A novel staging system for cancer cachexia.

Abstract

12073 Background: Cancer cachexia affects a large percentage of advanced cancer patients. It’s defined by a consensus definition of unintentional >5% body weight loss over six months. There is no standard way of assessing severity of cancer cachexia. We developed a novel cancer cachexia staging system based on routine clinical parameters. Methods: In a prospective case control study of newly diagnosed cancer patients to identify biomarkers of cancer cachexia, cases were patients with stage III/IV cancer and >5% body weight loss and serum albumin of <3.5g/dl. Controls were patients with stage I-III without weight loss and serum albumin of ≥3.5g/dl. Patients were prospectively followed up between April 2020 and August 2024 with blood biomarkers, anthropometric measurements and radiological parameters. Utilizing data from cases only a novel cancer cachexia staging system was developed called (University of Texas) UT Cancer Cachexia Staging System using 4 clinical parameters namely body mass index (BMI), serum albumin (Alb), neutrophil to lymphocyte ration (NLR) and resting heart rate (RHR). Using quartiles as cut off for each of these four variables, patients were divided into three groups and given a score of 0.5, 1.5 or 2.5 (Table). The cumulative score of each patient was calculated based on individual values of these 4 variables at the time of diagnosis and then categorized into stage I (≤5), Stage II (5-7) or Stage III (>7) cancer cachexia. Kaplan-Meier survival curves were generated for patients in each stage. The univariable Cox regression model was used to compare hazard ratios across the 3 stages. The multivariable Cox regression model was employed to compare hazard ratios between the stages, adjusting for other key demographic and clinical covariates. Results: A total of 109 patients were enrolled in the cachexia group (Male=69, Females=40, Median age = 69 years). The cancer types included Lung cancer (n=50), GI cancers (n=41) and other cancers (n= 18). There were 49 patients (45%) patients with stage I cachexia, 40 (36%) with stage II and 20 (18%) with stage III cachexia. Median overall survival (OS) for patients with stage I cancer cachexia was 11.4 months, for stage II 6.5 months and for stage III 3.5 months. In univariate cox-regression model the difference in hazard ratio between stage I and stage II patients was statistically significant (p=0.004) as was between stage I and stage III (P =0.007). In multi-variable Cox-regression model controlling for age, gender and cancer type, patients with stage II and III cancer cachexia had significantly worse outcome as compared to patients with stage I cancer cachexia. Conclusions: UT cancer cachexia staging system represents a novel staging system which should be validated on a larger data set. Once validated this can help guide clinical management as well as clinical research in patients with cancer cachexia. Development of cancer cachexia staging system based on BMI, albumin, NLR and RHR by using quartiles as cutoff points in the case group (n=109). Score=0.5 Score=1.5 Score=2.5 Variable Cutoff Number of patients Cutoff Number of patients Cutoff Number of patients BMI ≥29 26 21-29 56 <21 26 Albumin ≥3.2 30 2.3-3.2 60 <2.3 18 NLR <3 30 3-8 50 >8 28 RHR * <73 25 73-95 57 >95 26 UT cancer cachexia stage groups defined by using cutoff points for total cancer cachexia score. Stage I <5 Stage II 5-7 Stage III >7