Comparative Study on Associations Between Lung Cancer Prognosis and Diagnostic Criteria Set by the European Palliative Care Research Collaboration and the Asian Working Group for Cachexia

Abstract

Background: Cachexia is a poor prognostic factor in many advanced cancers. Cachexia diagnostic criteria of the European Palliative Care Research Collaboration (EPCRC) may underestimate cachexia in Asians; therefore, new criteria have been proposed by the Asian Working Group for Cachexia (AWGC). We compared both criteria to determine differences in diagnostic rates and their association with lung cancer prognosis.

Patients and methods: This single-center, retrospective cohort study considered lung cancer outpatients receiving chemotherapy. Survival was analyzed using Kaplan-Meier curves and log-rank tests. The association between cachexia diagnosis and prognosis was examined for each set of criteria using a Cox proportional hazards model. C-statistic analysis was performed to compare the discriminative power for prognosis.

Results: Among the 106 participants analyzed (median age, 75 [71-79] years; 75 males [70.8%]; 91 [85.9%] with performance status [PS] 0-1), 58 (54.7%) and 77 (72.6%) cachexia cases were diagnosed using the EPCRC and AWGC criteria, respectively. The latter encompassed all but one patient diagnosed using the EPCRC criteria. Patients with cachexia had a significantly poorer prognosis according to both criteria (EPCRC, p = 0.002; AWGC, p = 0.001). Both criteria had almost equal discriminative power for prognosis (EPCRC, C-statistic = 0.658; AWGC, C-statistic = 0.658). CRP in the AWGC criteria was most strongly related to prognosis.

Conclusions: Cachexia was an independent poor prognostic factor in lung cancer patients receiving chemotherapy under the AWGC and EPCRC criteria, both of which had similar prognostic discriminatory power. Among CRP, anorexia, and grip strength, elevated CRP may be the most prognostically relevant parameter in the AWGC criteria.

Keywords: cancer cachexia; lung cancer; new cachexia diagnostic criteria for Asians; prognosis.

FIGURE 1

Patient flowchart.

FIGURE 2

Prevalence of cachexia. *BMI < 21 kg/m² but no weight loss within 6 months, good appetite, no elevated CRP, and no loss of grip strength. AWGC, Asian Working Group for Cachexia; BMI, body mass index; CRP, C‐reactive protein; EPCRC, European Palliative Care Research Collaboration.

FIGURE 3

Breakdown of 77 cases diagnosed with cachexia by AWGC criteria. AWGC, Asian Working Group for Cachexia; BMI, body mass index; CRP, C‐reactive protein; EPCRC, European Palliative Care Research Collaboration.

FIGURE 4

Overall survival. (A) AWGC. (B) EPCRC. AWGC, Asian Working Group for Cachexia; CI, confidence interval; EPCRC, European Palliative Care Research Collaboration; OS, overall survival.