Predicting survival in cancer patients: the role of cachexia and hormonal, nutritional and inflammatory markers

Abstract

Background: Cancer can lead to weight loss, anorexia, and poor nutritional status, which are associated with decreased survival in cancer patients.

Methods: Male cancer patients (n = 136) were followed for a mean time of 4.5 years. Variables were obtained at baseline: cancer stage, albumin, hemoglobin, tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, bioavailable testosterone, appetite questionnaire, and weight change from baseline to 18 months. Primary statistical tests included Kaplan-Meier survival analysis and Cox proportional hazard regression (PHREG).

Results: Univariate PHREG showed that cancer stage, albumin, hemoglobin, TNF-α, IL-6, and weight change were each significantly associated with mortality risk (P < 0.05), but bioavailable testosterone was not. Multivariate PHREG analysis established that weight change and albumin were jointly statistically significant even after adjusting for stage.

Conclusion: In this sample of male oncology patients, cancer stage, serum albumin, and weight loss predicted survival. High levels of inflammatory markers and hemoglobin are associated with increased mortality, but do not significantly improve the ability to predict survival above and beyond cancer stage, albumin, and weight loss.

Fig. 1

Cox proportional hazard regression models including the effects of different variables on survival accounting for cancer stage. *P < 0.05. All variables were assessed at baseline. Weight change (“baseline to F/U”) was measured from baseline to 18 months follow-up. Weight change (“6 months prior to baseline”) was measured from 6 months prior to baseline. Appetite is measured using a visual analogue scale question: “How would you rate/describe your appetite?” and is rated on self-report on a scale of 0 to 9 (Supplemental Materials)