Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-Cho, Yonago, 683-8504, Japan.
Department of Surgery, Japanese Red Cross Tottori Hospital, 117 Shotoku-Cho, Tottori, 680-8517, Japan.
Surg Today. 2024 Mar;54(3):231-239. doi: 10.1007/s00595-023-02721-w. Epub 2023 Aug 1.
To investigate the prognostic utility of the cachexia index (CXI) in unresectable advanced gastric cancer (UAGC).
The relationship between CXI and the outcomes was evaluated in 102 patients with UAGC who had received first-line palliative 5-fluorouracil-based chemotherapy between January 2012 and December 2021.
The median survival time (MST) from first-line chemotherapy initiation was 16.2 months, and the cohort included 60 and 42 patients with high and low CXIs, respectively, based on the optimal CXI cutoff. The rates of patients with a performance status score of 0, recurrence, third-line chemotherapy, and all grade 3-4 side effects, including febrile neutropenia (FN), were significantly higher in the CXI group than in the CXI group. The prognosis based on MST was significantly better in the CXI group than in the CXI group (22.5 vs. 11.6 months, p < 0.001). According to a multivariate analysis, a low CXI and performance status score of 1-2 were poor prognostic factors.
Patients with UAGC and a low CXI had poorer prognoses and more frequent grade 3-4 side effects, including FN, than those with a high CXI. Patients with UAGC and a low CXI should be carefully managed to control for side effects to receive subsequent treatment.
研究恶病质指数（CXI）在不可切除的晚期胃癌（UAGC）中的预后价值。
2012 年 1 月至 2021 年 12 月，102 例接受一线基于 5-氟尿嘧啶姑息性化疗的 UAGC 患者，评估 CXI 与结局的关系。
一线化疗开始后的中位生存时间（MST）为 16.2 个月，根据最佳 CXI 截止值，队列中分别有 60 例和 42 例患者的 CXI 较高和较低。根据 MST，CXI 组患者的体能状态评分 0 级、复发、三线化疗和所有 3-4 级不良反应（包括发热性中性粒细胞减少症[FN]）的发生率明显高于 CXI 组。CXI 组的预后明显优于 CXI 组（22.5 个月比 11.6 个月，p<0.001）。多变量分析显示，低 CXI 和体能状态评分 1-2 是不良预后因素。
UAGC 患者的 CXI 较低，预后较差，FN 等 3-4 级不良反应的发生率较高。应仔细管理 CXI 较低的 UAGC 患者，以控制不良反应，接受后续治疗。
