (PFS/DFS/RFS) rates, and the rate of complete response. DATA ANALYSIS The QUality In Prognostic Studies (QUIPS) tool was used to evaluate the quality of the included trials. This meta-analysis comprised 14 studies involving 2777 patients. A low CXI was associated with decreased OS (hazard ratio [HR] 2.34, 95% confidence interval [CI] 2.01-2.72; P < .001), PFS/DFS/RFS (HR 1.93, 95% CI 1.68-2.22; P < .001), and complete response (odds ratio [OR] 0.49, 95% CI 0.36-0.66; P < .001). Patients with a low CXI had a lower body mass index (mean difference [MD] -0.75, 95% CI -1.00 to 0.50; P < .001), skeletal muscle index (standardized MD -0.80, 95% CI -0.98 to -0.61; P < .001), and serum albumin level (MD -0.23, 95% CI -0.26 to -0.20; P < .001); and a higher neutrophil-lymphocyte ratio (MD 1.88, 95% CI 1.29-2.47; P < .001) and more advanced disease stages (OR 0.80, 95% CI 0.71-0.91; P = .001). CONCLUSION A low CXI was found to be associated with poor survival in patients with cancer. While the CXI is a promising marker for predicting cancer cachexia, further studies are required to verify its usefulness.
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Affiliation(s)
- Xintian Xu
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Mengxing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Chen Chen Ding
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Huiting Xu
- Department of Abdominal Oncology 1, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Huifen Wang
- Nursing Department, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
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Yuan Q, Liu L, Wang K, Zhou S, Miao J, Gao B, Ding C, Guan W. Developing and validating a Modified Cachexia Index to predict the outcomes for colorectal cancer after radical surgery. Eur J Clin Nutr 2024:10.1038/s41430-024-01469-x. [PMID: 38987657 DOI: 10.1038/s41430-024-01469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND It was reported that the cachexia index (CXI:ALB * SMI NLR ) was an essential index for predicting the prognosis of tumor patients. However, since for SMI needs to be measured by CT imaging methods and its calculation was inconvenient. Thus, we developed a modified cachexia index (mCXI:ALB NLR * UCR ). The purpose of this study was to evaluate the association between mCXI and prognosis in patients with colorectal cancer. METHODS An analysis of 215 patients with newly diagnosed colorectal cancer was carried out retrospectively. An optimal cut-off value of mCXI was established by the receiver operating characteristic (ROC) curves for predicting prognosis. Prognostic implications of mCXI were investigated using Kaplan-Meier curves and Cox regression analysis. A comparative assessment of the predictive capacity between mCXI and the CXI was performed using time-dependent receiver operating characteristic analysis. RESULTS Patients were classified into two groups based on the cut-off value of mCXI: the LOW mCXI group (n = 60) and the HIGH mCXI group (n = 155). The 3-year Overall survival (OS) (76.6% vs 96.7%, p < 0.01) and 3-year Recurrence-free survival (RFS) (68.3% vs 94.1%, p < 0.01) were significantly worse in the LOW mCXI group in contrast to that in the HIGH mCXI group. In Cox multivariate regression analysis, mCXI was an independent prognostic factor for OS (HR = 8.951, 95%CI: 3.105-25.807, <0.01). Moreover, compared with CXI (AUC = 0.723), mCXI (AUC = 0.801) has better predictive efficacy, indicating that mCXI is more suitable for prognostic assessment. CONCLUSIONS The mCXI significantly correlated with survival outcomes for colorectal cancer patients after radical surgery.
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Affiliation(s)
- Qinggang Yuan
- Department of General Surgery, Nanjing Drum Tower Clinical College of Xuzhou Medical University, Nanjing, Jiangsu, China
| | - Lixiang Liu
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Kai Wang
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Shizhen Zhou
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Ji Miao
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
| | - Chao Ding
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
| | - Wenxian Guan
- Department of General Surgery, Nanjing Drum Tower Clinical College of Xuzhou Medical University, Nanjing, Jiangsu, China.
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Zhang H, Tang X, Zhang J, Man C, Jiang D, Xu Y, Zhang W, Gong D, Fan Y. Cachexia Index as a Predictor of Reduced Survival in Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis. Nutr Cancer 2024:1-9. [PMID: 38943494 DOI: 10.1080/01635581.2024.2372115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
The cachexia index is a novel indicator of cachexia, but its prognostic implications for survival outcomes have not been systematically assessed in patients with gastrointestinal cancer. This systematic review and meta-analysis aimed to examine the association between the cachexia index and survival outcomes in gastrointestinal cancer patients. Two independent reviewers searched PubMed, Embase, and Web of Science to identify studies that evaluated the prognostic significance of the cachexia index in patients with gastrointestinal cancer. The prognostic value of the cachexia index was determined by combining the adjusted hazard ratios (HR) and 95% confidence intervals (CI). Thirteen studies were identified, including a total of 4207 patients. Meta-analysis indicated that a lower cachexia index was associated with shorter overall survival (HR 2.18; 95% CI 1.78-2.66) and disease-free survival (HR 1.72; 95% CI 1.50-1.97) in gastrointestinal cancer patients. Further stratified analysis confirmed the significant association between a lower cachexia index and shorter overall survival in different study designs, regions, patients' age, sample sizes, gastrointestinal cancer subtypes, tumor stages, and follow-up duration subgroups. The cachexia index could be utilized as a predictor of overall survival and disease-free survival in patients with gastrointestinal cancer. However, future prospective studies are required to confirm these findings.
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Affiliation(s)
- Heng Zhang
- Department of General Surgery, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Xuan Tang
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Junfang Zhang
- Department of Medical Nutrition, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Changfeng Man
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Dapeng Jiang
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Ying Xu
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Wenbo Zhang
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Dandan Gong
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
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Muduly DK, Colney L, Kar M, Imaduddin M, Patra S, Sultania M, G S, Swain PK, Sahoo B, Mohakud S, Nayak HK, Panigrahi MK. Effect of Preoperative Body Mass Index on Postoperative and Long-Term Outcomes in an East Indian Gastric Cancer Cohort. J Gastrointest Cancer 2024; 55:829-837. [PMID: 38315330 DOI: 10.1007/s12029-024-01018-6] [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] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Gastric cancer is a global health concern with varying clinical outcomes. This study aims to investigate the influence of preoperative Body Mass Index (BMI) on survival in patients who underwent curative resection for gastric cancer in Eastern India. METHODS Data from a prospectively maintained Surgical Oncology database were analysed for patients who underwent curative resection for primary gastric adenocarcinoma between May 2016 and March 2022. Patients with incomplete data were excluded. Preoperative BMI was categorised into three groups: Underweight (< 18.5 kg/m2), Normal (18.5-22.9 kg/m2), and Overweight/Obese (=23 kg/m2). Clinicopathological details, short-term outcomes, and long-term oncological outcomes were assessed. Statistical analysis included survival estimates, Cox proportional hazard models, and subgroup analysis. RESULT Of 162 patients, 145 met the inclusion criteria. Patients were predominantly male (68%) with middle or lower socioeconomic status. No significant differences amongst BMI groups were observed in performance score, tumour grade, clinical stage, or short-term outcomes. Postoperative complications and 30-day mortality were similar. However, underweight patients had poorer 4-year disease-free survival (DFS) compared to overweight/obese patients (14.3% vs. 39.7%, p = 0.03). Overweight/obese patients showed significantly better 4-year overall survival (OS) than underweight patients (47.8% vs. 20.4%, p = 0.03). CONCLUSIONS In Eastern Indian gastric cancer patients undergoing curative resection, preoperative higher BMI (overweight/obese) was associated with better long-term survival. Understanding these findings could guide tailored interventions to improve outcomes in this population.
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Affiliation(s)
- Dillip Kumar Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India.
| | - Lalchhandami Colney
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Sudhakar G
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Phanindra Kumar Swain
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Hemanta Kumar Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
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Feng Y, Cheng X, Xu M, Zhao R, Wan Q, Feng W, Gan H. CT-determined low skeletal muscle index predicts poor prognosis in patients with colorectal cancer. Cancer Med 2024; 13:e7328. [PMID: 38924332 PMCID: PMC11196831 DOI: 10.1002/cam4.7328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Sarcopenia is highly prevalent among patients with colorectal cancer (CRC). Computed tomography (CT)-based assessment of low skeletal muscle index (SMI) is widely used for diagnosing sarcopenia. However, there are conflicting findings on the association between low SMI and overall survival (OS) in CRC patients. The objective of this study was to investigate whether CT-determined low SMI can serve as a valuable prognostic factor in CRC. METHODS We collected data from patients with CRC who underwent radical surgery at our institution between June 2020 and November 2021. The SMI at the third lumbar vertebra was calculated using CT scans, and the cutoff values for defining low SMI were determined using receiver operating characteristic curves. Univariate and multivariate analyses were performed to assess the associations between clinical characteristics and postoperative major complications. RESULTS A total of 464 patients were included in the study, 229 patients (46.7%) were classified as having low SMI. Patients with low SMI were older and had a lower body mass index (BMI), a higher neutrophil to lymphocyte ratio (NLR), and higher nutritional risk screening 2002 (NRS2002) scores compared to those with normal SMI. Furthermore, patients with sarcopenia had a higher rate of major complications (10.9% vs. 1.3%; p < 0.001) and longer length of stay (9.09 ± 4.86 days vs. 8.25 ± 3.12 days; p = 0.03). Low SMI and coronary heart disease were identified as independent risk factors for postoperative major complications. Moreover, CRC patients with low SMI had significantly worse OS. Furthermore, the combination of low SMI with older age or TNM stage II + III resulted in the worst OS in each subgroup analysis. CONCLUSIONS CT-determined low SMI is associated with poor prognosis in patients with CRC, especially when combined with older age or advanced TNM stage.
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Affiliation(s)
- Yue Feng
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xiao‐Hong Cheng
- Division of Gastrointestinal Surgery, Department of General Surgery, West China HospitalSichuan UniversityChengduSichuanChina
| | - Mei Xu
- Department of Gastroenterology and Hepatology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Rui Zhao
- Division of Gastrointestinal Surgery, Department of General Surgery, West China HospitalSichuan UniversityChengduSichuanChina
| | - Qian‐Yi Wan
- Division of Gastrointestinal Surgery, Department of General Surgery, West China HospitalSichuan UniversityChengduSichuanChina
| | - Wei‐Hua Feng
- Department of Laboratory Medicine, West China HospitalSichuan UniversityChengduSichuanChina
| | - Hua‐Tian Gan
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
- Laboratory of Inflammatory Bowel Disease, the Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease‐Related Molecular Network, West China HospitalSichuan UniversityChengduChina
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Takano Y, Kai W, Kobayashi Y, Kanno H, Hanyu N. Cachexia Index in Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis. J Gastrointest Cancer 2024:10.1007/s12029-024-01055-1. [PMID: 38676902 DOI: 10.1007/s12029-024-01055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The cachexia index is a novel biomarker of cancer cachexia. This systematic review and meta-analysis aimed to evaluate the prognostic impact of cachexia index on prognosis after surgery for gastrointestinal cancer. METHODS In August 2023, we systematically searched PubMed, the Cochrane Library, and Ovid for relevant studies on the oncological outcome after gastrointestinal cancer surgery and analyzed the findings from these studies for meta-analysis. RESULTS Our systematic and meta-analysis review identified eight studies involving 1876 patients. The number of patients with low cachexia index accounted for 813 patients (43.3%). We found that low cachexia index was associated with worse overall survival (pooled HR, 2.30; 95% CI, 1.85-2.87; z = 7.49; P < 0.001) and disease/relapse/progression-free survival (pooled HR, 1.77; 95% CI, 1.45-2.18; z = 5.50; P < 0.001). CONCLUSION Our meta-analysis showed that cachexia index was associated with oncological outcome after gastrointestinal cancer surgery. However, the limitations of this meta-analysis should be taken into consideration when interpreting the results.
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Affiliation(s)
- Yasuhiro Takano
- Department of Surgery, Tokyo General Hospital, 3-15-2, Ekoda, Nakano, Tokyo, 165-8906, Japan.
| | - Wataru Kai
- Department of Surgery, Tokyo General Hospital, 3-15-2, Ekoda, Nakano, Tokyo, 165-8906, Japan
| | - Yasunobu Kobayashi
- Department of Surgery, Tokyo General Hospital, 3-15-2, Ekoda, Nakano, Tokyo, 165-8906, Japan
| | - Hironori Kanno
- Department of Surgery, Tokyo General Hospital, 3-15-2, Ekoda, Nakano, Tokyo, 165-8906, Japan
| | - Nobuyoshi Hanyu
- Department of Surgery, Tokyo General Hospital, 3-15-2, Ekoda, Nakano, Tokyo, 165-8906, Japan
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Brown LR, Thomson GG, Gardner E, Chien S, McGovern J, Dolan RD, McSorley ST, Forshaw MJ, McMillan DC, Wigmore SJ, Crumley AB, Skipworth RJE. Cachexia index for prognostication in surgical patients with locally advanced oesophageal or gastric cancer: multicentre cohort study. Br J Surg 2024; 111:znae098. [PMID: 38593042 PMCID: PMC11003541 DOI: 10.1093/bjs/znae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Features of cancer cachexia adversely influence patient outcomes, yet few currently inform clinical decision-making. This study assessed the value of the cachexia index (CXI), a novel prognostic marker, in patients for whom neoadjuvant chemotherapy and surgery for oesophagogastric cancer is planned. METHODS Consecutive patients newly diagnosed with locally advanced (T3-4 or at least N1) oesophagogastric cancer between 1 January 2010 and 31 December 2015 were identified through the West of Scotland and South-East Scotland Cancer Networks. CXI was calculated as (L3 skeletal muscle index) × (serum albumin)/(neutrophil lymphocyte ratio). Sex-stratified cut-off values were determined based on the area under the curve (AUC), and patients were divided into groups with low or normal CXI. Primary outcomes were disease progression during neoadjuvant chemotherapy and overall survival (at least 5 years of follow-up). RESULTS Overall, 385 patients (72% men, median age 66 years) were treated with neoadjuvant chemotherapy for oesophageal (274) or gastric (111) cancer across the study interval. Although patients with a low CXI (men: CXI below 52 (AUC 0.707); women: CXI below 41 (AUC 0.759)) were older with more co-morbidity, disease characteristics were comparable to those in patients with a normal CXI. Rates of disease progression during neoadjuvant chemotherapy, leading to inoperability, were higher in patients with a low CXI (28 versus 12%; adjusted OR 3.07, 95% c.i. 1.67 to 5.64; P < 0.001). Low CXI was associated with worsened postoperative mortality (P = 0.019) and decreased overall survival (median 14.9 versus 56.9 months; adjusted HR 1.85, 1.42 to 2.42; P < 0.001). CONCLUSION CXI is associated with disease progression, worse postoperative mortality, and overall survival, and could improve prognostication and decision-making in patients with locally advanced oesophagogastric cancer.
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Affiliation(s)
- Leo R Brown
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - Georgina G Thomson
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ellen Gardner
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - Siobhan Chien
- Centre for Sustainable Delivery, Golden Jubilee Hospital, Glasgow, UK
| | - Josh McGovern
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Stephen T McSorley
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Matthew J Forshaw
- Department of Upper Gastrointestinal Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Stephen J Wigmore
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew B Crumley
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Richard J E Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Beypinar I, Demir H, Culha Y, Kaya F. The Utility of the Cachexia Index and the Modified Glasgow Score in Young Patients With Breast Cancer. Cureus 2024; 16:e59301. [PMID: 38813321 PMCID: PMC11136474 DOI: 10.7759/cureus.59301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Background Breast cancer is the most common cancer in women. Body composition and inflammatory markers are increasingly important for predicting cancer prognosis. The Cancer Cachexia Index (CXI) and the modified Glasgow Prognostic Score (GPS) are two new markers evaluating prognosis in cancer. In this study, we evaluated the utility of the CXI and the modified GPS in young patients with breast cancer. Methods Eighty patients diagnosed between 2012 and 2023 were included in the study. The following information was recorded: patient features, pathological subtype, estrogen receptor and human epidermal growth factor receptor-2 (HER-2) status, disease stage, therapies, disease recurrence, and last control or death date. The CXI and the modified GPS were calculated using clinical data, including skeletal muscle index, albumin, C-reactive protein, and neutrophil-to-lymphocyte ratio. Results There were no differences in overall survival with respect to the CXI in the study population (p=0.96). Only stage 4 patients showed statistically significant survival differences according to the CXI (p=0.046). Although the median survival time was not reached for the modified GPS groups, there was a statistical overall survival difference favoring the negative group (p=0.017). No significant differences were observed in disease-free survival due to the CXI (p=0.128). In multivariate analysis, no factors, including the modified GPS and the CXI, influenced overall survival. There was a significant effect of the modified GPS and body mass index on recurrence (p=0.037; p=0.034). The CXI had a non-significant marginal p-value (p=0.074). Conclusion Our study showed that the modified GPS may be related to disease-free survival and overall survival, whereas the CXI has a more prominent prognostic effect on overall survival in advanced-stage breast cancers. In early-stage and young patients, optimization of risk scores is lacking.
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Affiliation(s)
- Ismail Beypinar
- Medical Oncology, Alanya Alaaddin Keykubat University, Antalya, TUR
| | - Hacer Demir
- Medical Oncology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Yaşar Culha
- Medical Oncology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Furkan Kaya
- Radiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
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Xu H, Zhang B, Zhang Y, Yang C, Bo C, Guo Y, Cheng Y, He L. Prognostic Significance of the Cachexia Index in Patients with Non-Small-Cell Lung Cancer and Brain Metastases after Stereotactic Radiotherapy. Clin Med Insights Oncol 2024; 18:11795549231222362. [PMID: 38440045 PMCID: PMC10910881 DOI: 10.1177/11795549231222362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/04/2023] [Indexed: 03/06/2024] Open
Abstract
Background The cachexia index (CXI) has been proposed as a novel biomarker of cancer cachexia. We aimed to investigate the association between CXI and survival outcomes after stereotactic radiotherapy (SRT) in patients with non-small cell lung cancer (NSCLC) and brain metastases. Methods Data from 145 patients with NSCLC, who underwent SRT for brain metastases between April 2016 and August 2020, were retrospectively analyzed. Cachexia index was calculated as skeletal muscle index (SMI) × serum albumin level/neutrophil-to-lymphocyte ratio, whereas SMI was calculated from computed tomography images captured at the L1 level. Kaplan-Meier curves and Cox proportional hazards models were used to assess progression-free survival (PFS) and overall survival (OS). The prognostic values of CXI and other cachexia biomarkers were assessed using receiver operating characteristic (ROC) curve analysis. Results Lower pretreatment CXI (<30.8) was significantly associated with older age (P = .039), lower Karnofsky performance score (P = .009), and a high likelihood of extracranial metastases (P = .001). Patients with a lower pretreatment CXI had a significantly shorter PFS and OS than those with a higher CXI (P < .001). Multivariate analysis revealed that pretreatment CXI was an independent risk factor for both PFS, hazard ratio (HR) = 2.375; 95% confidence interval (CI) = 1.610-3.504; P < .001, and OS, HR = 2.340; 95% CI = 1.562-3.505; P < .001. Compared with other biomarkers, pretreatment CXI had the highest area under the ROC curve value for prognostic assessment, reaching 0.734. Moreover, the loss of CXI was a strong risk factor for survival independent of pretreatment CXI (P = .011). Conclusions Cachexia index may serve as a clinically useful tool for predicting survival outcomes of patients with NSCLC and brain metastases who undergo SRT.
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Affiliation(s)
- Hui Xu
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bin Zhang
- Department of Emergency, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongqian Zhang
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chunchun Yang
- Department of Digestion, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Changwen Bo
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuanyuan Guo
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Cheng
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Li He
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
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Yan XL, Wu LM, Tang XB, Li ZZ, Zhang Z, Jiang HJ, Chen ZT, Chen DH, Li JY, Shen X, Huang DD. Comparison of the cachexia index based on hand-grip strength (H-CXI) with the original CXI for the prediction of cancer cachexia and prognosis in patients who underwent radical colectomy for colorectal cancer. Front Nutr 2024; 11:1290299. [PMID: 38445206 PMCID: PMC10912503 DOI: 10.3389/fnut.2024.1290299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Background and aims The cachexia index (CXI) is a novel biomarker for estimating cancer cachexia. The cachexia index based on hand-grip strength (H-CXI) has been recently developed as a simple proxy for CXI. The present study aims to compare both the H-CXI and CXI for the prediction of cancer cachexia and postoperative outcomes in patients who underwent radical colectomy for colorectal cancer. Methods Patients who underwent radical operations for colorectal cancer were included in this study. Cancer cachexia was diagnosed according to the international consensus outlined by Fearon et al. The cachexia index (CXI) was calculated as [skeletal muscle index (SMI) × serum albumin/neutrophil-to-lymphocyte ratio (NLR)]. The H-CXI was calculated as [hand-grip strength (HGS)/height2 × serum albumin/NLR]. The SMI was measured based on the preoperative CT images at the third lumbar vertebra (L3) level. HGS was measured before surgery. Results From July 2014 to May 2021, a total of 1,411 patients were included in the present study, of whom 361 (25.6%) were identified as having cancer cachexia. Patients with cachexia had a lower CXI (p < 0.001) and lower H-CXI (p < 0.001) than those without cachexia. A low CXI but not low H-CXI independently predicted cancer cachexia in the multivariate analysis (OR 1.448, p = 0.024). Both a low CXI (HR 1.476, p < 0.001 for OS; HR 1.611, p < 0.001 for DFS) and low H-CXI (HR 1.369, p = 0.007 for OS; HR 1.642, p < 0.001 for DFS) were independent predictors for overall survival (OS) and disease-free survival (DFS) after adjusting for the same covariates. A low H-CXI but not low CXI was an independent risk factor for postoperative complications (OR 1.337, p = 0.044). No significant association was found between cancer cachexia and postoperative complications. Conclusion The CXI and H-CXI exhibited better prognostic value than cancer cachexia for the prediction of postoperative outcomes in patients who underwent radical colectomy for colorectal cancer. The H-CXI was a superior index over the CXI in predicting short-term clinical outcomes, whereas the CXI demonstrated a closer correlation with Fearon's criteria for cancer cachexia. Ideal tools for the assessment of cancer cachexia should incorporate not only weight loss but also muscle mass, physical function, and inflammatory state.
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Affiliation(s)
- Xia-Lin Yan
- Department of Colorectal Anal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lian-Ming Wu
- Department of General Surgery, Yuhuan Second People 's Hospital, Taizhou, China
| | - Xiu-Bo Tang
- School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zong-Ze Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhao Zhang
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao-Jie Jiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhang-Tao Chen
- School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Ding-Hao Chen
- School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jiang-Yuan Li
- School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong-Dong Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Kumar V, Stewart JH. Editorial: Immunology of cachexia. Front Immunol 2023; 14:1339263. [PMID: 38116001 PMCID: PMC10728869 DOI: 10.3389/fimmu.2023.1339263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Vijay Kumar
- *Correspondence: John H. Stewart IV, ; Vijay Kumar, ;
| | - John H. Stewart
- Department of Surgery, Laboratory of Tumor Immunology and Immunotherapy, Morehouse School of Medicine, Atlanta, GA, United States
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Ding P, Wu J, Wu H, Sun C, Meng M, Lowe S, Tian Y, Guo H, Meng L, Zhao Q. Comment on 'Hand grip strength-based cachexia index as a predictor of cancer cachexia and prognosis in patients with cancer' by Xie et al. J Cachexia Sarcopenia Muscle 2023; 14:2449-2451. [PMID: 37501640 PMCID: PMC10570068 DOI: 10.1002/jcsm.13298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Affiliation(s)
- Ping'an Ding
- The Third Department of SurgeryThe Fourth Hospital of Hebei Medical UniversityShijiazhuangChina
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuangChina
| | - Jiaxiang Wu
- The Third Department of SurgeryThe Fourth Hospital of Hebei Medical UniversityShijiazhuangChina
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuangChina
| | - Haotian Wu
- The Third Department of SurgeryThe Fourth Hospital of Hebei Medical UniversityShijiazhuangChina
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuangChina
| | - Chenyu Sun
- Department of Thyroid and Breast SurgeryThe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Department of General Surgerythe Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Muzi Meng
- UK Program SiteAmerican University of the Caribbean School of MedicinePrestonUK
- Bronxcare Health SystemThe BronxNYUSA
| | - Scott Lowe
- College of Osteopathic MedicineKansas City UniversityKansas CityMOUSA
| | - Yuan Tian
- The Third Department of SurgeryThe Fourth Hospital of Hebei Medical UniversityShijiazhuangChina
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuangChina
| | - Honghai Guo
- The Third Department of SurgeryThe Fourth Hospital of Hebei Medical UniversityShijiazhuangChina
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuangChina
| | - Lingjiao Meng
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuangChina
- Research Center of the Fourth Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Qun Zhao
- The Third Department of SurgeryThe Fourth Hospital of Hebei Medical UniversityShijiazhuangChina
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuangChina
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Li G, He L, Sun H. Nutritional risk index predicts the prognosis of gastric cancer patients with pyloric stenosis who received preoperative parenteral nutrition. Oncol Lett 2023; 26:401. [PMID: 37600343 PMCID: PMC10433704 DOI: 10.3892/ol.2023.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Patients with gastric cancer with pyloric stenosis frequently have poor nutritional status and preoperative parenteral nutrition has been a common treatment strategy. The present study aimed to explore the predictive ability of the nutritional risk index (NRI) regarding the prognosis of patients with gastric cancer and pyloric stenosis who received preoperative parenteral nutrition. A total of 194 patients with gastric cancer with pyloric stenosis who received preoperative parenteral nutrition at Tthe Second People's Hospital of Neijiang (Neijiang, China) between January 2016 and December 2021 were included. At the same time, 221 patients with gastric cancer without pyloric stenosis who received surgery during the same period were also collected and the clinicopathological characteristics of the patients were compared. The optimal cut-off value of the NRI was determined from the receiver operating characteristic curve and prognostic factors were identified by survival analysis. Finally, a nomogram was constructed to predict the survival probability of patients with gastric cancer. The results indicated that patients with pyloric stenosis exhibited a wide range of unfavorable pathological characteristics and blood parameters. In addition, their overall survival (OS) was significantly worse (P<0.001). Among the patients with pyloric stenosis, there were 120 patients (61.9%) with an NRI <93.42 and 74 patients (38.1%) with NRI ≥93.42. Furthermore, patients with an NRI <93.42 had poorer OS (34.37 months vs. not reached, P=0.004). Of note, age, tumor size, radical resection, NRI and TNM stage were determined to be independent prognostic factors for OS. The C-index of the nomogram was 0.760 (95%CI: 0.688-0.832). In conclusion, the NRI was indicated to be an accurate score reflecting the nutritional status of patients, which was able to predict the clinical outcomes of patients with gastric cancer with pyloric stricture who received preoperative parenteral nutrition. Patients with a low NRI had shorter survival times.
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Affiliation(s)
- Guomiao Li
- Cancer Center, The Second People's Hospital of Neijiang, Neijiang, Sichuan 641000, P.R. China
| | - Lijuan He
- Department of Health Management Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Hao Sun
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
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