Skip to main content

Advertisement

SpringerLink
Log in

Is the ECOG-PS similar to the sarcopenia status for predicting mortality in older adults with cancer? A prospective cohort study

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Sarcopenia is a muscle dysfunction that increases negative outcomes in patients with cancer. However, its diagnosis remains uncommon in clinical practice. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is a questionnaire to assess the functional status, but it is unknown if is comparable with sarcopenia. We aimed at comparing ECOG-PS with sarcopenia to predict 12-month mortality in patients with cancer.

Methods

Cohort study including older adult patients with cancer in treatment (any stage of the disease or treatment) at a reference hospital for oncological care. Socio-demographic, clinical, and anthropometric data, muscle mass, and physical function variables (handgrip strength [HGS] and gait speed [GS]) were collected. Skeletal muscle quantity and quality were assessed by computed tomography at the L3. Sarcopenia was diagnosed according to the EWGSP2. ECOG-PS and all-cause mortality were evaluated. The Cox proportional hazards model was calculated.

Results

We evaluated 159 patients (69 years old, 55% males). Low performance (ECOG-PS ≥ 2) was found in 23.3%, 35.8% presented sarcopenia, and 22.0% severe sarcopenia. ECOG-PS ≥ 2 was not an independent predictor of mortality. Sarcopenia, severe sarcopenia, and probable sarcopenia has increased by 3.25 (confidence interval, CI 95% 1.55–6.80), 2.64 (CI 95% 1.23–5.67), and 2.81 (CI 95% 1.30–6.07) times the risk of mortality, respectively.

Conclusion

Sarcopenia, but not ECOG-PS, was a predictor of mortality. Therefore, ECOG-PS was not similar to sarcopenia to predict mortality in patients with cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to the presence of personal information of the participants.

References

  1. Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. https://doi.org/10.1093/ageing/afy169

    Article  PubMed  PubMed Central  Google Scholar 

  2. da Rocha IMG, Marcadenti A, de Medeiros GOC et al (2019) Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study. J Cachexia Sarcopenia Muscle. https://doi.org/10.1002/jcsm.12391

    Article  PubMed  PubMed Central  Google Scholar 

  3. Carvalho ALM, Gonzalez MC, Sousa IM et al (2021) Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: A cohort study. PLoS One. https://doi.org/10.1371/journal.pone.0247322

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang H, Yang R, Xu J et al (2021) Sarcopenia as a predictor of postoperative risk of complications, mortality and length of stay following gastrointestinal oncological surgery. Ann R Coll Surg Engl. https://doi.org/10.1308/rcsann.2021.0082

    Article  PubMed  PubMed Central  Google Scholar 

  5. Trejo-Avila M, Bozada-Gutiérrez K, Valenzuela-Salazar C et al (2021) Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. https://doi.org/10.1007/s00384-021-03839-4

    Article  PubMed  Google Scholar 

  6. Shachar SS, Williams GR, Muss HB, Nishijima TF (2016) Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. Eur J Cancer. https://doi.org/10.1016/j.ejca.2015.12.030

    Article  PubMed  Google Scholar 

  7. Aleixo GFP, Shachar SS, Nyrop KA et al (2020) Myosteatosis and prognosis in cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol. https://doi.org/10.1016/j.critrevonc.2019.102839

    Article  PubMed  Google Scholar 

  8. Au PC, Li HL, Lee GK et al (2021) Sarcopenia and mortality in cancer: A meta-analysis. Osteoporos Sarcopenia. https://doi.org/10.1016/j.afos.2021.03.002

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chen LK, Woo J, Assantachai P et al (2020) Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. https://doi.org/10.1016/j.jamda.2019.12.012

    Article  PubMed  PubMed Central  Google Scholar 

  10. Son SW, Song DS, Chang UI, Yang JM (2021) Definition of Sarcopenia in Chronic Liver Disease. Life (Basel). https://doi.org/10.3390/life11040349

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fearon K, Strasser F, Anker SD et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. https://doi.org/10.1016/S1470-2045(10)70218-7

    Article  PubMed  Google Scholar 

  12. Nishikawa H, Shiraki M, Hiramatsu A et al (2016) Japan society of hepatology guidelines for sarcopenia in liver disease: Recommendation from the working group for creation of sarcopenia assessment criteria. Hepatol Res. https://doi.org/10.1111/hepr.12774

    Article  PubMed  Google Scholar 

  13. Bilen MA, Martini DJ, Liu Y et al (2020) Combined effect of sarcopenia and systemic inflammation on survival in patients with advanced stage cancer treated with immunotherapy. Oncologist. https://doi.org/10.1634/theoncologist.2019-0751

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fayh APT, de Sousa IM, Gonzalez MC (2020) New insights on how and where to measure muscle mass. Curr Opin Support Palliat Care. https://doi.org/10.1097/SPC.0000000000000524

    Article  PubMed  Google Scholar 

  15. OncologyPRO (1982) Performance Scales: Karnofsky & ECOG Scores. https://oncologypro.esmo.org/oncology-in-practice/practice-tools/performance-scales/. Accessed 12 Dec 2022

  16. Owusuaa C, Dijkland SA, Nieboer D et al (2022) Predictors of Mortality in Patients with Advanced Cancer-A Systematic Review and Meta-Analysis. Cancers (Basel). https://doi.org/10.3390/cancers14020328

    Article  PubMed  Google Scholar 

  17. Zheng MM, Tu HY, Yang JJ et al (2021) Clinical outcomes of non-small cell lung cancer patients with leptomeningeal metastases after immune checkpoint inhibitor treatments. Eur J Cancer. https://doi.org/10.1016/j.ejca.2021.03.037

    Article  PubMed  Google Scholar 

  18. Oflazoglu U, Alacacioglu A, Varol U et al (2020) Prevalence and related factors of sarcopenia in newly diagnosed cancer patients. Support Care Cancer. https://doi.org/10.1007/s00520-019-04880-4

    Article  PubMed  Google Scholar 

  19. World Health Organization (WHO) (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation on Obesity. https://apps.who.int/iris/handle/10665/42330. Accessed 20 July 2022

  20. Elia M (2003) The “MUST” report the “MUST” report nutritional screening of adults: a multidisciplinary responsibility development and use of the “malnutrition universal screening tool” (‘MUST’) for adults. Redditch, Birmingham

  21. Caan BJ, Meyerhardt JA, Kroenke CH et al (2017) Explaining the Obesity Paradox : The Association between Body Composition and Colorectal Cancer Survival (C-SCANS Study). Cancer Epidemiol Biomarkers Prev. https://doi.org/10.1158/1055-9965.EPI-17-0200

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kroenke CH, Prado CM, Meyerhardt JA et al (2018) Muscle radiodensity and mortality in patients with colorectal cancer. Cancer. https://doi.org/10.1002/cncr.31405

    Article  PubMed  Google Scholar 

  23. Barbalho ER, Gonzalez MC, Bielemann RM et al (2019) Is skeletal muscle radiodensity able to indicate physical function impairment in older adults with gastrointestinal cancer? Exp Gerontol. https://doi.org/10.1016/j.exger.2019.110688

    Article  PubMed  Google Scholar 

  24. Cruz-Jentoft AJ, Sayer AA (2019) Sarcopenia. Lancet. https://doi.org/10.1016/S0140-6736(19)31138-9

    Article  PubMed  Google Scholar 

  25. Haiducu C, Buzea A, Mirea LE, Dan GA (2021) The prevalence and the impact of sarcopenia in digestive cancers. A systematic review. Rom J Intern Med. https://doi.org/10.2478/rjim-2021-0026

    Article  PubMed  Google Scholar 

  26. Vangelov B, Bauer J, Kotevski D, Smee RI (2022) The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: A systematic review. Br J Nutr. https://doi.org/10.1017/S0007114521001446

    Article  PubMed  Google Scholar 

  27. Ghignone F, Hernandez P, Mahmoud NN, Ugolini G (2020) Functional recovery in senior adults undergoing surgery for colorectal cancer: Assessment tools and strategies to preserve functional status. Eur J Surg Oncol. https://doi.org/10.1016/j.ejso.2020.01.003

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kelly CM, Shahrokni A (2016) Moving beyond Karnofsky and ECOG performance status assessments with new technologies. J Oncol. https://doi.org/10.1155/2016/6186543

    Article  PubMed  PubMed Central  Google Scholar 

  29. Fairclough DL, Cella DF (1996) Eastern Cooperative Oncology Group (ECOG). J Natl Cancer Inst Monogr 20:73–75

    Google Scholar 

  30. Simmons C, McMillan DC, Tuck S et al (2019) “How Long Have I Got?”-A Prospective Cohort Study Comparing Validated Prognostic Factors for Use in Patients with Advanced Cancer. Oncologist. https://doi.org/10.1634/theoncologist.2018-0474

    Article  PubMed  PubMed Central  Google Scholar 

  31. Shiroyama T, Nagatomo I, Koyama S et al (2019) Impact of sarcopenia in patients with advanced non–small cell lung cancer treated with PD-1 inhibitors: A preliminary retrospective study. Sci Rep. https://doi.org/10.1038/s41598-019-39120-6

    Article  PubMed  PubMed Central  Google Scholar 

  32. de Lucena P, Alves C, Câmara M, DantasMacêdo GA et al (2022) Agreement between upper and lower limb measures to identify older adults with low skeletal muscle strength, muscle mass and muscle quality. PLoS One. https://doi.org/10.1371/journal.pone.0262732

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yang F, Markovic SN, Molina JR et al (2020) Association of sex, age, and Eastern Cooperative Oncology Group Performance Status with survival benefit of cancer immunotherapy in randomized clinical trials: A systematic review and meta-analysis. JAMA Netw Open. https://doi.org/10.1001/jamanetworkopen.2020.12534

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bobos P, Nazari G, Lu Z, MacDermid JC (2020) Measurement properties of the hand grip strength assessment: A systematic review with meta-analysis. Arch Phys Med Rehabil. https://doi.org/10.1016/j.apmr.2019.10.183

    Article  PubMed  Google Scholar 

  35. Dolan RD, Daly LE, Simmons CP et al (2020) The Relationship between ECOG-PS, mGPS, BMI/WL grade and body composition and physical function in patients with advanced cancer. Cancers (Basel). https://doi.org/10.3390/cancers12051187

    Article  PubMed  Google Scholar 

  36. Cederholm T, Bosaeus I, Barazzoni R et al (2015) Diagnostic criteria for malnutrition—An ESPEN Consensus Statement. Clin Nutr. https://doi.org/10.1016/j.clnu.2015.03.001

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all the patients for their willingness to participate in the study, as well as all the employees of the Liga Norteriograndense Contra o Cancer who directly or indirectly contributed to the study.

Funding

This work was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

Author information

Author notes

  1. Iasmin Matias Sousa and Ana Paula Trussardi Fayh contributed equally to this work.

Authors and Affiliations

  1. Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande Do Norte, Natal, RN, Brazil

    Iasmin Matias Sousa & Ana Paula Trussardi Fayh

  2. Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande Do Norte, Senador Salgado Filho Avenue, nº 3000, Natal, RN, 59078-970, Brazil

    Ana Paula Trussardi Fayh

Authors
  1. Iasmin Matias Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Paula Trussardi Fayh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Iasmin Matias de Sousa. Data analysis was performed by Ana Paula Trussardi Fayh and Iasmin Matias de Sousa. The first draft of the manuscript was written by both authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ana Paula Trussardi Fayh.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Universidade Federal do Rio Grande do Norte (protocol number 73315617.4.0000.5292).

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 17 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sousa, I.M., Fayh, A.P.T. Is the ECOG-PS similar to the sarcopenia status for predicting mortality in older adults with cancer? A prospective cohort study. Support Care Cancer 31, 370 (2023). https://doi.org/10.1007/s00520-023-07845-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-07845-w

Keywords

Search

Navigation