Cachexia Index in Advanced Non-Small-Cell Lung Cancer Patients

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The cachexia index is a novel index for estimating cachexia that is also associated with prognosis in both male and female patients with advanced non-small cell lung cancer (NSCLC), according to a study published in Clinical Medicine Insights: Oncology.

Because many patients with advanced NSCLC experience cancer cachexia, researchers developed the cachexia index to evaluate its extent.

For the study, researchers retrospectively analyzed data from 112 patients with metastatic NSCLC diagnosed between 2000 and mid-2011 at Louisiana State University Health Science Center.

Researchers used findings from patients’ abdominal computed tomography (CT) scans done within 1 month of diagnosis to estimate skeletal muscle area (SMA) and skeletal muscle index (SMI). Researchers then developed their cachexia index with the formula: cachexia index = (SMI x serum albumin)/(neutrophil-to-lymphocyte ratio).

Patients were then divided into 2 groups: those with a cachexia index 35 or greater (stage I cachexia) or a cachexia index less than 35 (stage II cachexia).

Researchers found that patients with stage II cachexia had significantly worse progression-free survival and overall survival compared with those with stage I cachexia.

The findings suggest that the cachexia index is an objective method for estimating the degree of cachexia in patients with advanced NSCLC, allowing it to be used to identify patients who are at high risk of early disease progression and identify those who should receive therapies directed against cancer cachexia.

Cancer cachexia affects many advanced non-small-cell lung cancer patients.
Cancer cachexia affects many advanced non-small-cell lung cancer patients.

Abstract

Introduction: Cancer cachexia affects many advanced non-small-cell lung cancer (NSCLC) patients. Cachexia index (CXI) was developed to assess the degree of cachexia in these patients.

Methods: Patients with metastatic NSCLC diagnosed between January 1, 2000, and June 30, 2011, at our institution were retrospectively studied.

Abdominal computed tomography scans done within 1 month of diagnosis were reviewed to estimate skeletal muscle area (SMA) and skeletal muscle index (SMI) at the L3 level. CXI was developed as follows: CXI = (SMI x Alb) / NLR where SMI is the skeletal muscle index, Alb is the serum albumin, and NLR is the neutrophil-to-lymphocyte ratio.

Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Survival among various factors was calculated using the log-rank test. Multivariate Cox regression was used to perform survival analysis in order to estimate the effects of various factors.

Results: Patients were divided into two groups around the median into stage I cachexia (CXI ≥35, n = 56) and stage II cachexia (CXI <35, n = 56). Groups did not differ in age, gender, ethnicity, or histology of cancer.

Patients with stage II cachexia had significantly worse PFS (2.45 vs 5.43 months, P < 0.0001) and OS (3.45 vs 8.8 months, P = 0.0001) than those with stage I cachexia.

On multivariate analysis adjusting for gender, race, and histology, patients with stage II cachexia were found to have worse PFS (hazard ratio [HR] 1.94, 95% confidence interval [CI] 1.27–2.95) and OS (HR 1.53, 95% CI 1.0009–2.34).

Conclusion: The CXI is a novel index for estimating cachexia that also correlates with prognosis in both men and women with advanced NSCLC.

Keywords: lung cancer, cancer cachexia, systemic inflammation, sarcopenia

CITATION: Jafri et al. Cachexia Index in Advanced Non-Small-Cell Lung Cancer Patients. Clinical Medicine Insights: Oncology 2015:9 87–93 doi: 10.4137/CMO.S30891.

TYPE: Original Research

RECEIVED: June 24, 2015. RESUBMITTED: August 24, 2015. ACCEPTED FOR PUBLICATION: August 27, 2015. Academic editor: William C. S. Cho, Editor in Chief

PEER REVIEW: Seven peer reviewers contributed to the peer review report. Reviewers' reports totaled 2,079 words, excluding any confidential comments to the academic editor.

FUNDING: Authors disclose no funding sources.

COMPETING INTERESTS: Authors disclose no potential conflicts of interest.

CORRESPONDENCE: Syed.H.Jafri@uth.tmc.edu

COPYRIGHT: © the authors, publisher and licensee Libertas Academica Limited. This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.

Paper subject to independent expert blind peer review. All editorial decisions made by independent academic editor. Upon submission manuscript was subject to antiplagiarism scanning. Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human and animal study participants, and compliance with any copyright requirements of third parties. This journal is a member of the Committee on Publication Ethics (COPE).

Published by Libertas Academica. Learn more about this journal.

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