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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Original versionNutrition and Cancer 2015, 67(3):472-480 10.1080/01635581.2015.1004728
There is no universally accepted definition of cancer cachexia. Two classifications have been proposed; the 3-factor classification requiring ≥2 of 3 factors; weight loss ≥10%, food intake ≤1500 kcal/day, and C-reactive protein ≥10 mg/l, and the consensus classification requiring weight loss >5% the past 6 mo, or body mass index <20 kg/m2 or sarcopenia, both with ongoing weight loss >2%. Precachexia is the initial stage of the cachexia trajectory, identified by weight loss ≤5%, anorexia and metabolic change. We examined the consistency between the 2 classifications, and their association with survival in a palliative cohort of 45 (25 men, median age of 72 yr, range 35–89) unresected pancreatic cancer patients. Computed tomography images were used to determine sarcopenia. Height/weight/C-reactive protein and survival were extracted from medical records. Food intake was self-reported. The agreement for cachexia and noncachexia was 78% across classifications. Survival was poorer in cachexia compared to noncachexia (3-factor classification, P = 0.0052; consensus classification, P = 0.056; when precachexia was included in the consensus classification, P = 0.027). Both classifications showed a trend toward 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.