Widely used cachexia diagnostic criteria could “underestimate” the condition in Asian patients with lung cancer, according to study findings published in Thoracic Cancer.
Cachexia is an indicator of poor prognosis in lung cancer treatment. Diagnostic criteria from the European Palliative Care Research Collaboration (EPCRC) is typically used to identify the condition, but new criteria has been proposed by the Asian Working Group for Cachexia (AWGC).
Under the EPCRC guidelines, a cachexia diagnosis is made in patients with body weight loss > 5% in the last 6 months, those with a body mass index (BMI) < 20 kg/m2 and continuous weight loss > 2%, or individuals with sarcopenia and ongoing weight loss > 2%, according to the study authors.
In contrast, the study authors explained that under the proposed AWGC guidelines, a cachexia diagnosis is made in patients with chronic wasting disease and a BMI < 21 kg/m2 or weight loss > 2% in the previous 3–6 months in addition to anorexia, decreased grip strength, or C-reactive protein (CRP) > 0.5 mg/dL.
To uncover potential differences in diagnostic rates and how they correlate with lung cancer prognosis, a team of researchers from Japan compared traditional diagnostic criteria from the EPCRC with newly proposed criteria from the AWGC.
The single-center retrospective cohort study evaluated patients receiving outpatient chemotherapy for lung cancer. The investigators employed Kaplan-Meier curves and log-rank tests, a Cox proportional hazards model, and a C-statistics analysis to analyze and compare survival, the association between cachexia diagnosis and lung cancer prognosis, and “the discriminative power for prognosis,” respectively.
The study examined 106 patients; the median age was 75 years and 70.8% of participants were male. The EPCRC criteria diagnosed 58 cases of cachexia and the AWGC criteria diagnosed 77 cases. Furthermore, the AWGC criteria diagnosed all cases diagnosed by the EPCRC, except for one patient.
The results showed that, per both criteria, patients with cachexia had a “significantly poorer prognosis” (EPCRC, P=.002; AWGC, P=.001). In addition, both sets of criteria demonstrated an “almost equal” level of “discriminative power for prognosis (EPCRC, C-statistic=.658; AWGC, C-statistic=.658).”
Moreover, the study found that CRP in the AWGC criteria was the “most strongly related to prognosis.”
The researchers stated that cachexia indicated poor prognosis in lung cancer for patients undergoing chemotherapy per both sets of diagnostic criteria, and that both the AWGC and EPCRC criteria had “similar prognostic discriminatory power” for Asian patients with lung cancer.
“Among CRP, anorexia, and grip strength, elevated CRP may be the most prognostically relevant parameter in the AWGC criteria,” the investigators concluded.
Source: Thoracic Cancer
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