Clinical utility of the modified Glasgow Prognostic Score to classify cachexia in patients with advanced cancer in palliative care

Silva, Geisiane Alves da; Wiegert, Emanuelly Varea Maria; Calixto-Lima, Larissa; Oliveira, Lívia Costa de

doi:10.1016/j.clnu.2019.07.002

Cited by 48 publications

(47 citation statements)

References 26 publications

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“…However, the presence of albumin is not included in the criteria. Given the present and recent results from Silva et al [33] it is clear that hypoalbuminemia in the presence of a systemic inflammatory response offers readily available additional insight into body composition and the likely outcome of the patient with operable colorectal cancer.…”

Section: Discussionmentioning

confidence: 83%

“…The combination of C-reactive protein and albumin, termed the Glasgow Prognostic Score (GPS), has been reported to be informative of the nutritional risk of patients with cancer [33] and has been used successfully to predict survival in patients with a variety of common solid tumors, both in the operable [10] and advanced inoperable setting [9]. Therefore, taken together, the literature points to close linkage of nutritional risk and the systemic inflammatory response in patients with cancer and indicates that if one is measured, then the other should be measured also [7].…”

Section: Discussionmentioning

confidence: 99%

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Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer

Almasaudi

Dolan

Edwards

et al. 2020

Cancers

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It has long been recognized that albumin has prognostic value in patients with cancer. However, although the Global Leadership Initiative on Malnutrition GLIM criteria (based on five diagnostic criteria, three phenotypic criteria and two etiologic criteria) recognize inflammation as an important etiologic factor in malnutrition, there are limited data regarding the association between albumin, nutritional risk, body composition and systemic inflammation, and whether albumin is associated with mortality independent of these parameters. The aim of this study was to examine the relationship between albumin, nutritional risk, body composition, systemic inflammation, and outcomes in patients with colorectal cancer (CRC). A retrospective cohort study (n = 795) was carried out in which patients were divided into normal and hypoalbuminaemic groups (albumin <35 g/L) in the presence and absence of a systemic inflammatory response C-reactive protein (CRP >10 and <10 mg/L, respectively). Post-operative complications, severity of complications and mortality were considered as outcome measures. Categorical variables were analyzed using Chi-square test χ 2or linear-by-linear association. Survival data were analyzed using univariate and multivariate Cox regression. In the presence of a systemic inflammatory response, hypoalbuminemia was directly associated with Malnutrition Universal Screening Tool MUST (p < 0.001) and inversely associated with Body Mass Index BMI (p < 0.001), subcutaneous adiposity (p < 0.01), visceral obesity (p < 0.01), skeletal muscle index (p < 0.001) and skeletal muscle density (p < 0.001). There was no significant association between hypoalbuminemia and either the presence of complications or their severity. In the absence of a systemic inflammatory response (n = 589), hypoalbuminemia was directly associated with MUST (p < 0.05) and inversely associated with BMI (p < 0.01), subcutaneous adiposity (p < 0.05), visceral adiposity (p < 0.05), skeletal muscle index (p < 0.01) and skeletal muscle density (p < 0.001). Hypoalbuminemia was, independently of inflammatory markers, associated with poorer cancer-specific and overall survival (both p < 0.001). The results suggest that hypoalbuminemia in patients with CRC reflects both increased nutritional risk and greater systemic inflammatory response and was independently associated with poorer survival in patients with CRC.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer

Almasaudi

Dolan

Edwards

et al. 2020

Cancers

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“…Cancer cachexia is a multifactorial syndrome characterized by ongoing loss of skeletal muscle mass, malnutrition, and progressive functional impairment [10]. Cancer cachexia is associated with increased treatmentrelated toxicity and poor prognosis in cancer patients [11][12][13]. Given the high tumor burden of DLBCL and the favorable response rate with substantial treatmentrelated toxicities of R-CHOP treatment, the prognostic role of cancer cachexia is also likely to be observed in DLBCL patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic model based on the geriatric nutritional risk index and sarcopenia in patients with diffuse large B-cell lymphoma

Kim

Kang

et al. 2020

BMC Cancer

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Background: Systemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large Bcell lymphoma (DLBCL). The Geriatric Nutritional Risk Index (GNRI) is one of the main parameters used to assess these conditions, but its efficacy in DLBCL is inconclusive. Methods: We retrospectively reviewed 228 DLBCL patients who were treated with R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The patients were stratified according to GNRI score (> 98, 92 to 98, 82 to < 92, and < 82) as defined in previous studies. Additionally, the extent of sarcopenia was categorized as sarcopenia-both, sarcopenia-L3/PM alone, and non-sarcopenia-both according to skeletal muscle index. Results: Survival curves plotted against a combination of GNRI and sarcopenia scores revealed two clear groups as follows: high cachexia risk (HCR) group (GNRI < 82, sarcopenia-both, or GNRI 82-92 with sarcopenia-L3/PM alone) and low cachexia risk (LCR) group (others). The HCR group had a lower complete response rate (46.5% vs. 86.6%) and higher frequency of treatment-related mortality (19.7% vs. 3.8%) and early treatment discontinuation (43.7% vs. 8.3%) compared with the LCR group. The median progression-free survival (PFS) (not reached vs. 10.3 months, p < 0.001) and overall survival (OS) (not reached vs. 12.9 months, p < 0.001) were much shorter in the HCR group than in the LCR group. On multivariable analyses, the HCR group was shown to be an independent negative prognostic factor for PFS and OS after adjusting the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI). Conclusions: A combined model of GNRI and sarcopenia may provide prognostic information independently of the NCCN-IPI in DLBCL.

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“…Of the present criteria considered, it is the only one that is completely objective as it relies on two routine, laboratory-derived values. Indeed, it has been termed "laboratory cachexia" as its values become increasingly abnormal towards death [38] and the mGPS above has been used to define cancer cachexia [39,40]. There are other measures of the systemic inflammatory response that have been shown to have prognostic value, such as the neutrophil lymphocyte ratio which can be collected as part of the routine differential white cell count.…”

Section: Discussionmentioning

confidence: 99%

“…However, such ratios have not been well defined and their relationship with the syndrome of cachexia has not been shown [7,41,42]. With reference to BMI/WL grade it is not clear whether this has additional value to other nutritional risk screening tools such as the Malnutrition Universal Screening Tool (MUST) and the Patient Generated Subjective Global Assessment (PG-SGA) that are in routine clinical use [36,40]. Therefore, further comparative studies are required to establish the value of BMI/WL grade as a measure of cachexia in patients with advanced cancer.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer

Dolan

Daly

Simmons

et al. 2020

Cancers

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Cancer remains one of the leading causes of mortality worldwide and the associated reduction in physical function has a marked impact on both quality of life and survival. The aim of the present study was to examine the relationship between Eastern Cooperative Oncology Group-Performance status (ECOG-PS), modified Glasgow Prognostic Score (mGPS), Body Mass Index/Weight Loss grade (BMI/WL grade), and Computerised Tomography (CT)-derived body composition measurement and physical function in patients with advanced cancer. Nine sites contributed prospective data on patient demographics, ECOG-PS, mGPS, physical function tests, and CT-derived body composition. Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2-by-2 tables. Associations were analysed using binary logistic regression. A total of 523 cancer patients (266 males, 257 females) were included in the final analysis and most had metastatic disease (83.2%). The median overall survival was 5.6 months. On multivariate binary logistic regression analysis, a high ECOG-PS remained independently associated with a low skeletal muscle index (p < 0.001), low skeletal muscle density (p < 0.05), and timed up and go test failure (p < 0.001). A high mGPS remained independently associated with a low skeletal muscle density (p < 0.05) and hand grip strength test failure (p < 0.01). A high BMI/WL grade remained independently associated with a low subcutaneous fat index (p < 0.05), low visceral obesity (p < 0.01), and low skeletal muscle density (p < 0.05). In conclusion, a high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer body composition and physical function in patients with advanced cancer.

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Clinical utility of the modified Glasgow Prognostic Score to classify cachexia in patients with advanced cancer in palliative care

Cited by 48 publications

References 26 publications

Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer

Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer

Prognostic model based on the geriatric nutritional risk index and sarcopenia in patients with diffuse large B-cell lymphoma

The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer

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