AWGC2023 cachexia consensus as a valuable tool for predicting prognosis and burden in Chinese patients with cancer

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY Journal of Cachexia Sarcopenia and Muscle Pub Date : 2024-08-27 DOI:10.1002/jcsm.13555

Hailun Xie, Lishuang Wei, Guotian Ruan, Heyang Zhang, Jinyu Shi, Shiqi Lin, Chenan Liu, Xiaoyue Liu, Xin Zheng, Yue Chen, Junqiang Chen, Hanping Shi

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Abstract

Background

The Asian Working Group for Cachexia (AWGC) proposed the first consensus report on diagnostic criteria for cachexia in Asians in 2023. However, the current consensus lacks cohort evidence to validate its effectiveness and practicality. We aimed to explore the value of the AWGC2023 criteria for predicting the prognosis and medical burden of patients with cancer through a retrospective post hoc cross-sectional analysis of the Investigation on Nutrition Status and its Clinical Outcome of Common Cancers (INSCOC) project in China.

Methods

Cox regression analyses were performed to assess the independent association between cachexia and long-term survival. We utilized C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), inflammatory burden index (IBI), albumin (ALB) and Glasgow prognostic score (GPS) as diagnostic markers for cachexia, designating them as CRP-based cachexia, NLR-based cachexia, IBI-based cachexia, ALB-based cachexia and GPS-based cachexia, respectively. Additionally, we diagnosed cachexia using body mass index (BMI) cutoff values of 18.5, 20, 21 and 22 kg/m², respectively, and subsequently compared their prognostic predictive value through Harrell's concordance index (C-index). Logistic regression models were used to assess the association between cachexia and medical burden.

Results

A total of 5426 patients with cancer were enrolled in this study. Cox regression analysis confirmed that cachexia based on the AWGC2023 criteria was an independent predictor of long-term survival in patients with cancer. Patients with cachexia had significantly poorer long-term survival than patients without cachexia (66.4% vs. 49.7%, P < 0.001). Inflammatory biomarker-based cachexia was as an independent predictor of prognosis in patients with cancer, with inflammatory burden index (IBI)-based cachexia demonstrating the optimal prognostic discriminatory ability. The C-index indicated that cachexia based on BMI cutoff values of 18.5, 20, and 22 kg/m² did not perform as well as a BMI cutoff value of 21 kg/m². Logistic regression models revealed that using the AWGC2023 criteria, patients with cachexia had a 16.6% higher risk of prolonged hospitalization and a 16.0% higher risk of high medical expenses than patients without cachexia.

Conclusion

The AWGC2023 criteria represent a valuable tool for predicting survival and medical burden among Chinese patients with cancer. Encouragement for further validation in other Asian populations is warranted for the AWGC2023 criteria.

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AWGC2023 恶病质共识是预测中国癌症患者预后和负担的重要工具。

背景：亚洲恶病质工作组（AWGC）于 2023 年提出了第一份关于亚洲人恶病质诊断标准的共识报告。然而，目前的共识缺乏队列证据来验证其有效性和实用性。我们旨在通过对中国常见癌症营养状况及其临床结果调查（INSCOC）项目的回顾性事后横断面分析，探讨 AWGC2023 标准在预测癌症患者预后和医疗负担方面的价值：方法：采用Cox回归分析评估恶病质与长期生存之间的独立关联。我们将C反应蛋白（CRP）、中性粒细胞与淋巴细胞比值（NLR）、炎性负担指数（IBI）、白蛋白（ALB）和格拉斯哥预后评分（GPS）作为恶病质的诊断标志物，并将其分别命名为基于CRP的恶病质、基于NLR的恶病质、基于IBI的恶病质、基于ALB的恶病质和基于GPS的恶病质。此外，我们还使用体重指数（BMI）临界值来诊断恶病质，临界值分别为 18.5、20、21 和 22 kg/m2，然后通过哈雷尔一致性指数（C-index）来比较它们的预后预测价值。采用逻辑回归模型评估恶病质与医疗负担之间的关系：共有 5426 名癌症患者参与了这项研究。Cox回归分析证实，基于AWGC2023标准的恶病质是癌症患者长期生存的独立预测因素。有恶病质患者的长期生存率明显低于无恶病质患者（66.4% vs. 49.7%，P 2）。逻辑回归模型显示，使用 AWGC2023 标准，恶病质患者的长期住院风险比无恶病质患者高出 16.6%，高医疗费用风险比无恶病质患者高出 16.0%：AWGC2023标准是预测中国癌症患者生存率和医疗负担的重要工具。鼓励在其他亚洲人群中进一步验证 AWGC2023 标准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.