Exploration Of Staging Diagnosis And Circulating Biomarkers Of Cancer Cachexia

Purpose Cancer cachexia is a multifactorial syndrome that is highly prevalent in advanced cancer patients and leads to progressive functional impairments.Classification of cachexia stages is essential for diagnosing and treating cachexia.Since there is lack of staging criteria or special biomakers of cancer cachexia,our study is aimed to investigate the prevalence of cachexia in advanced cancer patients and analyze its associated factors,validate the Chinese version of Functional assessment of anorexia-cachexia therapy(FAACT)scale and evaluate cachexia patients' quality of life and symtom burden.Moreover,our study is also aimed to develop and validate a clinically applicable cachexia staging score(CSS),and analyze the potential biomarkers of cachexia.Methods Eligible cancer patients were participated in our study.Patients' demographic and clinical characteristics were collected from the electronic medical records.Weigt loss in the past 6 months was reported by themselves.Patients were also asked to complete the Chinese version of FAACT scale and the MD Anderson symptom inventory(MDASI)for assessing their quality of life and symptom burden.A CSS was developed and clinical outcomes were compared among cancer patients with different cachexia stages.Hematological biomarkers were compared among patients with different cachexia stages.Results Prevalence of cachexia in advanced cancer patients was 50.9%(145/285).Patients' Eastern Cooperative Oncology Group(ECOG)performance status,body mass index(BMI)classification and tumor stage were independently associated with prevalence of cachexia.The Chinese version of FAACT scale had good reliability and validity in Chinese cancer patients,and cancer patients with cachexia had worse quality of life(QOL)and more severe symtom burden than those without cachexia.CSS is comprised of five components: weight loss,a simple questionnaire of sarcopenia(SARC-F),Eastern cooperative oncology group(ECOG),appetite loss and abnormal biochemistry.According to CSS,patients with more severe cachexia stages had lower skeletal muscle indexes,higher prevalence of sarcopenia,more severe symptom burden,poorer quality of life and shorter survival times.Patients in refractory cachexia stage had higher white blood cells(WBC),Neutrophils(N),Neutrophil Lymphocyte Ratio(NLR),Platelet Lymphocyte Ratio(PLR),C reactive protein(CRP)and IL-6 than patients in other cachexia stages,and patients in non-cachexia stage had higher Leptin levels than patients in cachexia and refractory cachexia stages.Conclusion Prevalence of cachexia is really high in advanced cancer patients and has a negative impact on patients' quality of life and symptom burden.The FAACT scale has good reliability and validity in Chinese cancer patients.The CSS is a simple and clinically applicable tool with excellent discrimination for classifying cachexia stages.CRP and IL-6 may be good biomarkers for late cachexia,and leptin may be good biomarker for early cachexia.Further studies are needed to confirm these results.