Comparing two classifications of cancer cachexia and their association with survival in patients with unresected pancreatic cancer

Abstract

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.