Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
J Cachexia Sarcopenia Muscle. 2023 Apr;14(2):891-902. doi: 10.1002/jcsm.13207. Epub 2023 Mar 7.
Cancer cachexia is prevalent in digestive tract cancer patients and has significant impacts on prognosis; it is vital to identify individuals who are at risk of cancer cachexia to allow for appropriate evaluation and treatment. This study evaluated whether digestive tract cancer patients with a risk of cancer cachexia and who had a risk of adverse survival could be identified before abdominal surgery.
This large-scale cohort study involved patients who underwent abdominal surgery between January 2015 and December 2020 to treat digestive tract cancer. Participants were allocated to the development cohort, the validation cohort, or the application cohort. Univariate and multivariate analyses of the development cohort were performed to detect distinct risk variables for cancer cachexia to create a cancer cachexia risk score. The performance of the risk score across all the three cohorts was assessed through calculating the area under the receiver operating characteristic curve (AUC), as well as calibration and decision curves. We tested how well the score predicted survival outcomes in the application cohort.
A total of 16 264 patients (median 64 years of age; 65.9% male) were included, with 8743 in the development cohort, 5828 in the validation cohort, and 1693 in the application cohort. Seven variables were identified as independent predictive factors and were included in the cancer cachexia risk score: cancer site, cancer stage, time from symptom onset to hospitalization, appetite loss, body mass index, skeletal muscle index, and neutrophil-lymphocyte ratio. The risk score predicting cancer cachexia owns a good discrimination, with the mean AUC of 0.760 (P < 0.001) in the development cohort, 0.743 (P < 0.001) in the validation cohort, and 0.751 (P < 0.001) in the application cohort, respectively, and had an excellent calibration (all P > 0.05). The decision curve analysis revealed net benefits of the risk score across a range of risk thresholds in the three cohorts. In the application cohort, compared with the high-risk group, the low-risk group experienced significantly longer overall survival [hazard ratio (HR) 2.887, P < 0.001] as well as relapse-free survival (HR 1.482, P = 0.01).
The cancer cachexia risk score constructed and validated demonstrated good performance in identifying those digestive tract cancer patients before abdominal surgery at a higher risk of cancer cachexia and unfavourable survival. This risk score can help clinicians to enhance their capabilities to screen for cancer cachexia, assess patient prognosis, and strengthen early decision-making on targeted approaches to attune cancer cachexia for digestive tract cancer patients before abdominal surgery.
癌症恶病质在消化道癌症患者中普遍存在，对预后有重大影响；识别有癌症恶病质风险的个体，以便进行适当的评估和治疗至关重要。本研究旨在评估在腹部手术前，是否可以识别出有癌症恶病质风险和不良生存风险的消化道癌症患者。
这是一项大规模的队列研究，纳入了 2015 年 1 月至 2020 年 12 月期间接受腹部手术治疗消化道癌症的患者。将参与者分配到发展队列、验证队列或应用队列。对发展队列进行单变量和多变量分析，以确定癌症恶病质的独特风险变量，从而建立癌症恶病质风险评分。通过计算受试者工作特征曲线下面积（AUC）、校准和决策曲线评估风险评分在所有三个队列中的表现。我们还在应用队列中检验了评分对生存结局的预测效果。
共纳入 16264 例患者（中位年龄 64 岁；65.9%为男性），其中 8743 例来自发展队列，5828 例来自验证队列，1693 例来自应用队列。7 个变量被确定为独立的预测因素，并纳入癌症恶病质风险评分：癌症部位、癌症分期、从症状出现到住院的时间、食欲减退、体重指数、骨骼肌指数和中性粒细胞-淋巴细胞比值。预测癌症恶病质的风险评分具有良好的区分度，发展队列的平均 AUC 为 0.760（P<0.001），验证队列为 0.743（P<0.001），应用队列为 0.751（P<0.001），且均具有良好的校准度（均 P>0.05）。决策曲线分析显示，该风险评分在三个队列的一系列风险阈值下均具有净获益。在应用队列中，与高危组相比，低危组的总生存时间显著延长[风险比（HR）2.887，P<0.001]，无复发生存时间也更长（HR 1.482，P=0.01）。
构建和验证的癌症恶病质风险评分在识别腹部手术前有更高癌症恶病质和不良生存风险的消化道癌症患者方面表现良好。该风险评分有助于临床医生提高筛查癌症恶病质、评估患者预后的能力，并在腹部手术前加强针对消化道癌症患者的癌症恶病质的靶向治疗的早期决策能力。
