Prognostic significance of cachexia index in patients with advanced hepatocellular carcinoma treated with systemic chemotherapy

Abstract

Cancer cachexia affects quality of life, response to chemotherapy, and survival in many advanced cancer patients. The aim of this study was to evaluate the prognostic value of pretreatment cachexia index (CXI) in patients with advanced hepatocellular carcinoma (HCC) treated with systematic chemotherapy. Patients with advanced HCC treated with lenvatinib therapy between October 2018 and October 2020 were retrospectively studied. The CXI was calculated as (L3 skeletal muscle index) × (serum albumin)/(neutrophil-to-lymphocyte ratio). The association with treatment response and early adverse events within the first two months of lenvatinib therapy was investigated. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method with log-rank test. Multivariable Cox regression was used to identify the predictors of survival. A total of 116 patients (median age: 60, male: 84.5% ) with calculated CXI. They divided into two groups: high CXI (≥ 53, n = 82) and low CXI (< 53, n = 34). Patients with low CXI had a significantly lower disease control rate (61.8% vs. 89.0%, p = 0.001) and a shorter median OS (8.0 [95% CI 6.2–9.8] vs. 12.3 [95% CI 10.1–14.4] months, p = 0.002) than those with high CXI. In multivariable analysis, low CXI was independently associated with shorter OS (HR: 2.07, 95% CI: 1.17–3.65, p = 0.01) and PFS (HR: 1.84, 95% CI: 1.09–3.09, p = 0.02). Of note, during the first two months of lenvatinib therapy, anorexia (41.2% vs. 22.0%, p = 0.04) developed more frequently among patients with low CXI than those with high CXI. The CXI may be a clinically useful index for predicting poor treatment response and prognosis in patients with advanced HCC undergoing lenvatinib treatment.

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

“…All these features are included in the CXI and might therefore be desirable to measure cancer cachexia. Recent studies reported that CXI had significant associations with survival in patients with lung cancer, liver cancer, biliary tract cancer, and aggressive lymphomas [ 15 , 20 , 21 , 22 , 23 ]. However, the prognostic value of CXI in patients with GC remains unclear.…”

Prognostic value of cachexia index in patients with colorectal cancer: A retrospective study

“…Cachexia index (CXI), a new measure of cachexia, is consisted of three objective indicators including SMI, serum albumin, and neutrophil-lymphocyte ratio (NLR) (11). Recent studies have indicated that CXI is significantly associated with treatment response and prognosis in patients with malignancies such as lung cancer, liver cancer, and aggressive lymphomas (11)(12)(13)(14)(15). In this study, we aim to evaluate the prognostic value of CXI in patients with colorectal cancer, which might be helpful to distinguish the potentially cachexic patients.…”

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

“…In our study, an optimal cutoff of 72.7 for men and 57.1 for women was established for CXI using ROC curve analysis, respectively, but at a cutoff of 35, CXI also predicted poor survival in patients with lung cancer in a univariate and multivariate analysis study [11]. A CXI cutoff of 49.8 (median) [12] also predicted poor survival in patients with diffuse large B-cell lymphoma, while in patients with hepatocellular carcinoma [19], a CXI cutoff of 53 predicted poor survival. Cumulatively, these results supported CXI in gauging survival in patients with different cancers.…”