One-Year Mortality in Patients with Cancer Cachexia: Association with Albumin and Total Protein

Figures & data

Figure 1 Flowchart.

Note: This nested case–control study was based on a multicenter clinical investigation.

Table 1 Detailed Baseline Characteristics of the Study Population

Characteristics	Survival Less Than 1 Year	Survival More Than 1 Year	P value
	n=266	n=266
Age	59.65±9.73	59.79±9.71	0.873
Gender (%)
Male	169 (63.5)	169 (63.5)	1
Female	97 (36.5)	97 (36.5)	1
Tumor type (%)			1
Lung cancer	62 (23.3)	62 (23.3)
Gastric cancer	65 (24.4)	65 (24.4)
Esophagus cancer	34 (12.8)	34 (12.8)
Colorectal cancer	62 (23.3)	62 (23.3)
Others*	43 (16.2)	43 (16.2)
Tumor stage (%)			1
I	8 (3.0)	8 (3.0)
II	31 (11.7)	31 (11.7)
III	87 (32.7)	87 (32.7)
IV	140 (52.6)	140 (52.6)
Treatment (%)
Surgery	62 (23.3)	70 (26.3)	<0.001
Chemotherapy	125 (47.0)	157 (59.0)	<0.001
Radiotherapy	12 (4.5)	4 (1.5)	<0.001
Others**	67 (25.2)	35 (13.2)	<0.001
Family history of cancer, n (%)	43 (16.2)	39 (14.7)	0.719
Nutrition support, n (%)	184 (69.2)	217 (81.6)	0.001
Laboratory measurements
Total Protein, g/L	64.91±8.43	67.38±6.86	<0.001
Albumin, g/L	35.22±5.33	38.00±4.84	<0.001
Hb, g/L	113.74±20.81	120.46±17.98	<0.001
WBC, ×10^9/L	7.89±4.05	6.45±3.18	<0.001
Neutrophils, ×10^9/L	5.84±3.75	4.34±2.76	<0.001
Lymphocyte, ×10^9/L	1.27±0.66	1.48±0.63	<0.001
RBC, ×10^12/L	3.92±0.72	4.14±0.60	<0.001
PLT, ×10^9/L	258.13±115.15	234.93±95.18	0.012
Anthropometric measurements
BMI, kg/m^2	20.14±2.91	21.21±3.23	<0.001
MAC, cm	24.49±3.28	25.30±3.57	0.007
TSF mm	12.49±6.63	14.73±7.23	<0.001
HGS, kg	22.19±9.70	24.25±8.37	0.009
CC, cm	30.92±3.53	31.89±3.61	0.002

Notes: Continuous variables are presented as mean ± standard deviation, and categorical variables are presented as numbers (percentages). *Other types: liver cancer, breast cancer, bladder cancer, pancreatic cancer, prostate cancer, ovarian cancer, and nasopharyngeal cancer. **Other treatments: targeted therapy, immunotherapy, endocrinotherapy and treatment of complications. Differences in baseline characteristics were compared using the χ² test for categorical variables and the two-sample t-test for continuous variables.

Abbreviations: Hb, hemoglobin; WBC, white blood cell; RBC, red blood cell; PLT, platelet; BMI, body mass index; MAC, mid-arm circumference; TSF, triceps skin fold; HGS, handgrip strength; CC, calf circumference.

Table 2 Association of 1-Year Survival in Patients with Cancer Cachexia and Albumin Concentration

Albumin (g/L)	Cases/Controls	Unadjusted		Adjusted
		OR (95% CI)	P value	OR (95% CI)	P value
As continue value	266/266	0.90 (0.87,0.93)	<0.001	0.92 (0.89, 0.95)	<0.001
Cut-off
≤35g/L	127/69	Ref.		Ref.
>35g/L	139/197	0.38 (0.27, 0.55)	<0.001	0.48 (0.33, 0.71)	<0.001
Quartiles
Q1 (≤33.1)	92/43	Ref.		Ref.
Q2 (33.1–36.9)	74/58	0.6 (0.36, 0.98)	0.042	0.70 (0.41, 1.17)	0.174
Q3 (36.9–40.1)	52/80	0.30 (0.18, 0.50)	<0.001	0.42 (0.25, 0.71)	0.001
Q4 (>40.1)	48/85	0.26 (0.16, 0.44)	<0.001	0.35 (0.20, 0.59)	<0.001
P for trend			<0.001		<0.001

Notes: The ORs for 1-year survival in patients with cancer cachexia were estimated by modeling albumin as a continuous variable and as quartiles using conditional logistic regression. Adjusted for PLT, lymphocyte count, TSF, treatment, and nutrition support.

Abbreviations: CI, confidence interval; OR, odds ratio.

Table 3 Association of 1-Year Survival in Patients with Cancer Cachexia and Total Protein Concentration

Total Protein (g/L)	Cases/Controls	Unadjusted		Adjusted
		OR (95% CI)	P value	OR (95% CI)	P value
As continue value	266/266	0.96 (0.94,0.98)	<0.001	0.97 (0.94,0.99)	0.005
Cut-off
≤60 g/L	71/34	Ref.		Ref.
>60 g/L	195/232	0.4 (0.26,0.63)	<0.001	0.49 (0.30,0.79)	0.003
Quartiles
Q1 (≤61.8)	90/45	Ref.		Ref.
Q2 (61.8–66.8)	56/78	0.36 (0.22,0.59)	<0.001	0.38 (0.23,0.64)	<0.001
Q3 (66.8–71.2)	62/69	0.45 (0.27,0.74)	0.002	0.59 (0.35,1.01)	0.056
Q4 (>71.2)	58/74	0.39 (0.24,0.64)	<0.001	0.46 (0.27,0.78)	0.004
P for trend			0.001		0.03

Notes: The ORs of 1-year survival in patients with cancer cachexia were estimated by modeling total protein as a continuous variable and as quartiles using conditional logistic regression. Adjusted for PLT, lymphocyte count, TSF, treatment, and nutrition support.

Abbreviations: CI, confidence interval; OR, odds ratio.

Figure 2 The association of albumin (A and B) and total protein (C and D) with 1-year survival in patients with cancer cachexia.

Notes: (A) Unadjusted model: p<0.001; OR: 0.90; 95% CI: 0.87,0.93; (B) Adjusted model p<0.001; adjusted OR: 0.92; 95% CI: 0.89,0.95; (C) Unadjusted model: p<0.001; OR: 0.96; 95% CI: 0.94,0.98; (D) Adjusted model p=0.005; adjusted OR: 0.97; 95% CI: 0.94, 0.99. Adjusted for PLT, lymphocyte count, TSF, treatment, and nutrition support.

Abbreviations: PLT, platelet; TSF, triceps skin fold; CI, confidence interval; OR, odds ratio.

Figure 3 The association of albumin (A) and total protein (B) with the risk of 1-year survival in patients with cancer cachexia in various subgroups.

Notes: The albumin and total protein were analyzed as continuous variables. Adjusted for PLT, lymphocyte count, TSF, treatment and nutrition support.

Abbreviations: Hb, hemoglobin; WBC, white blood cell; RBC, red blood cell; PLT, platelet; BMI, body mass index; MAC, mid-arm circumference; TSF, triceps skin fold; HGS, handgrip strength; CC, calf circumference.

Figure 4 Results of the Kaplan–Meier survival analysis for patients with cancer cachexia stratified by albumin (A) and total protein (B) based on all patients with cancer cachexia.

Notes: (A) Based on all patients with cancer cachexia (n=3032). (B) Based on all patients with cancer cachexia (n=3027).