Staging of nutrition disorders in non‐small‐cell lung cancer patients: utility of skeletal muscle mass assessment

Abstract

Background An international consensus proposed in 2011 a definition and classification system for cachexia (CAX), mainly based on weight loss, sarcopenia [skeletal muscle mass (SMM) loss], inflammation, and anorexia. The aim of this study was to stage CAX in non‐small‐cell lung cancer (NSCLC) patients by using a classification based on the Fearon criteria and supported by quantifiable parameters. Methods This was a cross‐sectional and non‐interventional multicentre study. SMM was assessed by analysing L3 computed tomography‐scan images. Patients completed the anorexia/CAX subscale of the Functional Assessment of Anorexia/Cachexia Therapy, EORTC QLQ‐C30 quality of life (QoL) and International Physical Activity Questionnaire (IPAQ). Results Patients were recruited in 56 sites. The analysis population comprised 531 patients, and SMM was assessed in 312 patients. Male patients were 66.5%, with a mean (SD) age of 65.2 (10.0) years, 79.9% were PS 0–1, and the tumour stage was mainly IIIB‐IV (87.3%). Overall, 38.7% of patients had CAX, 33.8% pre‐CAX, and 0.9% refractory CAX. Molecular tumour profiles were significantly associated with the presence of CAX: 23.9% in EGFR, ALK, ROS1, BRAF, or HER2+ patients, 41.4% in K‐RAS+, and 43.2% in patients with no molecular abnormality ( P = 0.003). The more advanced the CAX stage, the poorer the scores of functional items of the QoL ( P < 0.001) and International Physical Activity Questionnaire ( P < 0.001). Sarcopenia was present in 66.7% of CAX and 68.5% of pre‐CAX patients. Overall, 43.8% of pre‐CAX patients had only sarcopenia with limited weight loss (≤2%) and no anorexia. Conclusions This is the first study to show the distribution of CAX in a population of NSCLC patients and an association between molecular abnormality in NSCLC and CAX. The original Fearon classification for CAX stages was supported by the associated functional QoL scores and physical activity levels, resulting in a clinically relevant system for detection of early stages of CAX.

A retrospective cohort study to investigate the incidence of cancer-related weight loss during chemotherapy in gastric cancer patients

“…It should be noted that we used only two of the EPCRC criteria but not the third (sarcopenia and > 2% weight loss). It has been shown that 12.6% of patients with lung cancer and cachexia were matched only to the third criterion [ 22 ], suggesting that the number of patients with WL in this study is underestimated as patients with cachexia.…”

Impact of cancer cachexia on the therapeutic outcome of combined chemoimmunotherapy in patients with non-small cell lung cancer: a retrospective study

“…However, approximately 90% of the patients with cachexia can be diagnosed using weight loss > 5% or BMI < 20 kg/m 2 and weight loss > 2% alone. 42 Second, there may have been bias in obtaining information on the body weight within 6 months preceding the chemoimmunotherapy initiation. Third, only Japanese patients were included in this study.…”

A Retrospective Cohort Study to Investigate the Incidence of Cachexia During Chemotherapy in Patients with Colorectal Cancer

“…In the present study, we applied cancer cachexia corresponding to the first two criteria of cancer cachexia without sarcopenia, because information on sarcopenia was available in only a limited number of the patients. Nevertheless, it is likely that most patients with cancer cachexia could be evaluated in the present study, because in another study, 87.4% of the patients with cachexia were diagnosed without the third criterion [ 20 ]. Because body weight measurement is easy for healthcare professionals to handle, information on cancer cachexia defined solely by body weight in clinical practice would be useful [ 25 ].…”

“…However, the third criterion (weight loss of > 2% with sarcopenia within the past 6 months) was not set as cancer cachexia, because records regarding sarcopenia were available for only a limited number of the patients during observational periods. As Antoun et al reported that 87.4% of patients with cancer cachexia were diagnosed on the basis of two criteria (1 and 2), we expected to be able to evaluate most of the patients with cancer cachexia in this study [ 20 ].…”