Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University) , Chongqing, China.
Nutrition. 2025 Jan;129:112594. doi: 10.1016/j.nut.2024.112594. Epub 2024 Oct 5.
The aim of this study was to evaluate the combined prognostic value of calf circumference (CC) and serum albumin on mortality in patients with cancer cachexia aged ≥65 years.
This multicenter cohort study involved 5322 older patients in hospital with cancer cachexia. The combined indicator of CC and albumin was defined as the calf circumference-albumin (CCA) index. Harrell's C index, a time-dependent receiver operating characteristic curve analysis, was used to assess the prognostic performance of the CCA index and other indices. The optimal thresholds method was used to determine the cutoff values of CC and albumin, and the association between the CCA index and all-cause mortality was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models.
A total of 3875 men and 1447 women with a mean age of 72.0 years (range: 68.0-78.0 years) and a mean follow-up time of 55.0 months (range: 25.0-85.0 months) were included in the study. A total of 1269 patients were classified into the low CCA index group (0 score) by the optimal thresholds method. In the overall population, the CCA index showed better differentiating power at predicting mortality in older patients with cancer cachexia compared with CC or albumin alone (C index = 0.639; 95% CI: 0.612-0.666; P < 0.05). The time-dependent receiver operating characteristic curve showed that the CCA index had the highest prognostic value of all the measures studied (P < 0.05). In the overall population, male and female patients with a high CCA index (2 score) showed better performance than those with a low CCA index (0 or 1 score).
The CCA index could significantly predict the mortality of older patients with cancer cachexia, which might provide renewed assistance for future clinical management.
本研究旨在评估小腿围（CC）和血清白蛋白联合对年龄≥65 岁癌症恶病质患者死亡率的预测价值。
本多中心队列研究纳入了 5322 名患有癌症恶病质的老年住院患者。CC 和白蛋白的联合指标定义为小腿围-白蛋白（CCA）指数。Harrell's C 指数、时间依赖性受试者工作特征曲线分析用于评估 CCA 指数和其他指标的预后性能。采用最佳阈值法确定 CC 和白蛋白的截断值，Kaplan-Meier 分析和 Cox 比例风险回归模型评估 CCA 指数与全因死亡率的相关性。
本研究共纳入 3875 名男性和 1447 名女性患者，平均年龄为 72.0 岁（范围：68.0-78.0 岁），平均随访时间为 55.0 个月（范围：25.0-85.0 个月）。采用最佳阈值法，共有 1269 例患者被归类为低 CCA 指数组（0 分）。在总体人群中，与单独使用 CC 或白蛋白相比，CCA 指数在预测癌症恶病质老年患者死亡率方面具有更好的区分能力（C 指数=0.639；95%CI：0.612-0.666；P<0.05）。时间依赖性受试者工作特征曲线显示，CCA 指数在所有研究指标中具有最高的预后价值（P<0.05）。在总体人群中，高 CCA 指数（2 分）的男性和女性患者比低 CCA 指数（0 分或 1 分）患者表现更好。
CCA 指数可显著预测老年癌症恶病质患者的死亡率，这可能为未来的临床管理提供新的帮助。
