Fujii Hironori, Kani Misato, Watanabe Daichi, Miura Yuto, Chikaishi Wakana, Tajima Jesse Yu, Makiyama Akitaka, Yamada Yunami, Ohata Koichi, Hirose Chiemi, Iihara Hirotoshi, Kobayashi Ryo, Matsuhashi Nobuhisa, Suzuki Akio
Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.
Int J Colorectal Dis. 2025 Jul 25;40(1):164. doi: 10.1007/s00384-025-04962-2.
Cachexia substantially affects the prognosis of patients with advanced cancer. While both the Asian Working Group for Cachexia (AWGC) and European Palliative Care Research Collaborative (EPCRC) criteria are widely used for diagnosis, their comparative effectiveness in diagnostic timing and prognostic value remain understudied.
This retrospective study included patients with metastatic colorectal cancer (mCRC) who received first-line chemotherapy between 2013 and 2023. Cachexia was assessed using three distinct criteria: AWGC criteria, defined as either weight loss > 2%, or body mass index (BMI) < 21 kg/m accompanied by at least one of the following: anorexia or elevated C-reactive protein level; EPCRC criteria, requiring weight loss > 5% (or weight loss > 2% if BMI is < 20); and Modified Glasgow Prognostic Score (mGPS). Analyses were performed using cumulative incidence and survival with a time-dependent Cox regression model.
We enrolled 313 patients with metastatic CRC. The 1-year cumulative incidence of cachexia showed marked variation across the different diagnostic criteria. Using the AWGC criteria, the incidence rate was 69%, whereas the EPCRC criteria identified 44% of the cases. The mGPS evaluation revealed incidence rates of 73% and 39% for scores of 1 and 2, respectively. Both AWGC- and EPCRC-defined cachexia correlated with significantly shorter overall survival (AWGC: hazard ratio (HR) = 2.41, P < 0.001; EPCRC: HR = 2.02, P < 0.001). Similarly, the mGPS scores indicated a poor prognosis.
The AWGC criteria identified a higher incidence of cachexia earlier in the disease course compared to the EPCRC criteria and showed a stronger association with overall survival. The mGPS shows promise as an alternative diagnostic tool to traditional weight-based assessments. These findings suggest new opportunities for early diagnosis of cachexia and intervention strategies in patients with mCRC.
恶病质严重影响晚期癌症患者的预后。虽然亚洲恶病质工作组（AWGC）标准和欧洲姑息治疗研究协作组（EPCRC）标准都广泛用于诊断，但它们在诊断时机和预后价值方面的比较有效性仍未得到充分研究。
这项回顾性研究纳入了2013年至2023年间接受一线化疗的转移性结直肠癌（mCRC）患者。使用三种不同标准评估恶病质：AWGC标准，定义为体重减轻>2%，或体重指数（BMI）<21kg/m²并伴有以下至少一项：厌食或C反应蛋白水平升高；EPCRC标准，要求体重减轻>5%（如果BMI<20，则体重减轻>2%）；以及改良格拉斯哥预后评分（mGPS）。使用累积发病率和生存情况以及时间依赖性Cox回归模型进行分析。
我们纳入了313例转移性CRC患者。恶病质的1年累积发病率在不同诊断标准之间存在显著差异。使用AWGC标准，发病率为69%，而EPCRC标准识别出44%的病例。mGPS评估显示，评分为1和2时的发病率分别为73%和39%。AWGC和EPCRC定义的恶病质均与显著缩短的总生存期相关（AWGC：风险比（HR）=2.41，P<0.001；EPCRC：HR=2.02，P<0.001）。同样，mGPS评分表明预后不良。
与EPCRC标准相比，AWGC标准在疾病进程中更早地识别出更高的恶病质发病率，并且与总生存期的关联更强。mGPS作为传统基于体重评估的替代诊断工具显示出前景。这些发现为mCRC患者恶病质的早期诊断和干预策略提供了新机会。
