There was no statistical difference in the outcome based on histology. Not receiving chemotherapy was linked with poor PFS (HR 2.81, 95% CI 1.46–5.4, P = 0.002) and OS (HR 3.1, 95% CI 1.75–5.56, P = 0.0001). SMI (>40) was not associated with better OS (HR 1.36, 95% CI 0.943–1.96, P = 0.10), but both NLR (≤5) and albumin <3 were significantly associated with better OS (HR 0.60, 95% CI 0.41–0.90, P = 0.0187 and HR 1.9, 95% CI 1.22–3.13, P = 0.0048, respectively). Patients with stage II cachexia also had poor PFS (HR 2.43, 95% CI 1.52–3.88, P = 0.0002) and OS (HR 2.08, 95% CI 1.38–3.12, P = 0.0005) (Table 3).
| Table II – Patient characteristics and outcome between stage I and stage II cachexia based on cachexia index (CXI). |
| Variable | Stage I Cachexia (CXI ≥35) (N = 56) (%) | Stage II Cachexia (CXI <35) (N = 56) (%) | P Value | ||||||||
| Age <60 | 30 (53) | 39 (70) | 0.11 | ||||||||
| Male | 40 (71) | 38 (68) | 0.83 | ||||||||
| White | 23 (41) | 31 (55) | 0.18 | ||||||||
| PS 0-1 | 47 (84) | 38 (67) | 0.04* | ||||||||
| Adenocarcinoma | 36 (64) | 35 (62) | 1.00 | ||||||||
| No chemotherapy | 11 (20) | 28 (50) | 0.001* | ||||||||
| Mets >2 | 20 (36) | 31 (55) | 0.05* | ||||||||
| Response to chemo | 30 (67) | 11 (39) | 0.0297* | ||||||||
| Median PFS (month) | 5.42 | 2.45 | <0.0001* | ||||||||
| Median OS (months) | 8.8 | 3.45 | 0.0001* |
| Note: *Statistically significant; Mets >2, more than two sites of metastatic disease Abbreviations: PS, performance status; PFS, progression-free survival; OS, overall survival. |
On multivariate analysis, controlling for gender, race, and histology, stage II cachexia remained independently associated with worse PFS (HR 1.94, 95% CI 1.27–2.95, P-value 0.0022) and OS (HR 1.53, 95% CI 1.009–2.34, P-value 0.045). In other words, patients with stage II cachexia at diagnosis were 53% more likely to have early progression of disease and die sooner as compared to patients with stage I cachexia (Table 3).
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