Cancer cachexia and sarcopenia are frequently observed in cancer patients and associated with poor survival. The majority of studies of cancer cachexia and sarcopenia have been done in patients with solid tumors of different origins, and there are currently no good predictors of the benefit of chemotherapy or factors that predict survival in advanced cancer.
The purpose of our prospective study was to evaluate prevalence of cachexia and sarcopenia using international consensus definition and criteria for diagnosis in patients with diagnosed advanced non-small cell lung cancer (NSCLC) stage IIIB and IV and their relation to chemotherapy toxicity and survival prediction. A secondary aim was to compare several biochemical markers (CRP, IL-6, protein, and albumin) with time to tumor progression in order to assess prognostic value or to guide a treatment.
Between December 2013 and April 2015, the prospective cohort study of 100 Caucasian patients with advanced NSCLC stage IIIB or IV, who were referred consecutively to Department for Respiratory Diseases “Jordanovac,” was evaluated. Anthropometric measurements and biochemical data (CRP, albumin, protein, IL-6, haemoglobin) together with body composition measurements (total muscle cross-sectional area, lumbar skeletal muscle index) were obtained for each patient before starting with platinum-doublet therapy. Skeletal muscle cross-sectional area at the third lumbar vertebra was measured by computerized tomography, and sarcopenia was defined using a previously published cutoff point. Toxicity was assessed after cycle 1 of treatment and time-to-tumor progression was determined prospectively.
One hundred patients with advanced lung cancer were recruited: 67 were male and median age was 64 years. The median time to disease progression was 187 days. The prevalence of cachexia and sarcopenia in study cohort was 69 and 47 %, respectively. CRP, IL-6, and albumin concentration in cachectic compared to non-cachectic patients demonstrated statistically significant difference (p = 0.020, p = 0.040, p = 0.003). Cachexia and sarcopenia were not found to be predictors of chemotoxicity nor was time to tumor progression. On the contrary, albumin concentration with established cutoff point of 37.5 g/L was clearly proved as the predictive factor of both chemotoxicity (OR (95 % CI) = 0.85; p < 0.001) and survival (HR (95 % CI) = 0.55).
Albumin level has been shown to be more important predictive marker of chemotherapy toxicity and survival than cachexia and sarcopenia are. This approach in clinical settings can be used to guide the choice of oncologic treatment.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Fearon K, Strasser F, Anker DS (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489–495
Prado CM, Lieffers JR, McCargar LJ, Reinman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumors of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635
Moses AWG, Slater C, Preston T, Barber MD, Fearon KCH (2004) Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer 90:996–1002
Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB (2009) Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabin treatment. Clin Cancer Res 15:2920–2926
Mir O, Coriat R, Blanchet B et al (2012) Sarcopenia predicts early dose-limiting toxicities pharmacokinetics of sorafenib in patients with hepatocellular carcinoma. PLoS One 7, e37563
Dewys WD, Begg C, Lavin PT et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69:491–497
Fearon KHC, Voss AC, Hustead DS on the bahalf of the Cancer Cachexia Study Group (2006) Definition of cancer cachexia: effect of weight loss, reduced food intake and systemic inflammation on functional status and prognosis. Am J Clin Nutr 83:1345–1350
von Haehling S, Anker SD (2010) Cachexia as a major underestimated and unmet medical need: facts and numbers. J Cachex Sarcopenia Muscle 1:1–5
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vanderwoude M, Zamboni M (2010) Sarcopenia: European concensus on definition and diagnosis: report of the European Working Group on sarcopenia in older people. Age Aging 39:412–423
Baracos VE, Reiman T, Mourtzakis M, Gioulbasanis I, Antoun S (2010) Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis. Am J Clin Nutr 91:1133S–1137S
Bistrian B (2007) Systemic response to inflammation. Nutr Rev 65(12 Pt 2):S170–S172
Delano MJ, Moldawer LL (2006) The origins of cachexia in acute and chronic inflammatory diseases. Nutr Clin Pract 21(1):68–81
Argiles JM, Lopez-Soriano FJ (1998) Catabolic proinflammatory cytokines. Curr Opin Clin Nutr Metab Care 1:245–251
Walsh D, Mahmoud F, Barna B (2003) Assessment of nutritional status and prognosis in advanced cancer: interleukin-6, C-reactive protein, and the prognostic and inflammatory nutritional index. Support Care Cancer 11(1):60–62
Deans C, Wigmore SJ (2005) Systemic inflammation, cachexia and prognosis in patients with cancer. Curr Opin Clin Nutr Metab Care 8:265–269
Heymsfield SB, Wang Z, Baumgartner RN, Ross R (1997) Human body composition: advances in models and methods. Annu Rev Nutr 17:527–558
Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R (1998) Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol 85:115–122
Shen W, Punyanitya M, Wang Z et al (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross sectional image. J Apl Physiol 97:2333–2338
Miller KD, Jones E, Yanovski JA, Shankar R, Feuerstein I, Falloon J (1998) Visceral abdominal-fat accumulation associated with use of indinavir. Lancet 351:871–875
Mourtzakis M, Prado CM, Lieffers JR et al (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33:997–1006
Lieffers JR, Mourtzakis M, Hall KD et al (2009) A viscerally driven cachexia syndrome in patients with advanced colorectal cancer: contributions of organ and tumor mass to whole-body energy demands. Am J Clin Nutr 89:1173–1179
Prado CM, Baracos VE, McCargar LJ, Mourtzakis M, Mulder KE, Reiman T, Butts CA, Scarfe AG, Sawyer MB (2007) Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res 13:3264–3268
WHO (2000) Obesity: preventing and managing the global epidemic. World Health Organization, Geneva, Switzerland
Martin L, Birdsell L, Macdonald N, Reinman T, Clandinin MT, McCargar LJ, Murphy R, Ghosh S, Sawyer MB, Baracos VE (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31:1539–1547
Kimura M, Naito T, Kenmotsu H, Taira T, Wakuda K, Oyakawa T, Hisamatsu Z, Tokito T, Imai H, Akamatsu H, Ono A, Kaira K, Murakami H, Endo M, Mori K, Takahashi T, Yamamoto N (2015) Prognostic impact of cancer cachexia in patients with advanced non-small cell lung cancer. Support Care Cancer 23:1699–1708
Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB (2003) Years of life lost due to obesity. JAMA 289:187–193
Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS (2001) Sarcopenia. J Lab Clin Med 137:231–243
Cosqueric G, Sebag A, Ducolombier C, Thomas C, Piette F, Weill-Engerer S (2006) Sarcopenia is predictive of nosocomial infection in care of elderly. Br J Nutr 96:895–901
Baumgartner RN, Koehler KM, Gallagher D, Romero L, Hezmsfield SB, Ross RR, Garrz PJ, Lindeman RD (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763
Kim EY, Ys K, Park I, Ahn HK, Cho EK, Jeong YM (2015) Prognostic significance of CT-determined sarcopenia in patients with small-cell lung cancer. J Thorac Oncol 10:1795–1799
Kim YS, Lee Y, Chung Y et al (2012) Prevalence of sarcopenia and sarcopenic obesity in the Korean population based on the Fourth Korean National Health and Nutritional Examination Surveys. J Gerontol A Biol Sci Med Sci 67:1107–1233
Simmons CP, Koinis F, Fallon MT, Fearon KC, Bowden J, Solheim TS, Gronberg BH, McMillan DC, Gioulbasanis I, Laird BJ (2015) Prognosis in advanced lung cancer—a prospective study examining key clinicopathological factors. Lung Cancer 88:304–309
The study was approved by the University Hospital Ethics Board.
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Srdic, D., Plestina, S., Sverko-Peternac, A. et al. Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer—chemotherapy toxicity and prognostic value. Support Care Cancer 24, 4495–4502 (2016). https://doi.org/10.1007/s00520-016-3287-y
- Cancer cachexia
- Non-small cell lung cancer
- Chemotherapy toxicity