Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.
Sci Rep. 2022 May 10;12(1):7647. doi: 10.1038/s41598-022-11736-1.
Cancer cachexia affects quality of life, response to chemotherapy, and survival in many advanced cancer patients. The aim of this study was to evaluate the prognostic value of pretreatment cachexia index (CXI) in patients with advanced hepatocellular carcinoma (HCC) treated with systematic chemotherapy. Patients with advanced HCC treated with lenvatinib therapy between October 2018 and October 2020 were retrospectively studied. The CXI was calculated as (L3 skeletal muscle index) × (serum albumin)/(neutrophil-to-lymphocyte ratio). The association with treatment response and early adverse events within the first two months of lenvatinib therapy was investigated. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method with log-rank test. Multivariable Cox regression was used to identify the predictors of survival. A total of 116 patients (median age: 60, male: 84.5% ) with calculated CXI. They divided into two groups: high CXI (≥ 53, n = 82) and low CXI (< 53, n = 34). Patients with low CXI had a significantly lower disease control rate (61.8% vs. 89.0%, p = 0.001) and a shorter median OS (8.0 [95% CI 6.2-9.8] vs. 12.3 [95% CI 10.1-14.4] months, p = 0.002) than those with high CXI. In multivariable analysis, low CXI was independently associated with shorter OS (HR: 2.07, 95% CI: 1.17-3.65, p = 0.01) and PFS (HR: 1.84, 95% CI: 1.09-3.09, p = 0.02). Of note, during the first two months of lenvatinib therapy, anorexia (41.2% vs. 22.0%, p = 0.04) developed more frequently among patients with low CXI than those with high CXI. The CXI may be a clinically useful index for predicting poor treatment response and prognosis in patients with advanced HCC undergoing lenvatinib treatment.
癌症恶病质会影响许多晚期癌症患者的生活质量、对化疗的反应和生存。本研究旨在评估系统化疗治疗的晚期肝细胞癌（HCC）患者治疗前恶病质指数（CXI）的预后价值。回顾性研究了 2018 年 10 月至 2020 年 10 月接受仑伐替尼治疗的晚期 HCC 患者。计算 CXI 为（L3 骨骼肌指数）×（血清白蛋白）/（中性粒细胞与淋巴细胞比值）。研究了 CXI 与仑伐替尼治疗前两个月内治疗反应和早期不良事件的关系。采用 Kaplan-Meier 法和对数秩检验估计总生存期（OS）和无进展生存期（PFS）。采用多变量 Cox 回归确定生存的预测因素。共纳入 116 例（中位年龄：60 岁，男性：84.5%）患者，计算 CXI。将患者分为两组：高 CXI（≥53，n=82）和低 CXI（<53，n=34）。低 CXI 组患者疾病控制率显著降低（61.8% vs. 89.0%，p=0.001），中位 OS 更短（8.0[95%CI 6.2-9.8] vs. 12.3[95%CI 10.1-14.4]个月，p=0.002）。多变量分析显示，低 CXI 与 OS 缩短独立相关（HR：2.07，95%CI：1.17-3.65，p=0.01）和 PFS 缩短独立相关（HR：1.84，95%CI：1.09-3.09，p=0.02）。值得注意的是，在仑伐替尼治疗的前两个月，低 CXI 组患者的厌食症（41.2% vs. 22.0%，p=0.04）比高 CXI 组更常见。CXI 可能是预测接受仑伐替尼治疗的晚期 HCC 患者治疗反应不良和预后不良的一个有用的临床指标。
