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

IF 8.9 1区 医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2023-07-28 DOI:10.1002/jcsm.13298
Ping'an Ding, Jiaxiang Wu, Haotian Wu, Chenyu Sun, Muzi Meng, Scott Lowe, Yuan Tian, Honghai Guo, Lingjiao Meng, Qun Zhao
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The study revealed that H-CXI is independently associated with patient prognosis and is linked to age, pathological stage, systemic inflammation, and nutritional status. Low H-CXI was found to be an independent predictor of cachexia and prognosis in cancer patients. Moreover, H-CXI has shown to be a better prognosis evaluation tool for patients with the same pathological stage. In light of these findings, H-CXI is an economic and procedural advantage over the original CXI, is a comprehensive indicator, and is a multi-centre, prospective, large-sample study that provides reliable results. H-CXI has a reliable clinical effect and a broad clinical prospect in predicting prognosis and cancer cachexia.</p><p>It was found that the study analysed tumours of varying types with different pathological factors, potentially impacting the outcome. Additionally, the study lacked a prospective approach with rigorous inclusion criteria to evaluate the clinical applicability of H-CXI. Thus, a cohort study with registration number NCT01516944 was conducted to explore the clinical applicability of H-CIX as a predictor of cancer cachexia and prognosis among patients with locally advanced gastric cancer (LAGC). The study prospectively enrolled 290 LAGC patients who underwent direct radical surgical resection, of whom 111 (38.28%) had complete serologic and anthropometric data. The cohort primarily composed of males (62.16%) with a mean age of 58 years. Based on the optimal cut-off value for H-CXI from a previous study, 61 (54.95%) patients were categorized into the high H-CXI group and the remaining 50 (45.05%) into the low H-CXI group. During the follow-up period with a median duration of 64.9 months, 21 (18.92%) patients developed cancer cachexia, and patients in the high H-CXI group had a significantly lower risk of developing cancer cachexia than those in the low H-CXI group (11.48% vs. 28.00%, <i>P</i> = 0.027). Furthermore, patients in the high H-CXI group showed significantly better overall survival (OS) and disease-free survival (DFS) rates than those in the low H-CXI group (OS: 59.02% vs. 36.00%, <i>P</i> = 0.0043; DFS: 54.10% vs. 26.00%, <i>P</i> = 0.0024). Moreover, subgroup analysis revealed better 5-year OS and DFS rates for patients with high H-CXI at all pathological stages. Thus, the study found that H-CXI effectively predicted the prognosis and the risk of developing cancer cachexia in patients with LAGC, which was consistent with previous findings.</p><p>The occurrence of cachexia in cancer patients is prevalent and has a negative impact on their quality of life and treatment outcomes.<span><sup>2, 3</sup></span> Hence, it is crucial to identify biomarkers for timely detection and evaluation of patients at high risk of developing cachexia. 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引用次数: 1

Abstract

The study conducted by Xie et al.1 caught our attention, and we extend our gratitude for their valuable contribution. Measuring skeletal muscle index can be costly and tedious. Xie et al. proposed an alternative by using hand grip strength (HGS) to establish a new composite index, HGS-based cachexia index (CXI) (H-CXI), which is calculated as [HGS (kg)/height (m)2 × serum albumin (g/L)]/neutrophil-to-lymphocyte ratio. The H-CXI proved to be a rapid and accurate assessment tool, which can effectively evaluate the risk of cachexia and clinical outcome in cancer patients. The study revealed that H-CXI is independently associated with patient prognosis and is linked to age, pathological stage, systemic inflammation, and nutritional status. Low H-CXI was found to be an independent predictor of cachexia and prognosis in cancer patients. Moreover, H-CXI has shown to be a better prognosis evaluation tool for patients with the same pathological stage. In light of these findings, H-CXI is an economic and procedural advantage over the original CXI, is a comprehensive indicator, and is a multi-centre, prospective, large-sample study that provides reliable results. H-CXI has a reliable clinical effect and a broad clinical prospect in predicting prognosis and cancer cachexia.

It was found that the study analysed tumours of varying types with different pathological factors, potentially impacting the outcome. Additionally, the study lacked a prospective approach with rigorous inclusion criteria to evaluate the clinical applicability of H-CXI. Thus, a cohort study with registration number NCT01516944 was conducted to explore the clinical applicability of H-CIX as a predictor of cancer cachexia and prognosis among patients with locally advanced gastric cancer (LAGC). The study prospectively enrolled 290 LAGC patients who underwent direct radical surgical resection, of whom 111 (38.28%) had complete serologic and anthropometric data. The cohort primarily composed of males (62.16%) with a mean age of 58 years. Based on the optimal cut-off value for H-CXI from a previous study, 61 (54.95%) patients were categorized into the high H-CXI group and the remaining 50 (45.05%) into the low H-CXI group. During the follow-up period with a median duration of 64.9 months, 21 (18.92%) patients developed cancer cachexia, and patients in the high H-CXI group had a significantly lower risk of developing cancer cachexia than those in the low H-CXI group (11.48% vs. 28.00%, P = 0.027). Furthermore, patients in the high H-CXI group showed significantly better overall survival (OS) and disease-free survival (DFS) rates than those in the low H-CXI group (OS: 59.02% vs. 36.00%, P = 0.0043; DFS: 54.10% vs. 26.00%, P = 0.0024). Moreover, subgroup analysis revealed better 5-year OS and DFS rates for patients with high H-CXI at all pathological stages. Thus, the study found that H-CXI effectively predicted the prognosis and the risk of developing cancer cachexia in patients with LAGC, which was consistent with previous findings.

The occurrence of cachexia in cancer patients is prevalent and has a negative impact on their quality of life and treatment outcomes.2, 3 Hence, it is crucial to identify biomarkers for timely detection and evaluation of patients at high risk of developing cachexia. 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. Fortunately, H-CXI is a useful indicator that predicts cancer cachexia and prognosis effectively. Besides being convenient and quick, it provides an efficient complement to the stratification of TNM stage prognosis.

We extend our gratitude to Xie et al.1 for their valuable contribution and recognize the crucial implications of their discoveries for related domains. The H-CXI method offers a comprehensive evaluation of the muscle, nutritional, and inflammatory status in LAGC patients suffering from cachexia. This method serves as a significant point of reference for the prognosis assessment and individualized treatment of patients. Our cohort study of LAGC patients reveals that H-CXI has a high level of accuracy in predicting and assessing the cachexia and prognostication of LAGC patients. H-CXI has the potential to enhance clinical evaluations and treatment strategies for LAGC patients, ultimately benefiting patient survival (Figure 1).

This work was supported by the Cultivating Outstanding Talents Project of Hebei Provincial Government Fund (No. 2019012); Hebei Public Health Committee County-Level Public Hospitals Suitable Health Technology Promotion and Storage Project (No. 2019024); and Hebei University Science and Technology Research Project (No. ZD2019139).

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Xie等人对“基于握力的恶病质指数作为癌症患者癌症恶病质和预后的预测指标”的评论。
Xie et al.1的研究引起了我们的注意,我们对他们的宝贵贡献表示感谢。测量骨骼肌指数既昂贵又乏味。Xie等人提出了一种替代方法,利用手握力(HGS)建立新的复合指数——基于HGS的恶病质指数(CXI) (H-CXI),计算方法为[HGS (kg)/身高(m)2 ×血清白蛋白(g/L)]/中性粒细胞与淋巴细胞比值。事实证明,H-CXI是一种快速准确的评估工具,可以有效地评估癌症患者恶病质的风险和临床结局。研究显示,H-CXI与患者预后独立相关,与年龄、病理分期、全身性炎症和营养状况有关。低H-CXI被发现是癌症患者恶病质和预后的独立预测因子。此外,H-CXI已被证明是同一病理分期患者更好的预后评估工具。根据这些发现,H-CXI在经济和程序上优于原始的CXI,是一个全面的指标,是一个多中心、前瞻性、大样本的研究,提供了可靠的结果。H-CXI在预测预后和肿瘤恶病质方面具有可靠的临床效果和广阔的临床前景。研究发现,该研究分析了具有不同病理因素的不同类型的肿瘤,这些因素可能会影响结果。此外,该研究缺乏前瞻性方法和严格的纳入标准来评估H-CXI的临床适用性。因此,我们开展了一项注册号为NCT01516944的队列研究,探讨H-CIX作为局部晚期胃癌(LAGC)患者癌症恶病质和预后预测因子的临床适用性。该研究前瞻性地招募了290例接受直接根治性手术切除的LAGC患者,其中111例(38.28%)具有完整的血清学和人体测量数据。该队列主要由男性(62.16%)组成,平均年龄58岁。根据既往研究中H-CXI的最佳临界值,61例(54.95%)患者被划分为高H-CXI组,其余50例(45.05%)患者被划分为低H-CXI组。在中位随访时间为64.9个月期间,21例(18.92%)患者发生癌症恶病质,高H-CXI组患者发生癌症恶病质的风险显著低于低H-CXI组(11.48% vs. 28.00%, P = 0.027)。此外,高H-CXI组患者的总生存率(OS)和无病生存率(DFS)明显优于低H-CXI组(OS: 59.02% vs. 36.00%, P = 0.0043;DFS: 54.10% vs. 26.00%, P = 0.0024)。此外,亚组分析显示,在所有病理阶段,高H-CXI患者的5年OS和DFS率都更高。因此,本研究发现H-CXI可有效预测LAGC患者的预后及发生恶性恶病质的风险,与前人研究结果一致。恶病质在癌症患者中普遍存在,并对其生活质量和治疗结果产生负面影响。2,3因此,鉴别生物标志物对于及时发现和评估发生恶病质的高危患者至关重要。一些研究已经证明CXI作为预测癌症患者预后的生物标志物的潜在功效。然而,CXI的实际应用受到相关成本和骨骼肌指数测试程序复杂性的限制。遗憾的是,最近开发CXI的研究一直处于停滞状态。幸运的是,H-CXI是一种有效预测癌症恶病质和预后的有用指标。除方便快捷外,还为TNM分期预后分层提供了有效补充。我们对谢等人的宝贵贡献表示感谢,并认识到他们的发现对相关领域的重要意义。H-CXI方法可以对患有恶病质的LAGC患者的肌肉、营养和炎症状况进行全面评估。该方法对患者的预后评估和个体化治疗具有重要的参考意义。我们对LAGC患者的队列研究表明,H-CXI在预测和评估LAGC患者恶病质和预后方面具有较高的准确性。H-CXI具有提高LAGC患者临床评价和治疗策略的潜力,最终有利于患者的生存(图1)。本研究得到河北省政府基金培养杰出人才项目(No. 2019012)的支持;河北省公共卫生委员会县级公立医院适宜卫生技术推广与储存项目(2019024);河北大学科技攻关计划项目(项目编号:8111111);ZD2019139)。
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来源期刊
Journal of Cachexia, Sarcopenia and Muscle
Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine
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期刊介绍: The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.
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