Abstract
The CAchexia SCOre (CASCO) was described as a tool for the staging of cachectic cancer patients. The aim of this study is to show the metric properties of CASCO in order to classify cachectic cancer patients into three different groups, which are associated with a numerical scoring. The final aim was to clinically validate CASCO for its use in the classification of cachectic cancer patients in clinical practice. We carried out a case -control study that enrolled prospectively 186 cancer patients and 95 age-matched controls. The score includes five components: (1) body weight loss and composition, (2) inflammation/metabolic disturbances/immunosuppression, (3) physical performance, (4) anorexia, and (5) quality of life. The present study provides clinical validation for the use of the score. In order to show the metric properties of CASCO, three different groups of cachectic cancer patients were established according to the results obtained with the statistical approach used: mild cachexia (15 ≤ × ≤ 28), moderate cachexia (29 ≤ × ≤ 46), and severe cachexia (47 ≤ × ≤ 100). In addition, a simplified version of CASCO, MiniCASCO (MCASCO), was also presented and it contributes as a valid and easy-to-use tool for cachexia staging. Significant statistically correlations were found between CASCO and other validated indexes such as Eastern Cooperative Oncology Group (ECOG) and the subjective diagnosis of cachexia by specialized oncologists. A very significant estimated correlation between CASCO and MCASCO was found that suggests that MCASCO might constitute an easy and valid tool for the staging of the cachectic cancer patients. CASCO and MCASCO provide a new tool for the quantitative staging of cachectic cancer patients with a clear advantage over previous classifications.
Highlights
Cancer cachexia is a syndrome present in a large number of cancer patients that results in body weight loss, inflammation, reduced physical performance, and decreased quality of life (Evans et al, 2008; Muscaritoli et al, 2010; Fearon et al, 2011; Cederholm et al, 2016)
The value of the Maximum Likelihood Estimation (ML), applied to the matrix R, provided initial results in an adjusted model (χ 2 = 675.11; df = 253, p < 0.001; Comparative Fit Index (CFI) = 0.912; Tucker Lewis Index (TLI) = 0.941; Root Mean Standard Error (RMSEA) = 0.04; Adjusted and Standardized Root Mean Residuals (SRMR) = 0.039; 95% Confidence Interval of SRMR 0.02–0.05; Ratio χ2/df = 3.277)
Physical performance (PHP) took 15% while ANO 18% and Quality of life (QoL) 45%, the three representing 78% of the initial value, which is regarded as a high level of variance accounted for by the reduction of dimension
Summary
Cancer cachexia is a syndrome present in a large number of cancer patients that results in body weight loss, inflammation, reduced physical performance, and decreased quality of life (Evans et al, 2008; Muscaritoli et al, 2010; Fearon et al, 2011; Cederholm et al, 2016). In spite of the fact that, in addition to definition, diagnostic criteria have been established (Evans et al, 2008), only few studies deal with cachexia staging and classification of patients (Bozzetti and Mariani, 2009; Gabison et al, 2010). From this point of view, Fearon et al (2011) have established a classification of the syndrome based on inflammation and body weight loss. CASCO was designed to fulfill the gap of a numerical classification system and enable the proper quantitative staging of cachectic cancer patients
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