Cachexia Index as a Prognostic Indicator in Patients with Gastric Cancer: A Retrospective Study

Abstract

The current diagnostic criteria for cancer cachexia are inconsistent, and the prognostic value of cachexia in gastric cancer (GC) is controversial. This study aimed to investigate the prognostic value of the cachexia index (CXI) in patients with GC. We calculated the CXI as skeletal muscle index (SMI) × serum albumin/neutrophil-lymphocyte ratio (NLR), and a total of 161 and 163 patients were included in the high and low CXI groups, respectively. Low CXI was significantly associated with a more advanced tumor–node–metastasis (TNM) stage, a higher level of serum C-reactive protein, serum interleukin-6, and NLR, but also a decreased level of serum prealbumin and albumin. In addition, patients in the low CXI group were more likely to have postoperative pulmonary infections (9.8% vs. 3.7%, p = 0.03). Cox proportional analyses indicated that patients with low CXI (HR 0.45, 95% CI 0.29 to 0.69; p < 0.001) or TNM stage III+IV (HR 4.38, 95% CI 2.54 to 7.55; p < 0.001) had a significantly poorer overall survival (OS). Kaplan–Meier survival curves suggested that patients with low CXI had a significantly decreased OS, which was not affected by subgroup analyses of different sex, age, cachexia, body mass index (BMI), and TNM stage. Furthermore, low CXI combined with cachexia, low BMI, or TNM stage III+IV caused the worst OS in each subgroup analysis, respectively. Our study demonstrated that CXI had a good prognostic value in GC. Greater attention should be paid to patients with low CXI, particularly those combined with cachexia, low BMI, or TNM stage III+IV.

The Cancer Cachexia Index Can Be Used to Prognostically Predict Patients with Gastric Cancer Undergoing Gastrectomy

“…The discrepancy between Cang et al [17] and our results is that in their subgroup analyses, they reported that CXI was associated with OS regardless of age, while we showed that CXI was associated with OS only in elderly and not in non-elderly patients (Electronic Supplementary Information; online suppl. Fig.…”

“…In this study, we showed that CXI was predictive of OS rates in patients with GC undergoing gastrectomy, independent of cancer staging. Our results agreed with Cang et al [17]. Our study is the first to elucidate the impact of CXI in GC CSS and show that CXI is a prognostic factor for CSS in GC patients undergoing gastrectomy.…”

“…material, see https://doi.org/10.1159/000534244). One possible explanation is the difference in patient characteristics between our studies as Cang et al [17] enrolled much younger patients with more advanced cancer than patients in our study. We hypothesize that young patients with a lower sarcopenia frequency than elderly patients do not necessarily have poor nutrition when they have low muscle mass.…”

Comment on 'Hand grip strength‐based cachexia index as a predictor of cancer cachexia and prognosis in patients with cancer' by Xie et al.

“…Several studies have demonstrated the potential efficacy of CXI as a biomarker to predict cancer patients' prognosis. 4,5 However, the practical application of CXI is limited by the associated cost and complexity of skeletal muscle index testing procedures. Sadly, recent research on developing CXI has been at a standstill.…”

Nutritional risk index predicts the prognosis of gastric cancer patients with pyloric stenosis who received preoperative parenteral nutrition

“…Mechanical obstruction of the pyloric duct due to tumor progression causes patients to suffer from digestive system symptoms such as abdominal pain, bloating and loss of appetite, which severely affects energy intake. The increase in energy consumption caused by cancer makes the nutritional status of patients with pyloric stenosis deteriorate rapidly, even leading to cachexia (7)(8)(9). Numerous studies have explored that poor nutritional status was an important negative influence on the development of postoperative complications and on prognosis (10)(11)(12).…”