The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer.

Ross D Dolan,Donald C Mcmillan,Michael I Bennett,Aoife M Ryan,Marie Fallon,Derek G Power,Andrew Wilcock,Matthew Maddocks,Caroline Usborne,Claribel Pl Simmons,Barry J Laird,Wei Mj Sim,Louise E Daly

doi:10.3390/cancers12051187

Abstract

Cancer remains one of the leading causes of mortality worldwide and the associated reduction in physical function has a marked impact on both quality of life and survival. The aim of the present study was to examine the relationship between Eastern Cooperative Oncology Group-Performance status (ECOG-PS), modified Glasgow Prognostic Score (mGPS), Body Mass Index/Weight Loss grade (BMI/WL grade), and Computerised Tomography (CT)-derived body composition measurement and physical function in patients with advanced cancer. Nine sites contributed prospective data on patient demographics, ECOG-PS, mGPS, physical function tests, and CT-derived body composition. Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2-by-2 tables. Associations were analysed using binary logistic regression. A total of 523 cancer patients (266 males, 257 females) were included in the final analysis and most had metastatic disease (83.2%). The median overall survival was 5.6 months. On multivariate binary logistic regression analysis, a high ECOG-PS remained independently associated with a low skeletal muscle index (p < 0.001), low skeletal muscle density (p < 0.05), and timed up and go test failure (p < 0.001). A high mGPS remained independently associated with a low skeletal muscle density (p < 0.05) and hand grip strength test failure (p < 0.01). A high BMI/WL grade remained independently associated with a low subcutaneous fat index (p < 0.05), low visceral obesity (p < 0.01), and low skeletal muscle density (p < 0.05). In conclusion, a high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer body composition and physical function in patients with advanced cancer.

Highlights

Cancer remains one of the leading causes of mortality worldwide and is responsible for 8.8 million deaths each year
Over the last decade or so there has been increasing interest in identifying objective criteria to define cancer cachexia. This has proven problematic since cancer cachexia is a syndrome impacting on quality of life, body composition, physical function, and survival
Eastern Cooperative Oncology GroupPerformance status (ECOG-PS) and modified Glasgow Prognostic Score (mGPS) were consistently associated with low skeletal muscle mass and function and together with our previous study [11], both ECOG-PS and mGPS would appear to pass the duck test as criteria to define cancer cachexia

Summary

Introduction

Cancer remains one of the leading causes of mortality worldwide and is responsible for 8.8 million deaths each year. The importance of cachexia syndrome, with escalating nutritional and functional decline leading to poor clinical outcomes, is well recognised [3]. How this complex syndrome is best defined is the subject of continuing debate. Defining any syndrome is difficult due to its multifaceted nature In such circumstances one may resort to the duck test approach: “If it looks like a duck, swims like a duck, quacks like a duck, it probably is a duck”. Such abductive reasoning has been commonly used to settle legal cases and more recently has gained popularity in artificial intelligence

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