Fida Saba, Xu Hongxia, Weng Min, Zhou Chunling, Ma Hu, Li Wei, Cui Jiuwei, Shi Hanping, Song Chunhua
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 Aug;136:112794. doi: 10.1016/j.nut.2025.112794. Epub 2025 Apr 8.
Handgrip strength (HGS) and platelet-to-albumin ratio (PAR) are established prognostic markers of cancer cachexia. This study evaluates the combined efficacy of HGS and PAR using a single index (HPA) for predicting survival outcomes in cancer patients with cachexia aged ≥18 years.
The multicenter Nutrition Status and Its Clinical Outcomes in Common Cancers study, conducted from July 2013 to April 2022, enrolled 5189 participants. Thresholds for HGS and PAR were determined using optimal stratification, leading to the development of HPA index. Prognostic accuracy was assessed using time-dependent receiver operating characteristic analysis, Kaplan-Meier survival curves, and Cox proportional hazards models.
The cohort consisted of 3127 men and 2062 women, with a median follow-up of 36 months, and mean age of 58 years. Low HGS thresholds were 19 kg (female) and 31.9 kg (male), and high PAR cut-offs were 9.07 × 10⁹ (female) and 6.52 × 10⁹ (male). Both low HGS and high PAR levels were linked to increased mortality risk. The HPA index showed superior prognostic accuracy (C-index = 0.611; 95% confidence interval: 0.58-0.61; P < 0.001) compared with HGS or PAR alone. Kaplan-Meier analysis indicated significantly reduced survival in patients with low HGS and high PAR.
The HPA index is a clinically significant prognostic tool for cancer cachexia, enhancing survival prediction and guiding patient management.
握力（HGS）和血小板与白蛋白比值（PAR）是已确定的癌症恶病质预后标志物。本研究使用单一指标（HPA）评估HGS和PAR联合预测≥18岁癌症恶病质患者生存结局的疗效。
2013年7月至2022年4月进行的多中心常见癌症营养状况及其临床结局研究纳入了5189名参与者。使用最优分层法确定HGS和PAR的阈值，从而开发出HPA指数。使用时间依赖性受试者工作特征分析、Kaplan-Meier生存曲线和Cox比例风险模型评估预后准确性。
该队列包括3127名男性和2062名女性，中位随访时间为36个月，平均年龄为58岁。低HGS阈值为19千克（女性）和31.9千克（男性），高PAR临界值为9.07×10⁹（女性）和6.52×10⁹（男性）。低HGS和高PAR水平均与死亡风险增加相关。与单独的HGS或PAR相比，HPA指数显示出更高的预后准确性（C指数=0.611；95%置信区间：0.58 - 0.61；P<0.001）。Kaplan-Meier分析表明，低HGS和高PAR患者的生存率显著降低。
HPA指数是一种对癌症恶病质具有临床意义的预后工具，可提高生存预测并指导患者管理。
