Cancer Cachexia: Identification by Clinical Assessment versus International Consensus Criteria in Patients with Metastatic Colorectal Cancer

Figures & data

Figure 1. Study flowchart.

Table 1. Baseline characteristics for the total study population and for cachectic vs. non-cachectic patients.

	Total	Fearon et al. criteria			Clinical assessment
	(n = 69)	Cachectic (n = 36)	Not cachectic (n = 33)	P	Cachectic (n = 6)	Not cachectic (n = 63)	P
Age (years)	65 ± 11	66 ± 11	65 ± 11	0.661	69 ± 11	66 ± 11	0.444
Gender male	46 (67%)	24 (67%)	22 (67%)	1.000	4 (67%)	42 (67%)	1.000
WHO performance score				0.123			0.087
0	27 (40%)	12 (33%)	15 (47%)		0 (0%)	27 (44%)
1	39 (57%)	24 (67%)	15 (47%)		6 (100%)	33 (53%)
2	2 (3%)	0 (0%)	2 (6%)		0 (0%)	2 (3%)
Charlson comorbidity index	0 [0–1]	0 [0–1]	1 [0–1]	0.278	1 [0–1]	0 [0–1]	0.862
C reactive protein (mg/l)	20 [7–106]	36 [8–73]	8 [3–35]	0.007	52 [20–80]	15 [5–59]	0.220
Carcinoembryonic antigen (μg/l)	16 [5–61]	47 [7–149]	13 [7–72]	0.216	149 [10–1110]	19 [7–80]	0.112
Body mass index (kg/m^2)	25.7 ± 4.1	24.7 ± 3.3	26.7 ± 4.7	0.042	22.2 ± 3.7	26.0 ± 4.0	0.032
Weight change recent 6 months (%)	3.6 ± 7.7	–9.1 ± 5.7	2.4 ± 4.4	<0.001	–6.9 ± 8.3	–3.3 ± 7.7	0.286
Skeletal muscle index (cm^2/m^2)
Male	45.7 ± 6.7	45.2 ± 7.1	46.1 ± 6.5	0.656	42.0 ± 6.5	46.0 ± 6.7	0.262
Female	39.1 ± 5.0	38.5 ± 4.5	39.7 ± 5.6	0.574	31.6 ± 2.0	39.8 ± 4.6	0.023
Below sex-specific cutoff	55 (80%)	29 (81%)	26 (79%)	0.855	6 (100%)	49 (78%)	0.196
Chemotherapy regimen (%)				0.823			0.827
CAPOX (-B)	53 (77%)	27 (75%)	26 (79%)		4 (67%)	49 (78%)
Capecitabine (-B)	8 (12%)	4 (11%)	3 (9%)		1 (17%)	7 (11%)
FOLFOX (-B)	8 (12%)	5 (14%)	4 (12%)		1 (17%)	7 (11%)
Start treatment dose (%)	100 [100–100]	100 [100–100]	100 [96–100]	0.946	100 [75–100]	100 [100–100]	0.578
Start treatment reduced dose	16 (24%)	8 (22%)	8 (24%)	0.868	2 (33%)	14 (22%)	0.738
QoL function scales
Physical functioning	83 [67–100]	73 [67–93]	93 [67–100]	0.066	60 [40–80]	88 [67–100]	0.018
Role functioning	67 [50–100]	67 [50–83]	83 [50–100]	0.112	50 [17–100]	67 [50–100]	0.402
Emotional functioning	75 [58–92]	75 [58–83]	75 [67–92]	0.386	54 [33–75]	75 [67–100]	0.048
Cognitive functioning	83 [83–100]	73 [73–100]	83 [83–100]	0.816	92 [83–100]	83 [83–100]	0.886
QoL symptom scales/items
Fatigue	33 [22–56]	44 [33–56]	22 [11–33]	0.002	56 [33–78]	33 [22–56]	0.077
Appetite loss	0 [0–33]	0 [0–33]	0 [0–33]	0.093	33 [33–33]	0 [0–33]	0.071
QoL perceived health	67 [50–83]	67 [50–67]	67 [67–83]	0.019	42 [33–50]	67 [50–83]	0.009
QoL perceived QoL	67 [50–83]	67 [33–83]	83 [67–83]	0.033	42 [17–67]	83 [50–83]	0.008

Data presented as mean ± standard deviation, median [interquartile range] or number (%).

WHO – world health organization; QoL – quality of life.

Missing data: WHO performance score n = 1 (WHO 0–1 but not further specified), C reactive protein n = 11, Carcinoembryonic antigen n = 4, QoL function scales: physical n = 5; role n = 6; emotional n = 7; cognitive n = 4, QoL symptom scales/ items: fatigue n = 6, appetite loss n = 4, perceived health n = 4, perceived QoL n = 4.

Bold values indicates statistically significant values (P < 0.05).

Figure 2. Frequency of criteria for cachexia according to the Fearon et al. criteria. In total, 36 out of 69 patients fulfilled one or more of the Fearon et al. criteria for cachexia.

Table 2. Cancer cachexia – agreement between identification by clinical assessment vs. Fearon et al. criteria.

		Cachectic according to clinical assessment
		Yes	No	Total
Cachectic according to Fearon et al. criteria	Yes	4	32	36
	No	2	31	33
	Total	6	63	69

Kappa 0.049, 95% CI 0.079–0.176, P = 0.457.

Figure 3. Kaplan-Meier curves for progression-free survival of patients with metastatic colorectal cancer who are cachectic vs. not cachectic based on the Fearon et al. criteria (a) and based on clinical assessment (b).