Cachexia Score Research Articles

A novel prediction tool for mortality in patients with acute lower gastrointestinal bleeding requiring emergency hospitalization: a large multicenter study

The study aimed to identify prognostic factors for patients with acute lower gastrointestinal bleeding and to develop a high-accuracy prediction tool. The analysis included 8254 cases of acute hematochezia patients who were admitted urgently based on the judgment of emergency physicians or gastroenterology consultants (from the CODE BLUE J-study). Patients were randomly assigned to a derivation cohort and a validation cohort in a 2:1 ratio using a random number table. Assuming that factors present at the time of admission are involved in mortality within 30 days of admission, and adding management factors during hospitalization to the factors at the time of admission for mortality within 1 year, prognostic factors were established. Multivariate analysis was conducted, and scores were assigned to each factor using regression coefficients, summing these to measure the score. The newly created score (CACHEXIA score) became a tool capable of measuring both mortality within 30 days (ROC-AUC 0.93) and within 1 year (C-index, 0.88). The 1-year mortality rates for patients classified as low, medium, and high risk by the CACHEXIA score were 1.0%, 13.4%, and 54.3% respectively (all P < 0.001). After discharge, patients identified as high risk using our unique predictive score require ongoing observation.

Prevalence of cardiac cachexia among congestive heart failure patients

Cardiac cachexia is a serious, multifaceted condition that is linked to congestive heart failure and can strike at any age or level of ventricular function. For the diagnosis of cardiac cachexia in patients, no particular test is employed. However, specific nutritional screening methods, such as the CASCO (cachexia score), are employed to identify cardiac cachexia in patients with congestive heart failure. A prospective observational study was used. The study was conducted at a tertiary hospital. The study used the CASCO (cachexia score) tool. The objective of the study was to determine the prevalence of cardiac cachexia among congestive heart failure patients. The results of the study showed that individuals with congestive heart failure had a significantly higher prevalence of malnutrition and cardiac cachexia.

Association of a newly developed Cancer Cachexia Score with survival in Stage I-III colorectal cancer.

Cancer cachexia, a complex multifactorial syndrome associated with sarcopenia, negatively affects the quality of life and survival in patients with several cancers. We aimed to develop a new score for cachexia assessment and evaluate its effectiveness in the classification of patients undergoing radical resection for colorectal cancer. This study included 396 patients who underwent radical resection for Stage I-III colorectal cancer. To develop the Cancer Cachexia Score (CCS), we analyzed predictive factors of cachexia status related to the development of sarcopenia and incorporated significant factors into the score. We then evaluated the relationship between CCS and survival after radical resection for colorectal cancer. As body mass index (P < 0.001), prognostic nutritional index (P = 0.005), and tumor volume (P < 0.001) were significantly associated with the development of sarcopenia, these factors were included in CCS. Using CCS, 221 (56%), 98 (25%), and 77 (19%) patients were diagnosed with mild, moderate, and severe cancer cachexia, respectively. In multivariate analysis, severe CCS (P < 0.001), N stage 1-2 (P < 0.001), and occurrence of postoperative complications (P = 0.007) were independent predictors of disease-free survival. Age ≥ 65years (P = 0.009), severe CCS (P < 0.001), and N stage 1-2 (P < 0.001) were independent predictors of overall survival. CCS may be a useful prognostic factor for predicting poor survival after radical resection in patients with Stage I-III colorectal cancer.

A novel tissue inhibitor of metalloproteinases-1/liver/cachexia score predicts prognosis of gastrointestinal cancer patients.

BackgroundCachexia, a devastating syndrome in cancer patients, critically determines survival and life quality. It is characterized by impaired homeostasis of multiple organs including the liver, involves tissue wasting, and is conventionally diagnosed and classified by weight loss (WL). However, recent studies pointed at the problem that WL is not sufficient for precise classification of cancer patients according to disease severity (i.e. prognosis). Tissue inhibitor of metalloproteinases‐1 (TIMP‐1) is an easily accessible cachexia‐associated biomarker in the blood, known to alter liver homeostasis. Here, we investigated the value of combining blood levels of TIMP‐1 with parameters of liver functionality towards establishment of a cachexia‐associated clinical score, which predicts survival of cancer patients, reflects the clinical manifestation of cachexia, and is easily accessible in the clinic.MethodsThe TIMP‐1/liver cachexia (TLC) score, expressed as numerical value ranging from 0 to 1, was calculated by categorizing the blood levels of TIMP‐1 and parameters of liver functionality (C‐reactive protein, ferritin, gamma‐glutamyl transferase, albumin, and total protein) for each patient as below/above a certain risk threshold. The TLC score was tested in a cohort of colorectal cancer (CRC) patients (n = 82, 35.4% women, 64.6% men, median age: 70 years) and validated in a cohort of pancreatic cancer (PC) patients (n = 84, 54.8% women, 45.2% men, median age: 69 years).ResultsIn CRC patients, the TLC score positively correlated with presence of cachexia‐related symptoms (WL, impaired liver function), predicted survival [P < 0.001, hazard ratio (HR): 96.91 (9.85–953.90)], and allowed classification of three prognostically distinct patient subpopulations [low (LO)‐risk, intermediate (IM)‐risk, and high (HI)‐risk groups; LO vs. IM: P = 0.003, LO vs. HI: P < 0.001, IM vs. HI: P = 0.029]. The prognostic power of the cachexia‐associated TLC score [P < 0.001, HR: 7.37 (2.80–19.49)] and its application to define risk groups (LO vs. IM: P = 0.032, LO vs. HI: P < 0.001, IM vs. HI: P = 0.014) was confirmed in a cohort of PC patients. The prognostic power of the TLC score was independent of presence of liver metastases in CRC or PC patients and was superior to clinically established staging classifications.ConclusionsThe TLC score, a result of straightforward determination of blood parameters, is an objective cachexia‐associated clinical tool for precise survival prediction of gastrointestinal cancer patients.

Cancer cachexia: an overview of diagnostic criteria and therapeutic approaches for the accredited practicing dietitian.

Cancer cachexia (CC) is a multifactorial syndrome characterised by ongoing skeletal muscle loss that leads to progressive functional impairment driven by reduced food intake and abnormal metabolism. Despite the traditional use of non-volitional weight loss as the primary marker of CC, there is no consensus on how to diagnose and manage CC. The aim of this narrative review was to describe and discuss diagnostic criteria and therapeutic approaches for the accredited practicing dietitian with respect to identifying and managing CC. Available diagnostic criteria for cachexia include the cancer-specific (Fearon and Cachexia Score) and general criteria (Evans and Global Leadership Initiative on Malnutrition). These include phenotypic criteria [weight loss, body mass index, (objective) muscle mass assessments, quality of life] and aetiological criteria (disease burden, inflammation, energy expenditure, anorexia and inadequate food intake) and can be incorporated into the nutrition care process (NCP). This informs the nutrition diagnosis of 'chronic disease- or condition-related malnutrition (undernutrition) as related to increased nutrient needs, anorexia or diminished intake due to CC'. Optimal nutrition care and management of CC is multidisciplinary, corrects for increased energy expenditure (via immunonutrition/eicosapentaenoic acid), suboptimal protein/energy intake and poor nutrition quality of life, and includes a physical exercise intervention. Monitoring of intervention efficacy should focus on maintaining or slowing the loss of muscle mass, with weight change as an alternative gross indicator. Dietitians and the NCP can play an essential role with respect to identifying and managing CC, focusing on aspects of nutrition screening, assessment and intervention.

Cachexia at Diagnosis adversely predicts outcomes in patients with Aggressive B-Cell NHL receiving standard of care treatment: A Prospective Observational Study from India

Background and Objectives:Cancer associated malnutrition and cachexia is an important determinant of the patient's short and long term outcomes. This prospective study was conducted to determine the association between cachexia at diagnosis and overall survival of patients with aggressive B-cell non-Hodgkin's Lymphoma (ABNHL) Methods:This investigator initiated single centre prospective observational study was conducted at the Tata Medical Center, Kolkata, India between Jan 2015 and Mar 2019 after IRB approval. Patients diagnosed with ABNHL receiving standard of care chemo-immunotherapy were eligible. This study was supported by an educational research grant from Baxter to our institution. All patients who consented to participate were screened for cachexia at entry using a modified Subjective Global Assessment (SGA) tool (1). Baseline clinical factors of prognostic importance including stage, IPI score, etc. were recorded. All statistical analysis was carried out using EpiInfo-ver.7 software. Results:239 patients diagnosed with high grade B-NHL were recruited. The study group included 89 women and 150 men, and 77 (32.1%) were older than 65 years. 130 (54.3%) patients received private care. 88(36.8%) had IPI stage high-intermediate plus high grade; 136 (56.9%) had Ann Arbor stage III plus IV disease; 40 (16.7%) had extra-nodal NHL; 96 (40.1%) had weight loss and 107(44.7%) had reduced food intake. Cachexia scores estimated by the modified SGA tool was SGA-A in 101, SGA-B in 120 and SGA-C in 18 patients. Only 37 (15.4%) had been subjected to screening for malnutrition prior to cancer treatment. 44 (20.5%) patients experienced neutropenic sepsis during treatment. At a median follow up of 457 days, 69% achieved complete remission at the end of initial therapy, 50 (20.9%) patients died during the study period. In univariate analysis, SGA, IPI, Stage and age groups were statistically significant prognostic markers. The 2-year actuarial survival of all patients adjusted for SGA, IPI and Stage was 72%. The two-year actuarial survival in the SGA-A, SGA-B, and SGA-C groups were respectively 80%, 68% and 45% (p&lt;0.001). In a multivariate analysis using cox proportional hazards method the hazard ratio for SGA B was 1.67 (0.94-2.97), and SGA-C was 3.65, after adjusting for IPI and stage groups (p=0.0137).The follow up is continuing and final multivariate analysis will be done when sufficient events have occurred. Conclusions:Cachexia at diagnosis is an important independent prognostic biomarker in patients with ABNHL. The role of routine screening for cachexia before initiating treatments and providing individualized medical nutrition therapy along with physical therapy during chemotherapy to prevent worsening of cachexia and improve survival needs evaluation.

Evaluating mild cachexia syndrome in the HIV-positive pregnant woman

Background Immune activation and inflammation are common symptoms throughout HIV infection and lead to elevated circulating concentrations of cachectic cytokines. Aims To evaluate cachexia-like symptoms among HIV-positive and HIV-negative pregnant women, and investigate whether cachexic mechanisms may contribute to impaired HIV-exposed fetal and infant growth. Methods Pregnant women (n=114; 39% HIV-positive) were prospectively enrolled from an antenatal clinic in semi-rural Tanzania. Maternal cachexia-associated plasma cytokines and hormones, and clinical and anthropometric data were assessed. Cachexia scores were quantified using a novel adaptation of a validated cachexia scoring system. Infant growth anthropometry was measured at birth and after 6 months. Results Maternal cachexia score was inversely associated with infant birth weight, birth length, and weight-for-age z-score at 6 months. Conclusions Symptoms consistent with a mild cachectic state were associated with poorer infant outcomes. This effect was greater for HIV-exposed infants. A better understanding of the maternal cachexia burden and implications for maternal and infant health in HIV, other infections, and inflammatory conditions is needed.

Impact of Cachexia and Opioid Analgesic Cotreatment on Pregabalin Pharmacokinetics and Central Nervous System Symptoms in Cancer Patients.

Patients with cancer receiving pregabalin potentially have a high incidence of central nervous system (CNS) symptoms. The purpose of this study was to explore clinical factors influencing the incidence of CNS symptoms, including plasma pregabalin exposure, cancer cachexia, and opioid analgesic cotreatment. Sixty-eight patients with cancer receiving twice-daily pregabalin were enrolled. Plasma concentrations of pregabalin, clinical laboratory data, opioid analgesic cotreatment, and the Glasgow Prognostic Score, which is an inflammation-based cachexia score, were considered as clinical factors. The incidence of CNS symptoms was collected from the patients' medical records. The predose plasma concentrations of pregabalin at steady state were determined by ultra-high-performance liquid chromatography. The steady-state trough plasma pregabalin concentrations showed a large variability with an interquartile range of 0.43-1.2 mg/L per mg/kg and were negatively correlated with an estimated glomerular filtration rate (eGFR). C-reactive protein (standardized partial regression coefficient, β = 0.31) and opioid analgesic cotreatment (β = 0.24) were also identified in addition to eGFR (β = -0.60) in the multiple regression analysis. The incidence of CNS symptoms was significantly increased with opioid analgesic cotreatment and a higher Glasgow Prognostic Score but not with the absolute value of plasma pregabalin concentrations, eGFR, or other clinical laboratory data. In patients with cancer, steady-state trough plasma pregabalin concentrations were altered with renal function, systemic inflammation, and opioid analgesic cotreatment. However, a higher incidence of CNS symptoms observed in patients with cancer on pregabalin was more related to cachexia and opioid analgesic cotreatment than to altered pregabalin concentrations.

The animal cachexia score (ACASCO).

BackgroundNone of the published studies involving cancer cachexia experimental models have included a measure of the severity of the syndrome like the scoring system previously developed for human subjects. The aim of the present investigation was to define and validate a cachexia score usable in both rat and mouse tumor models.MethodsIn order to achieve this goal, we included in the study one rat model (Yoshida AH‐130ascites hepatoma) and two mouse models (Lewis lung carcinoma and Colon26 carcinoma). The Animal cachexia score (ACASCO) includes five components: (a) body and muscle weight loss, (b) inflammation and metabolic disturbances, (c) physical performance, (d) anorexia, and (e) quality of life measured using discomfort symptoms and behavioral tests.ResultsUsing the ACASCO values, three cut‐off values were estimated by applying hierarchical cluster analysis. Four groups were originally described, one exactly below the observed mean, a second exactly over the mean, and two other groups adjusted to every cue (inferior and superior). The three cut‐off values were estimated through maximization of the classification function. This was accomplished by using a similarity matrix based on the metric properties of the variables and assuming multinormal distribution. The results show that the four groups were: no cachexia, mild cachexia, moderate cachexia and advanced cachexia.ConclusionsThe results obtained allow us to conclude that the score could be very useful as an endpoint in pre‐clinical studies involving therapeutic strategies for cancer cachexia. The potential usefulness of ACASCO relates to the primary endpoint in pre‐clinical cancer cachexia drug evaluations.

MON-PO413: Prediction of 1-Year Survival After Radical Gastrectomy in Gastric Cancer by Cachexia Score Assessed by CT

MON-PO413: Prediction of 1-Year Survival After Radical Gastrectomy in Gastric Cancer by Cachexia Score Assessed by CT

PF716 CLINICAL IMPACT OF PROGNOSTIC NUTRITIONAL INDEX IN DIFFUSE LARGE B CELL LYMPHOMA

Please indicate where the abstract has been published before: Annals of HematologyBackground:Cachexia is an indicator of tumor progression in patients with malignancy. Cachectic patients exhibit intolerance and a reduced response to antitumor therapy, and have an unfavorable prognosis. An international consensus proposed diagnostic criteria for cancer cachexia including weight loss, low body mass index (BMI), and/or presence of sarcopenia. Other potential biomarkers (e.g., albumin, C‐reactive protein, pro‐inflammatory cytokines, and microRNAs) and scoring systems (e.g., cachexia score [CASCO], Glasgow prognostic score [GPS], prognostic nutritional index [PNI]) have also been studied to diagnose cancer cachexia and assess its severity.Aims:In this study, we assessed the associations among PNI, other clinical outcomes, and survival in patients with DLBCL. Then we sought valid cachexia markers with prognostic significance and designed a novel model to improve the prognostic ability of well‐known clinical indices for patients with DLBCL.Methods:A total of 228 DLBCL patients treated with first‐line R‐CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) were retrospectively reviewed. PNI was calculated as 10 × serum levels of albumin (g/dL) + 0.005 × absolute lymphocyte count (/mm3). Patients were categorized into low‐ and high‐PNI groups based on a cut‐off value of 40. The nomogram for predicting overall survival (OS) was constructed using a Cox regression model. PNI was positively correlated with skeletal muscle index, body mass index, and serum levels of albumin.Results:The low‐PNI group had a lower complete response rate (60.3% vs. 87.6%), increased treatment‐related toxicity, and more frequent treatment discontinuation (43.5% vs. 8.8%) than the high‐PNI group. The median OS was shorter in the low‐PNI group than the high‐PNI group (15.6 months vs. not reached; p &lt; 0.001, Figure.1). Multivariate Cox regression analyses showed that PNI, sarcopenia, and the international prognostic index (IPI) were independent prognostic factors for OS. The nomogram developed using this regression model showed excellent discriminatory ability for predicting OS (c‐index, 0.80) compared to the IPI alone (c‐index, 0.75).Summary/Conclusion:This study supports the results of a previous study [29], whereby low PNI is an independent poor prognostic factor in patients with DLBCL treated with first‐line R‐CHOP immunochemotherapy. In addition, we newly found that treatment‐related toxicity and early discontinuation of treatment occurred more frequently in DLBCL patients with low PNI. We anticipate that the new prognostic nomogram developed using PNI, SMI, and IPI may help to realize individualized therapy that considers both the disease characteristics and the patient's tolerance to treatment in patients with DLBCL. This will be validated externally in a future study.image

Validated screening tools for the assessment of cachexia, sarcopenia, and malnutrition: a systematic review

There is great overlap between the presentationof cachexia, sarcopenia, and malnutrition. Distinguishing between these conditions would allow for better targeted treatment for patients. The aim was to systematically review validated screening tools for cachexia, sarcopenia, and malnutrition in adults and, if a combined tool is absent, make suggestions for the generation of a novel screening tool. A systematic search was performed in Ovid Medline, EMBASE, CINAHL, and Web of Science. Two reviewers performed data extraction independently. Each tool was judged for validity against a reference method. Psychometric evaluation was performed as was appraisal of the tools' ability to assess the patient against consensus definitions. Thirty-eight studies described 22 validated screening tools. The Cachexia score (CASCO) was the only validated screening tool for cachexia and performed well against the consensus definition. Two tools assessed sarcopenia [the Short Portable Sarcopenia Measure (SPSM) and the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls)] and scored well against the 1998 Baumgartner definition. The SPSM required large amounts of equipment, and the SARC-F had a low sensitivity. Nineteen tools screened for malnutrition. The 3-Minute Nutrition Score performed best, meeting consensus definition criteria (European Society for Clinical Nutrition and Metabolism) and having a sensitivity and specificity of >80%. No tool contained all of the currently accepted components to screen for all 3 conditions. Only 3 tools were validated against cross-sectional imaging, a clinical tool that is gaining wider interest in body-composition analysis. No single validated screening tool can be implemented for the simultaneous assessment of cachexia, sarcopenia, and malnutrition. The development of a tool that encompasses consensus definition criteria and directs clinicians toward the underlying diagnosis would be optimal to target treatment and improve outcomes. We propose that tool should incorporate a stepwise assessment of nutritional status, oral intake, disease status, age, muscle mass and function, and metabolic derangement.

Prevalence and Correlates of Cardiac Cachexia among Jordanian Patients with Chronic Heart Failure

BACKGROUND: Cardiac cachexia is considered as an ominous complication that possibly associated with the terminal stages of chronic heart failure as it consumes the protein-calories reserves of the patients.AIMS: The aims of this study were to identify the prevalence, level, and correlates of cardiac cachexia among Jordanian patients with chronic heart failure.METHODS: A cross-sectional design was employed. A convenient sample of 300 chronic heart failure patients was recruited from accessible chronic heart failure patients who regularly visit the cardiac care clinics at two different hospitals that represent two health sectors in Jordan. A self-developed instrument was used to collect the data for the purpose of this study.RESULTS: The mean of the total cachexia score of the sample was 5.88. Cardiac cachexia was detected in 58.7% (n= 176) about half of them were having mild cachexia. The prevalence of cardiac cachexia was 13.15%. There were statistically significant correlation between the total cachexia score and some variables that include the patients’ age, monthly income, and number of years since diagnosed as chronic heart failure patients; however, number of daily smoked cigarettes wasn’t significantly correlated with the total cachexia score.CONCLUSION: Cardiac cachexia has not been widely investigated yet. The findings of this study can be used as a baseline data since this study is the first of its kind conducted at the national and regional level. In addition, this study can be useful for determining effective therapeutic modalities that can be employed on behalf of those patients among the health care team; particularly nurses.

Fit for transport? Broiler chicken fitness assessment for transportation to slaughter

AbstractEU legislation stipulates that unfit broilers may not be transported, but no guidelines for fitness-for-transport assessment are provided. Moreover, the impact of pre-slaughter conditions (eg crate stocking density) may depend on broiler fitness. We aimed to evaluate a fitness-assessment method and test physiological responses to the pre-slaughter phase with different stocking densities. Broilers (41 days; n = 1,939) were transported for 45 min at ‘high’ (160 cm2per kg), ‘medium’ (190 cm2per kg) or ‘low’ (220 cm2per kg) stocking density, and were subjected to a commercially representative pre-slaughter phase duration of ≈ 16 h. Pre-loading, lameness, illness, hock burns, foot-pad dermatitis, lesions, physical defects, cleanliness and cachexia were scored on a sample, for categorisation as fit (n = 49) or unfit (n = 25). Blood was collected before and after the pre-slaughter phase for determination of plasma levels of corticosterone (CORT), lactate, glucose and thiobarbituric acid-reactive substances (TBARS). Lameness, foot-pad dermatitis, lesions, illness, defects, and cachexia scores were, or tended to be, correlated with ≥ 1 physiological stress indicators. Unfit chickens tended to show or showed lower pre-transport glucose and lactate levels than fit chickens. Post-lairage, unfit chickens had higher TBARS and lower lactate levels compared to fit chickens. At high and low stocking densities, unfit chickens showed higher CORT levels than fit chickens. Furthermore, CORT levels of unfit chickens increased more at low stocking density. The results show that our method potentially identifies chickens experiencing additional stress during the pre-slaughter phase, due to poor physical condition. High and low stocking density proved a stressor for all, and especially for unfit chickens, with detrimental implications for their welfare.

Prognostic significance of cachexia score assessed by CT in male patients with small cell lung cancer.

To determine the prognostic significance of CT-determined cachexia scores (CSs) in 127 consecutive male small cell lung cancer (SCLC) patients, cross-sectional areas of muscle and fat tissues at the third lumbar vertebra (L3) were retrospectively measured on baseline CT images. CSs were determined based on the presence of sarcopenia and/or adipopenia. According to the presence of sarcopenia (L3 muscle index <55cm2 /m2 , 86.8%) and adipopenia (L3 fat index <22cm2 /m2 , 11.8%), CSs were defined as follows: CS2 (sarcopenia and adipopenia, 11.8%), CS1 (sarcopenia only, 74.8%) and CS0 (13.4%). CS2 was significantly related to lower body mass index (p<.001) and poor performance status (p=.002), and patients with CS2 had shorter OS than patients with CS1 or CS0 (median OS, 5.0months vs. 8.9months vs. 18.3months; p=.007). Multivariable analysis revealed that CS was an independent prognostic factor of poor survival (HR, 1.99 for CS1 and 2.59 for CS2, p=.036 and .023, CS0 as a reference), along with extensive stage (p<.001), supportive care only (p<.001) and an elevated lactate dehydrogenase (p=.005). CT-determined CSs, based on the presence of sarcopenia and/or adipopenia, could be used to predict prognosis in male SCLC.

Validation of the CAchexia SCOre (CASCO). Staging Cancer Patients: The Use of miniCASCO as a Simplified Tool.

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.

The cachexia score (CASCO) as a tool for staging cachectic cancer patients.

e20700 Background: An effective treatment for cancer cachexia requires an early recognition of its development by the identification of a staging system. The CAchexia SCOre (CASCO) has been conceiv...

Mild HIV‐induced maternal cachexia predicts adverse birth outcomes in rural Tanzania (620.5)

Chronic HIV immune activation alters systemic levels of cytokines regulating appetite and body composition and we hypothesized this is contributing to a mild degree of cachexia that typically remains undetected during pregnancy in food insecure regions. We developed a novel cachexia scoring system adapted to this context that included nutritional status (body mass index, mid‐upper arm circumference), anorexia, quality of life, hemoglobin, CD4, plasma ghrelin and cytokines: IL‐1β, IL‐6, TNF‐α, IFN‐γ, IL‐10. Forty‐four HIV+ (mean CD4=560 cells/µl) women who received antiretrovirals by delivery and 70 HIV‐ pregnant women volunteered for this prospective cohort. Women appeared similar and did not statistically differ by obstetrical histories, demographic, nutritional or clinical factors. More HIV+ women experienced adverse outcomes (combined miscarriage, stillbirth, low birth weight; 14 v 6 %) and delivered infants with lower mean birth weights (3026 v 3299 g; p=0.018) and lengths (45.7 v 47.0 cm; p=0.007). Among HIV+ women, cachexia score predicted lower birth weights (p=0.028) and lengths (p=0.002) indicating the observed cachexia explains in part less favorable birth outcomes in this setting.Grant Funding Source: Mario Einuadi Center for International Studies

Prognostic impact of fat tissue loss and cachexia assessed by computed tomography scan in elderly patients with diffuse large B‐cell lymphoma treated with immunochemotherapy

Approximately 30% of DLBCL patients are older than 70 yr. This study evaluated the prognostic impact of a cachexia score (CS) including fat tissue loss (adipopenia) and sarcopenia as assessed by computed tomography (CT scan) in elderly DLBCL patients treated with chemotherapy and rituximab (R). This retrospective analysis included 80 DLBCL patients older than 70 yr treated with R-CHOP or R-miniCHOP. Skeletal muscle (SM) and visceral (V) and subcutaneous (S) adipose (A) tissues were measured by analysing CT images at the third lumbar (L3) level. The median age of the patients was 78 yr. Forty-four and 46 patients were considered sarcopenic and adipopenic, respectively. The median progression-free survival (PFS) was 13.6 months in the adipopenic group and 49.4 months in the non-adipopenic group [hazard ratio (HR) = 2.27; 95% confidence interval (CI): 1.3-4; P = 0.0042]. The median overall survival (OS) was 25.7 months in the adipopenic group and 57.1 months in the non-adipopenic group (HR = 1.93; 95% CI: 1.05-3.55; P = 0.0342). A two-point CS including adipopenia and sarcopenia was created and defined two distinct risk groups with differences in outcomes that were highly significant. The CS was predictive of the prognosis in a multivariate analysis including body mass index (BMI) (< or ≥ 25 kg/m(2) ), age (< or ≥ 80 yr), international prognostic index (IPI) and albuminaemia (HR = 3.67; 95% CI = 1.93-6.97; P < 0.0001). A CS including sarcopenia and adipopenia, assessed by a single CT scan slice, predicts outcome independent of BMI and the IPI.

Clinical Relevance Of Cachexia Assessed By An Anthropometric Tool In Elderly Patients With Diffuse Large B-Cell Lymphoma Treated By Immunochemotherapy

BackgroundCancer Cachexia is a metabolic syndrome that can be present even in absence of weight loss and associated with significantly impaired survival. Muscle wasting represents a key-symptom of this syndrome and we recently demonstrated the strong prognosis impact of sarcopenia assessed by computed tomography (CT)-scan in diffuse large B-cell lymphoma (DLBCL) (Lanic et al. Leukemia & Lymphoma 2013). Conversely, the clinical relevance of loss of fat mass (adipopenia) remains unclear. The aim of this study was (i) to investigate the prognostic impact of a multidimensional tool combining a nutritional parameter (albuminemia) and body composition measurements (skeletal muscle and body fat composition) in elderly patients with DLBCL treated by chemotherapy and rituximab (R) (ii) to document the evolution of sarcopenia after immunochemotherapy. MethodsThis retrospective analysis included 80 DLBCL patients older than 70 years (y) and treated by R-CHOP or R-miniCHOP. Skeletal muscle (SM), visceral (V) and subcutaneal (S) adipose (A) tissues were measured by analysis of stored CT images at the Lumbar vertebrae 3 (L3) level. The surface of the muscular and adipose tissues was selected according to CT Hounsfield unit. Values were normalized for stature to calculate the L3 SM index (LSMI, in cm2/m2), the LVAI and the LSAI and used to define sarcopenia and visceral/subcutaneal adipopenia. ResultsThe characteristics of the patients were as follows: median age = 78 y [70-95]; 36 males; IPI 0-2 = 22, 3-5 = 58; treatment by R-CHOP (n = 45) or R-miniCHOP (n = 35); median body mass index (BMI; in kg/m2) = 23.9. According to the sex-specific defined cut-offs for LSMI (< 55.8 cm²/m² for men and 38.9 cm²/m² for women), 44 DLBCL patients (55 %, 23 males) were considered as sarcopenic. With a median follow-up of 39 months, the 2y overall survival (OS) in the sarcopenic population was 46% as compared to 84% in the non-sarcopenic group (HR = 3.12; CI95%, 1.66-5.88; p=0.0004). The median LSAI was 76.3 cm2/m2 [10-167] in females and 47.4 cm2/m2[22-100] in males. The median LVSAI was 43.5 cm2/m2[3-141] in females and 50.4 cm2/m2[14-159] in males. Adipopenia, defined by a low LVAI and/or a low LSAI was also highly predictive of the outcome. The 2y OS of the low LVAI population was 48% as compared to 82% for the non-adipopenic group (HR = 2.20; CI95%, 1.19-4.05; p=0.01). The 2y OS in the low LSAI population was 48% as compared to 80% in the non-adipopenic group (HR = 2.28; CI95%, 1.23-4.21; p=0.008). A Three-point cachexia score (CS) including adipopenia, sarcopenia and hypo-albuminemia (defined by an albuminemia < 35 g/L) was build and delineates three distinct risk-groups (Figure 1). More importantly the CS remains predictive of the prognosis in a multivariate analysis including BMI (< or >= 25 kg/m2), age (< or >= 80y), IPI and gender (HR=2.5; CI95%= 1.14-5.39; p =0.02). LMSI was subsequently reassessed in thirty seven patients during the routine CT scan follow-up [mean = 10 months after pre-treatment CT scan (range 2.8-19.2)]. 15 (40%) patients displayed a 5% decrease of their LSMI, whereas 13 (35%) and 9 (25%) displayed no significant change or increase (>5%) of the LMSI respectively. [Display omitted] ConclusionOur study demonstrates that sarcopenia and adipopenia estimated by CT-scan define cachexia more accurately than BMI or weight loss in elderly DLBCL patients. These factors can be integrated in a cachexia scoring tool which predicts the outcome independently of the BMI and of the IPI. CT scan follow-up indicates that cachexia is a reversible process that should be integrated as part of the therapeutic target in combination with lymphoma treatment. A prospective multicentric trial (registered as NCT01715961/Clinical.gov) is ongoing to validate these anthropometric and nutritional parameters and compare to geriatric assessment scales. Disclosures:No relevant conflicts of interest to declare.