Comparing two classifications of cancer cachexia and their association with survival in patients with unresected pancreatic cancer
Journal article, Peer reviewed
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Cancer cachexia is characterized by reduced weight and muscle mass, poor treatment tolerance and short survival. A universally accepted definition of this condition lacks. Two classifications have recently been proposed; the 3-factor classification requiring ≥two of three factors; weight loss ≥10%, food intake ≤1500 kcal/d, and C-reactive protein ≥10 mg/l, and the consensus classification defining cachexia by either weight loss >5% the past 6 months, or BMI <20 kg/m² or sarcopenia, both with ongoing weight loss >2%. Furthermore, cachexia may be considered a trajectory with pre-cachexia as the initial stage identified by weight loss ≤5%, anorexia and metabolic change. We examined the consistency between the two classifications, and their association with survival in a palliative cohort of pancreatic cancer patients. Patients with unresected pancreatic cancer were recruited. CT-images were used to determine sarcopenia. Height/weight/C-reactive protein and survival were extracted from medical records. Food intake was estimated from patients’ self-report. Forty-five patients (25 males, median age 72 years, range 35-89) were included. The agreement for cachexia and non-cachexia was 78% across classifications. Overall survival was poorer in cachectic compared to non-cachectic patients (3-factor classification, P=0.0052; consensus classification, P=0.056; when pre-cachexia was included in the consensus classification, P=0.027). Both classifications showed a trend towards lower median survival (P<0.05) with the presence of cachexia. In conclusion, the two classifications showed good overall agreement in defining cachectic pancreatic cancer patients, and cachexia was associated with poorer survival according to both.