Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489-495. [PMID: 21296615 DOI: 10.1016/s1470-2045(10)70218-7]

A neuroimmune circuit mediates cancer cachexia-associated apathy

Cachexia, a severe wasting syndrome associated with inflammatory conditions, often leads to multiorgan failure and death. Patients with cachexia experience extreme fatigue, apathy, and clinical depression, yet the biological mechanisms underlying these behavioral symptoms and their relationship to the disease remain unclear. In a mouse cancer model, cachexia specifically induced increased effort-sensitivity, apathy-like symptoms through a cytokine-sensing brainstem-to-basal ganglia circuit. This neural circuit detects elevated interleukin-6 (IL-6) at cachexia onset and translates inflammatory signals into decreased mesolimbic dopamine, thereby increasing effort sensitivity. We alleviated these apathy-like symptoms by targeting key circuit nodes: administering an anti-IL-6 antibody treatment, ablating cytokine sensing in the brainstem, and optogenetically or pharmacologically boosting mesolimbic dopamine. Our findings uncovered a central neural circuit that senses systemic inflammation and orchestrates behavioral changes, providing mechanistic insights into the connection between chronic inflammation and depressive symptoms.

TRIM22 governs tumorigenesis and protects against endometrial cancer-associated cachexia by inhibiting inflammatory response and adipose thermogenic activity

BACKGROUND

Endometrial cancer (EC) is one of the most common cancers in women, with a short overall survival and poor prognosis. Besides the biologically aggressive EC properties, Cancer-associated cachexia is the main factor. However, the detailed mechanism underlying EC-related cachexia and its harmful effects on EC progression and patient prognosis remains unclear.

METHODS

For clinical specimen and the vitro experiment, we detected TRIM22 expression level, EC patients' survival time, EC cell functional change, and adipose thermogenic changes to identify the function of TRIM22 in EC progression, EC-associated cachexia, and their molecular mechanisms. Then, for the vivo experiment, we exploited the xenografts in mice to identify the function of TRIM22 again, and to screen the drug therapeutic schedule.

RESULTS

Herein, we demonstrated that TRIM22 inhibited EC cell growth, invasion, and migration. Interleukin (IL)-6 mediated brown adipose tissue activation and white adipose tissue browning which induced EC-related cachexia. TRIM22 suppressed the EC cells' secretion of IL-6, and IL-6 mediated EC-related cachexia. Mechanistically, TRIM22 inhibited EC progression by suppressing the nucleotide-binding oligomerization domain 2(NOD2)/nuclear factor-kappaB (NF-κB) signaling pathway, with the purpose of impeding the production of IL-6. Moreover, we revealed that TRIM22 inhibited EC-associated cachexia by suppressing the IL-6/IL-6 receptor (IL-6R) signaling pathway. Therapeutically, we demonstrated that combination treatment with a TRIM22 inducer (progesterone) and a thermogenic inhibitor (IL-6R antibody) synergistically augmented the antitumor efficacy of carbotaxol (carboplatin and paclitaxel), in vivo.

CONCLUSION

Our data reveals that TRIM22-EC-IL-6-cachexia cross-communication has important clinical relevance and that the use of combined therapy holds great promise for enhancing the efficacy of anti-ECs. (Fig. graphical abstract).

Muscle-specific strength predicts postoperative complications and survival in patients undergoing curative colectomy for colorectal cancer

BACKGROUND & AIMS

Muscle-specific strength was recently proposed as a component for the definition of sarcopenia. However, no previous study has investigated the association between muscle-specific strength and postoperative outcomes. The present study aims to explore the association between muscle-specific strength and postoperative outcomes in patients undergoing colectomy for colorectal cancer. We also aimed to investigate whether addition of muscle-specific strength to the definition of sarcopenia could lead to an increased prognostic value for postoperative outcomes.

METHODS

Clinical data of 1252 patients who underwent curative colectomy for colorectal cancer were prospectively collected and retrospectively analyzed. Muscle mass was measured by skeletal muscle index (SMI) determined by the preoperative computed tomography (CT) images at the third vertebra level. Grip strength and 6-m usual gait speed were measured before surgery. Muscle-specific strength was determined by the ratio of grip strength to SMI.

RESULTS

Low muscle-specific strength was associated with a higher incidence of postoperative complications, longer postoperative hospital stays, and more costs. Low muscle-specific strength was an independent predictor for postoperative complications, overall survival (OS) and disease-free survival (DFS). Addition of low muscle-specific strength to low muscle mass and strength led to significant predictive value for postoperative complications, and a higher hazard ratio in predicting OS and DFS.

CONCLUSION

Low muscle-specific strength could predict adverse postoperative outcomes in patients undergoing curative colectomy for colorectal cancer. Muscle-specific strength added prognostic value to sarcopenia for the prediction of postoperative outcomes, which should be incorporated into the diagnostic criteria of sarcopenia.

The Flavonoids and Monoterpenes from Citrus unshiu Peel Contained in Ninjinyoeito Synergistically Activate Orexin 1 Receptor: A Possible Mechanism of the Orexigenic Effects of Ninjinyoeito

Cancer cachexia, often observed in patients with advanced-stage cancer, is characterized by the loss of body weight and appetite. The Japanese herbal medicine Ninjinyoeito (NYT), which is composed of 12 crude herbal components, has been used as a therapeutic in Japan to improve anorexia and fatigue, which are commonly observed in cancer patients with cachexia. We have previously reported that Citrus unshiu peel (CUP) contained in NYT can enhance food intake by activating the orexin 1 receptor (OX1R). Using the CellKey™ system, which offers detection of OXR activity in intracellular impedance changes, NYT and CUP were found to activate OX1R, which in turn was inhibited by SB-674042, a selective OX1R antagonist. Among the flavonoids contained in CUP, nobiletin and hesperidin, but not naringin, activated OX1R. Furthermore, some monoterpenes contained in CUP, including limonene and linalool, but not terpineol, activated OX1R. In addition, nobiletin and limonene synergistically activated OX1R when added simultaneously. However, neither NYT nor CUP induced OX2R activity. The results collectively suggested that the CUP contained in NYT activates OX1R, but not OX2R, and that flavonoids and monoterpenes in CUP can synergistically activate OX1R. These findings could provide evidence supporting the therapeutic potential of NYT in cancer patients with cachexia.

Pancreatic enzyme replacement therapy in advanced adenocarcinoma of the pancreas improved overall survival: a retrospective, single institution study

BACKGROUND

Weight loss and exocrine pancreatic insufficiency are common in advanced pancreatic ductal adenocarcinoma (PDAC) and are associated with adverse outcomes. However, there is limited evidence on the impact of pancreatic enzyme replacement therapy (PERT) in patients with advanced PDAC.

PATIENTS AND METHODS

We retrospectively studied 501 patients with advanced PDAC and exocrine pancreatic insufficiency from the Virginia Mason Pancreas Cancer Program Data Resource treated between 2010 and 2019 with first-line chemotherapy. Clinical outcomes were compared between those who received PERT and those who did not at 8 weeks after chemotherapy start.

RESULTS

In total 188 (38%) patients received PERT; 313 patients (62%) did not. PERT patients experienced less weight loss (-1.5 vs -2.5 kg, P = .04), less decline in the prognostic nutrition index -1.9 vs -3.0, P = .01), and a greater reduction in the additive score of the Patient-Generated Subjective Global Assessment (-8.4 vs --6.0, P = .02). Importantly, median (95% CI) overall survival (OS) was significantly longer in the PERT vs non-PERT group (17.1 months vs 12.5 months, respectively P = .001), and the adjusted hazards ratio indicated superior median OS in patients prescribed PERT (HR = 0.73, P < .001).

CONCLUSIONS

Our findings suggest that treatment of exocrine pancreatic insufficiency (EPI) in advanced PDAC is associated with improvements in nutrition and overall survival.

Establishment and characterization of novel cancer cachexia-inducing cell line, Aku60GC, of scirrhous gastric cancer

Cancer cachexia is a pathological state characterized by severe weight loss, skeletal muscle depletion, and adipose tissue reduction. Cancer cachexia is observed in gastric cancer (GC) with a higher incidence over 80%. Approximately 80% patients with advanced GC including scirrhous gastric cancer (SGC), which has the worst prognosis among all GC, are affected with cachexia. The exact pathophysiology in SGC cancer cachexia remains elusive, and therapeutic approaches for the cancer cachexia have not been established. Patient-derived cancer cachexia models are promising for elucidating the underlying mechanisms of disease progression and developing novel treatments, none of which originate from SGC. Therefore, we established a novel cancer cachexia-inducing cell line, designated Aku60GC, through stepwise selection of a patient-derived SGC cell line, HSC-60. Subcutaneous implantation of the Aku60GC cells into nude mice resulted in weight loss, muscle atrophy, and adipose tissue depletion with high reproducibility, accompanied by elevation of the circulating cytokines IL-8 and IL-18. Compared to parental HSC-60 cells, Aku60GC cells exhibited additional genomic changes, such as AKT2 and CCNE1 gains, a somatic mutation of RUNX1, and accelerated growth. Thus, our results demonstrate that the Aku60GC cell line is a valuable resource for research on cancer cachexia in SGC.

Nutritional status and gastroenteropancreatic neuroendocrine neoplasms: lights and shadows with a clinical guide from the NIKE Group

Neuroendocrine neoplasms (NENs) originating in the gastroenteropancreatic (GEP) tract are rare tumors often associated with significant metabolic disturbances and nutritional challenges. This review explores the intricate relationship between nutritional status and the development, progression, and prognosis of GEP-NENs. Through an extensive literature search encompassing studies up to April 2024, we examined various factors, including obesity, malnutrition, metabolic syndrome and type 2 diabetes mellitus, and their roles in the development and progression of GEP-NENs. The review highlights the dual role of obesity, both as a risk factor and a potential prognostic indicator, drawing attention to the 'obesity paradox' observed in cancer research. Additionally, we discuss the impact of malnutrition on patient outcomes and emphasize the need for comprehensive nutritional assessments beyond BMI. This analysis highlights the importance of incorporating nutritional interventions into preventive and therapeutic strategies for GEP-NEN patients. Future research should further clarify these associations and develop personalized nutritional management protocols to improve patient prognosis and quality of life. Acronyms adopted in the text and tables: AOR: adjusted odd ratio, BIA: Bioelectrical Impedance Analysis, BMI: Body Mass Index, CI: confidence interval, CLARINET: Controlled Study of Lanreotide Antiproliferative Response in Neuroendocrine Tumor, FLI: fatty liver index, GEP: gastroenteropancreatic, GLIM: global leadership into malnutrition, HR: hazard ratio, MS: metabolic syndrome, MUST: malabsorption universal screening tool, NEC: neuroendocrine carcinoma, NENs: Neuroendocrine neoplasms, NETs: Neuroendocrine tumors, NRS: Nutritional Risk Screening, OR: odd ratio, OS: overall survival, PFS: progression-free survival, RR: risk ratio, SGA: Subjective Global Assessment, T2DM: type 2 diabetes mellitus, VAI: visceral adiposity index, WD: well-differentiated.

Oncological and Survival Endpoints in Cancer Cachexia Clinical Trials: Systematic Review 6 of the Cachexia Endpoints Series

BACKGROUND

In patients receiving anti-cancer treatment, cachexia results in poorer oncological outcomes. However, there is limited understanding and no systematic review of oncological endpoints in cancer cachexia (CC) trials. This review examines oncological endpoints in CC clinical trials.

METHODS

An electronic literature search of MEDLINE, Embase and Cochrane databases (1990-2023) was performed. Eligibility criteria comprised participants ≥ 18 years old; controlled design; ≥ 40 participants; and a cachexia intervention for > 14 days. Trials reporting at least one oncological endpoint were selected for analysis. Data extraction was performed using Covidence and followed PRISMA guidelines and the review was registered (PROSPERO CRD42022276710).

RESULTS

Fifty-seven trials were eligible, totalling 9743 patients (median: 107, IQR: 173). Twenty-six (46%) trials focussed on a single tumour site: eight in lung, six in pancreatic, six in head and neck and six in GI cancers. Forty-two (74%) studies included patients with Stage III/IV disease, and 41 (70%) included patients receiving palliative anti-cancer treatment. Ten studies (18%) involved patients on curative treatment. Twenty-eight (49%) studies used pharmacological interventions, 29 (50%) used oral nutrition, and two (4%) used enteral or parenteral nutrition. Reported oncological endpoints included overall survival (OS, n = 46 trials), progression-free survival (PFS, n = 7), duration of response (DR, n = 1), response rate (RR, n = 9), completion of treatment (TC, n = 11) and toxicity/adverse events (AE, n = 42). Median OS differed widely from 60 to 3468 days. Of the 46 studies, only three reported a significant positive effect on survival. Seven trials showed a difference in AE, four in TC, one in PFS and one in RR. Reported significances were unreliable due to missing adjustments for extensive multiple testing. Only three of the six trials using OS as the primary endpoint reported pre-trial sample size calculations, but only one recruited the planned number of patients.

CONCLUSION

In CC trials, oncological endpoints were mostly secondary and only few significant findings have been reported. Due to heterogeneity in oncological settings, nutritional and metabolic status and interventions, firm conclusions about CC treatment are not possible. OS and AE are relevant endpoints, but future trials targeting clinically meaningful hazard ratios will required more homogeneous patient cohorts, adequate pre-trial power analyses and adherence to statistical testing standards.

Unraveling the Impact of Sarcopenia-Induced Lymphopenia on Treatment Response and Prognosis in Patients with Stage III Non-Small Cell Lung Cancer: Insights for Optimizing Chemoradiation and Immune Checkpoint Inhibitor

PURPOSE

Sarcopenia is a poor prognostic factor in non-small cell lung cancer (NSCLC). However, its prognostic significance in patients with NSCLC receiving immune checkpoint inhibitors (ICIs) and its relationship with lymphopenia remain unclear. We aimed to investigate the prognostic role of sarcopenia and its effect on lymphocyte recovery in patients with stage III NSCLC treated with concurrent chemoradiotherapy (CCRT) followed by ICI.

MATERIALS AND METHODS

We retrospectively evaluated 151 patients with stage III NSCLC who received definitive CCRT followed by maintenance ICI between January 2016 and June 2022. Sarcopenia was evaluated by measuring the skeletal muscle area at the L3 vertebra level using computed tomography scans. Lymphocyte level changes were assessed based on measurements taken before and during CCRT and at 1, 2, 3, 6, and 12 months post-CCRT completion.

RESULTS

Even after adjusting for baseline absolute lymphocyte count through propensity score-matching, patients with pre-radiotherapy (RT) sarcopenia (n=86) exhibited poor lymphocyte recovery and a significantly high incidence of grade ≥ 3 lymphopenia during CCRT. Pre-RT sarcopenia and grade ≥ 3 lymphopenia during CCRT emerged as prognostic factors for overall survival and progression-free survival, respectively. Concurrent chemotherapy dose adjustments, objective response after CCRT, and discontinuation of maintenance ICI were also analyzed as independent prognostic factors.

CONCLUSION

Our results demonstrated an association between pre-RT sarcopenia and poor survival, concurrent chemotherapy dose adjustments, and impaired lymphocyte recovery after definitive CCRT. Moreover, CCRT-induced lymphopenia not only contributed to poor prognosis but may have also impaired the therapeutic efficacy of subsequent maintenance ICI, ultimately worsening treatment outcomes.

The gut microbiome and dietary fibres: implications in obesity, cardiometabolic diseases and cancer

Dietary fibres constitute a heterogeneous class of nutrients that are key in the prevention of various chronic diseases. Most dietary fibres are fermented by the gut microbiome and may, thereby, modulate the gut microbial ecology and metabolism, impacting human health. Dietary fibres may influence the occurrence of specific bacterial taxa, with this effect varying between individuals. The effect of dietary fibres on microbial diversity is a matter of debate. Most intervention studies with dietary fibres in the context of obesity and related metabolic disorders reveal the need for an accurate assessment of the microbiome to better understand the variable response to dietary fibres. Epidemiological studies confirm that a high dietary fibre intake is strongly associated with a reduced occurrence of many types of cancer. However, there is a need to determine the impact of intervention with specific dietary fibres on cancer risk, therapy efficacy and toxicity, as well as in cancer cachexia. In this Review, we summarize the mechanisms by which the gut microbiome can mediate the physiological benefits of dietary fibres in the contexts of obesity, cardiometabolic diseases and cancer, their incidence being clearly linked to low dietary fibre intake.

MIF-ACKR3 causes irreversible fat loss by impairing adipogenesis in cancer cachexia

Both exercise and cancer can cause adipose tissue shrinkage. However, only cancer-associated weight loss, namely cachexia, is characterized by profound adipose inflammation and fibrosis. Here, we identified tumor-secreted macrophage migration inhibitory factor (MIF) as a major driver that skews the differentiation of adipose stem and progenitor cells (ASPCs) toward a pro-inflammatory and pro-fibrogenic direction, with reduced adipogenic capacity in cancer cachexia. By contrast, circulating MIF is moderately reduced after exercise. Mechanistically, atypical chemokine receptor 3 (ACKR3) in ASPCs serves as the predominant MIF receptor mediating its pathological effects. Inhibition of MIF by gene ablation in tumor cells or pharmacological blockade, as well as ASPC-specific Ackr3 deficiency, markedly alleviates tumor-induced cachexia. These findings unveil MIF-ACKR3 signaling as a critical link between tumors and cachectic manifestations, providing a promising therapeutic target for cancer cachexia.

Cachexia is an independent predictor of mortality in patients with hepatocellular carcinoma on systemic targeted therapy

BACKGROUND & AIM

This study aimed to investigate the prevalence and prognostic impact of cachexia in patients with unresectable hepatocellular carcinoma (HCC) receiving systemic targeted therapy.

METHODS

This single-center retrospective study included patients with HCC who underwent systemic targeted therapy. Cachexia was defined using novel criteria proposed in 2023. The prognostic impact of cachexia was evaluated using the Cox proportional hazards model.

RESULTS

Of the 200 patients (160 males [80%]; median age, 73 years), cachexia was identified in 70 patients and associated with higher des-gamma-carboxy prothrombin levels, and extrahepatic spread. Patients with cachexia had significantly shorter overall survival (OS) (median 14.1 vs. 20.9 months, p = 0.002) and post-progression survival (PPS) (4.8 vs. 11.1 months, p = 0.001) compared to patients without cachexia. Multivariable analyses revealed cachexia as an independent adverse factor for OS (hazard ratio 1.54; 95% confidence interval 1.03-2.30, p = 0.035) and PPS (hazard ratio 1.64; 95% confidence interval 1.08-2.47, p = 0.018). No significant differences were observed in Progression-free survival between the two groups. Treatment discontinuation due to general appearance deterioration was more common in cachectic patients.

CONCLUSIONS

Cachexia was prevalent among patients with HCC receiving systemic targeted therapy and was identified as an independent predictor of poorer OS and PPS. Given the prognostic impact, the evaluation of cachexia is crucial in managing patients with HCC undergoing systemic targeted therapy.

Body Composition Assessment in Critically Ill Adults - Where are We now?

This narrative review provides an overview of body composition methods available for use in critically ill patients. It focuses on the relevance and discussion of the most commonly used techniques. Further, we discuss the validity of these methods with a focus on muscle mass assessment, measuring changes over time and the identification of patients with lower-than-normal muscularity. Current available evidence, as well as future directions is highlighted.

Metabolic interplays between the tumour and the host shape the tumour macroenvironment

Metabolic reprogramming of cancer cells and the tumour microenvironment are pivotal characteristics of cancers, and studying these processes offer insights and avenues for cancer diagnostics and therapeutics. Recent advancements have underscored the impact of host systemic features, termed macroenvironment, on facilitating cancer progression. During tumorigenesis, these inherent features of the host, such as germline genetics, immune profile and the metabolic status, influence how the body responds to cancer. In parallel, as cancer grows, it induces systemic effects beyond the primary tumour site and affects the macroenvironment, for example, through inflammation, the metabolic end-stage syndrome of cachexia, and metabolic dysregulation. Therefore, understanding the intricate metabolic interplay between the tumour and the host is a growing frontier in advancing cancer diagnosis and therapy. In this Review, we explore the specific contribution of the metabolic fitness of the host to cancer initiation, progression and response to therapy. We then delineate the complex metabolic crosstalk between the tumour, the microenvironment and the host, which promotes disease progression to metastasis and cachexia. The metabolic relationships among the host, cancer pathogenesis and the consequent responsive systemic manifestations during cancer progression provide new perspectives for mechanistic cancer therapy and improved management of patients with cancer.

Prognostic impact of preoperative cachexia in patients undergoing major hepatopancreatobiliary surgery for malignancy

BACKGROUND & AIMS

Data regarding the association between cachexia and clinical outcomes in hepatopancreatobiliary (HPB) malignancies are limited. This retrospective study sought to investigate the prognostic significance of preoperative cachexia in patients undergoing major HPB surgery for malignancies.

METHODS

Data from patients, who underwent major open surgery for HPB malignancies between March 2014 and December 2018, were retrospectively reviewed. Cachexia was evaluated a few days before surgery, and defined according to modified Asian Working Group for Cachexia criteria: low body mass index (<21 kg/m2) and decreased handgrip strength (<28 kg [males] and <18 kg [females]) or elevated C-reactive protein level (>0.5 mg/dL). The primary endpoint was postoperative overall survival (OS); secondary endpoints included disease-free survival (DFS) and postoperative complications.

RESULTS

Of 332 patients (228 male; mean age, 68.8 ± 10.3 years), 93 (28 %) had preoperative cachexia. There were 154 (46 %) deaths and 181 (55 %) combined events (death or recurrence) during a five-year follow-up (mean, 3.3 ± 1.7 years), with no significant differences in major postoperative complications between the 2 groups (P = 0.329). After adjusting for covariates, cachexia (n = 93) exhibited significant associations with shorter OS (adjusted hazard ratio [HR] 1.65 [95 % confidence interval (CI) 1.18-2.30]; P = 0.004) and DFS (adjusted HR 1.39 [95 % CI 1.01-1.91; P = 0.043) compared with non-cachexia (n = 239). Cachexia significantly shortened OS only in a subset with pathological stage ≤ II disease (adjusted HR 2.45 [95 % CI 1.27-4.74]; P = 0.008) but not otherwise (P for interaction, 0.040).

CONCLUSIONS

Preoperative cachexia did not affect short-term surgical complications but significantly deteriorated postoperative prognosis in patients who underwent surgery for HPB malignancies.

The prognostic impact of body composition assessed by computed tomography in adult patients with newly diagnosed acute lymphoblastic leukemia

BACKGROUND

Body composition has emerged as a significant determinant of cancer patient outcomes, with computed tomography (CT) assessment at the L3 level offering a reliable evaluation method. While muscle mass and adiposity have been linked to poorer outcomes in hematological malignancies, their impact remains unstudied in adults with acute lymphoblastic leukemia (ALL).

METHODS

This retrospective single-center study enrolled adults newly diagnosed with ALL. Skeletal muscle, visceral, and subcutaneous fat areas were quantified. Low muscle mass was defined as a skeletal muscle index (SMI) less than 55 cm2/m2 in men, and less than 39 cm2/m2 in women, and receiver operating characteristic curves determined cutoff points for SMI, subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI) correlated with mortality.

RESULTS

Ninety patients were included. Low muscle mass was associated with mortality in patients treated with a pediatric inspired regimen (PIR) (HR 4.92, 95 % CI [1.38-17.57], p = 0.014) and lower median SMI was observed in patients who died during induction (p = 0.016). High visceral adiposity (HR 1.89, 95 % CI [1-3.57], p = 0.049) and high subcutaneous adiposity (HR 1.99, 95 % CI [1-3.96], p = 0.05) were also associated with mortality in the whole population. Furthermore, a higher VATI was observed in patients who developed an infectious episode during induction (p = 0.03), and a higher VATI was observed in patients who were treated with a PIR who had measurable residual disease positivity after induction chemotherapy (p = 0.044).

CONCLUSION

CT-assessed muscle mass, and adiposity bear prognostic significance in newly diagnosed ALL patients.

Calcium Handling Machinery and Sarcomere Assembly are Impaired Through Multipronged Mechanisms in Cancer Cytokine-Induced Cachexia

Background

Cachexia is a severe form of muscle wasting disorder particularly observed in patients with advanced cancer. The absence of effective strategies to ameliorate cachexia indicates our poor understanding of the mechanisms of cachexia. By employing system‐wide approaches, we investigated molecular mechanisms underlying cancer secreted pro‐inflammatory cytokine‐induced cachexia (CIC).

Methods

As cellular model systems, we employed mouse satellite stem cell‐derived primary muscle cells, mouse C2C12 myoblast progenitor cell‐derived myotubes, and neonatal rat cardiomyocytes. We induced CIC by incubating striated muscle cells with pro‐inflammatory cytokines TNF‐α and IFN‐γ. To understand the physiological effects of CIC, we probed the contractile properties of muscle cells following electrical stimulation and measured intracellular calcium transients. Effects of CIC on sarcomere organization were monitored by confocal microscopy. Large‐scale quantitative proteomics and RNA sequencing assays enabled us to examine molecular mechanisms underlying CIC. Using chromatin immunoprecipitation experiments, chromatin signalling and modulation of epigenetic marks on muscle‐specific genes were investigated.

Results

Here, we observed a drastic loss of striated muscle cell contraction in CIC, primarily, due to acutely disorganized sarcomere structures and impeded calcium handling process. In calcium transients, the extent of calcium (Ca2+) release, as indicated by the calcium amplitude during the excitation–contraction coupling (ECC) process, was reduced (19.6 ± 2.35% in control to 8.6 ± 1.52% in CIC, p = 4.8 * 10−11). Kinetics of calcium transients, i.e., the Ca2+ release rate (26 ± 0.5 ms in control to 29 ± 5.1 ms in CIC, median p = 0.014), and calcium re‐uptake rate (137 ± 13 ms in control to 185 ± 24 ms in CIC, p = 0.032) were both prolonged. Proteomic analysis showed altered proteostasis in CIC, particularly related to sarcomere and sarcoplasmic reticulum (SR). Transcriptomic analysis unravelled upstream deregulation of global transcriptional events for sarcomeric and SR genes. Mechanistically, chromatin loading of transcriptionally active RNA Polymerase II on muscle‐specific genes, including Myh1 and Atp2a1, was impeded. This was due to diminished transcriptionally active epigenetic marks H3K4 trimethylation on Myh1 and Atp2a1, resulted in lower transcriptional activity of these muscle‐specific genes in CIC and ultimately reduced MyHC‐IId molecular motor protein and SERCA1 protein levels.

Conclusions

Our top‐down approach elucidated that the altered transcriptional mechanism and proteomic state perturbed functionally related machinery responsible for calcium handling and sarcomere organization in CIC. Knowledge of the underlying cause of muscle mass loss and compromised muscle function is key for developing therapeutic solutions to ameliorate cachectic conditions.

Many ways, one destination: a comprehensive review of screening and assessment tools to detect malnutrition in patients with ovarian cancer

Malnutrition is a condition of deficiency, imbalance, or excess in a person's intake of energy and/or nutrients. Despite being common in patients with cancer, it is rarely diagnosed and managed by oncologists. Weight loss or changes in body mass index may fail to capture nutritional risk in patients with ovarian cancer due to masking ascites. The European Society for Clinical Nutrition and Metabolism and American Society for Parenteral and Enteral Nutrition guidelines recommend that patients with cancer undergo formal malnutrition screening and a full specialist assessment for those identified as high risk, and this recommendation is endorsed by European Society of Gynecologic Oncology and National Comprehensive Cancer Network for patients with ovarian cancer. The goal of this review was to describe the most common screening and assessment tools, studied in patients with ovarian cancer, as they relate to patient outcomes (complications, toxicity, and survival). Several tools have been tested in research and clinical settings, including serum markers, algorithms, scores, and clinical screening and assessment methods. These include but are not limited to pre-operative albumin, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, the Glasgow prognostic score, the prognostic nutritional index, and several clinical questionnaires. There are benefits and limitations to any individual tool as described in the review. Emerging technologies may also prove useful for malnutrition detection. We advocate that gynecologic oncology practices adopt a universal standardized method of screening and assessment for malnutrition in patients with ovarian cancer. Malnutrition can dramatically impact oncologic outcomes and patient well-being. Patients with malnutrition should be offered a nutritional care plan. These patients might also benefit from pre-habilitation, an emerging concept in gynecologic oncology, but evidence on its real impact is still limited. It is imperative that future research focus on strategies to reduce nutritional risk, improve patient overall health, and support resilience to cancer and anticancer treatment.

Sarcopenia in gynaecological cancers

Gynaecological cancers (GCs) comprise a group of cancers that originate in the female reproductive organs. Each GC is unique, with different signs and symptoms, risk factors and therapeutic strategies. Worldwide, the majority of GCs are still associated with high mortality rates, especially ovarian, due to difficulty in early detection. Despite numerous studies on the underlying pathophysiology, research in the field of GCs poses unique scientific and technological challenges. These challenges require a concerted multi- and inter-disciplinary effort by the clinical, scientific and research communities to accelerate the advancement of prognostic, diagnostic, and therapeutic approaches. Sarcopenia is a multifactorial disease which leads to the systemic loss of skeletal muscle mass and function. It can be caused by malignancies, as well as due to malnutrition, physical inactivity, ageing and neuromuscular, inflammatory, and/or endocrine diseases. Anorexia and systemic inflammation can shift the metabolic balance of patients with cancer cachexia towards catabolism of skeletal muscle, and hence sarcopenia. Therefore, sarcopenia is considered as an indicator of poor general health status, as well as the possible indicator of advanced cancer. There is a growing body of evidence showing the prognostic significance of sarcopenia in various cancers, including GCs. This review will outline the clinical importance of sarcopenia in patients with GCs.

Comprehensive insights into emerging advances in the Neurobiology of anorexia

BACKGROUND

Anorexia is a complex eating disorder influenced by genetic, environmental, psychological, and socio-cultural factors. Research into its molecular mechanisms and neural circuits has deepened our understanding of its pathogenesis. Recent advances in neuroscience, molecular biology, and genetics have revealed key molecular and neural circuit mechanisms underlying anorexia.

AIM OF REVIEW

Clarify the peripheral and central molecular mechanisms regulating various types of anorexia, identify key cytokines and neural circuits, and propose new strategies for its treatment. Key scientific concepts of review: Anorexia animal models, including activity-induced, genetic mutation, and inflammation-induced types, are explored for their relevance to studying the disorder. Anorexic behavior is regulated by cytokines, hormones (like GDF15, GLP-1, and leptin), and neural circuits such as AgRP, serotonergic, dopaminergic, and glutamatergic pathways. Disruptions in these pathways, including GABAergic signaling in AgRP neurons and 5-HT2C and D2 receptors, contribute to anorexia. Potential therapies target neurotransmitter receptors, ghrelin receptors, and the GDF15-GFRAL pathway, offering insights for treating anorexia, immune responses, and obesity.

Obesity paradox of sepsis in long-term outcome: The differential effect of body composition

BACKGROUND

The obesity paradox has been widely studied recently; however, its impact on the long-term prognosis of sepsis and the protective mechanism of body mass have not yet been sufficiently revealed.

METHODS

We retrospectively evaluated the association between obesity and 1-year survival after sepsis in a single university-affiliated hospital and examined the differential effects of muscle mass and adiposity.

RESULTS

Adult patients with sepsis or septic shock (n = 1492)were classified into obese (n = 300) and nonobese (n = 1192) groups. One-year mortality due to sepsis was lower in the obese than in the nonobese (52.0 % vs. 64.8 %; p < 0.001). In multivariate Cox analysis, one-year mortality due to sepsis was independently associated with body mass index (BMI) (hazard ratio 0.96). In the subgroup analysis, 705 were divided into four groups according to the psoas muscle index (PMI) and body fat percentage (BFP) to assess the differential impact of body fat and muscle mass on the one-year outcome of sepsis. One-year mortality was significantly different among the four groups (high BFP/low PMI, 60.6 %; high BFP/high PMI, 42.1 %; low BFP/high PMI, 34.8 %; low BFP/low PMI, 63.2 %; p = 0.002). The adjusted hazards ratio of one-year mortality of sepsis, which was normalized to the low BFP/high PMI group, were 1.2 (p = 0.585), 2.2 (p = 0.016), and 2.3 (p = 0.009) in groups of high BFP/high PMI, high BFP/low PMI, and low BFP/low PMI, respectively.

CONCLUSION

An obesity paradox has been observed in the long-term outcomes of patients with sepsis, and muscle mass may be more critical than fat mass as a protective mechanism against obesity.

IMPLICATIONS FOR CLINICAL PRACTICE

A high BMI is linked to a more favorable long-term prognosis in sepsis, with muscle mass playing a more critical role than fat mass. A proactive nutritional and conditioning program may benefit patients anticipating major procedures and potential ICU admission. Such preparation could enhance their resilience and improve outcomes when facing critical illness, including sepsis.

A Novel Definition and Grading Diagnostic Criteria for Tumour-Type-Specific Comprehensive Cachexia Risk

BACKGROUND

The existing diagnostic criteria for cancer cachexia do not meet clinical needs. We aimed to establish novel comprehensive evaluation scales for cachexia specific to patients with solid tumours.

METHODS

This study included 12 651 patients (males: 6793 [53.7%]; females: 5858 [46.3%]; medium age: 58 [interquartile range:50/66] years; medium follow-up duration: 24.16 [13.32/44.84] months; 4271 [33.8%] patients died; mean survival: 55.53 [95% confidence interval, 54.87/56.10] months; 3344 [26.4%], 4184 [33.1%] and 5123 [40.5%] patients with Stage I-II, III and IV tumour, respectively; derivation set: 10022, validation set: 2629 patients) with 14 types of solid tumours, including lung, gastric, liver, breast, oesophageal, cervical, bladder, pancreatic, prostate, ovarian, colorectal cancer, nasopharyngeal and endometrial carcinoma and cholangiocarcinoma, from an open and ongoing multicentre cohort study in China. Risk factors for cachexia, including tumour characteristics and nutritional parameters, were examined to develop diagnostic scales using Cox proportional hazards models and Kaplan-Meier analysis.

RESULTS

Ten nutrition items (body mass index, weight loss, intake reduction, physical activity function, fatigue, handgrip strength, anorexia, albumin level, albumin/globulin ratio and neutrophil/lymphocyte ratio) with different weighted scores were identified to construct a nutrition-weighted scoring scale (NWSS) for nutrition risk. Tumour type and tumour burden status (tumour-node-metastasis stage and radical or non-radical tumour) were determined to construct a disease-weighted scoring scale (DWSS) for disease risk. A lumped scale (5 × 5 matrix) established using a five-grade classification of nutrition and disease risk was used to determine a five-grade classification of comprehensive cachexia risk: A, no cachexia risk (reference; lowest disease and nutrition risks); B, cachexia risk (hazard ratio [HR] = 4.517 [4.033/5.058]); C, pre-cachexia (HR = 9.755 [8.73/10.901], medium survival = 21.21 months); D, cachexia (HR = 16.901 [14.995/19.049], medium survival = 11.61 months); and E, refractory cachexia (HR = 31.879 [28.244/35.981], medium survival = 4.83 months, highest disease and nutrition risks) (p < 0.001). Patients in Categories A-D benefited from nutrition therapy and anti-tumour treatments to varying degrees. Patients in Category E were clinically refractory to nutrition therapy without prolonged survival compared with patients without nutrition therapy (medium survival, pre-hospitalization nutrition therapy vs. hospitalization nutrition therapy vs. without nutrition therapy, 2.89 [1.91/3.88] vs. 4.04 [3.21/4.88] vs. 5.89 [4.73/7.04] months, p = 0.015) and anti-tumour treatments without prolonged survival compared with patients receiving palliative care (medium survival, radical anti-tumour treatments vs. adjuvant anti-tumour treatments vs. palliative anti-tumour treatments vs. and palliative care, 6.48 [4.42/8.53] vs. 6.48 [3.23/9.73] vs. 4.83 [4.22/5.44] vs. 2.70 [1.09/4.30] months, p = 0.263).

CONCLUSION

We systematically developed a novel definition and grading diagnostic criteria for tumour-type-specific comprehensive cancer cachexia risk.

The Optimal Timing for Initiating Anamorelin in the Treatment of Cancer Cachexia

Objective In 2021, anamorelin, an orally active ghrelin receptor selective antagonist, was approved for the treatment of cachexia in patients with non-small cell lung cancer, gastric cancer, pancreatic cancer, and colon cancer. Cancer cachexia is classified into three stages: pre-cachexia, cachexia, and refractory cachexia, with the pre-cachexia and cachexia stages considered reversible with a combination of nutritional therapy, pharmacotherapy, and exercise therapy. In addition, treatment of cachexia requires early intervention, but diagnosis and early detection of cachexia are difficult. We hypothesized that the initiation of anamorelin treatment may be delayed in clinical practice and explored the appropriate timing of treatment initiation. Methods The data of patients with cachexia who received anamorelin at our hospital from June 2021 to July 2023 were retrospectively reviewed. Anamorelin was administered to 201 patients, of whom 134 were included in the study. Survival time and duration of medication were compared based on the number of objective criteria for anamorelin prescription (C-reactive protein [CRP] >0.5 mg/dL, hemoglobin <12 g/dL, albumin <3.2 g/dL). Multivariate analysis was used to determine the factors associated with continuation of anamorelin treatment for 12 weeks. Results Patients with a higher number of objective criteria for anamorelin prescription (CRP >0.5 mg/dL, hemoglobin <12 g/dL, albumin <3.2 g/dL) had shorter anamorelin treatment duration and survival. In multivariate analysis, 12 weeks of anamorelin treatment was associated with CRP. Comparing CRP ≤0.5 mg/dL vs. CRP >0.5 mg/dL, survival was significantly longer for CRP ≤0.5 mg/dL (p < 0.01). Conclusions Initiating anamorelin treatment with close attention to CRP and ensuring that prescribing criteria are met may be helpful in treating cachexia.

Identification of a senescence-associated transcriptional program in skeletal muscle of cachectic pancreatic-tumor-bearing mice

Cancer cachexia is the involuntary loss of body and skeletal muscle mass, which negatively impacts physical function, quality of life, treatment tolerance, and survival. Skeletal muscles of cachectic people and mice with pancreatic tumors also exhibit skeletal muscle damage, nonresolute immune cell infiltration, and impaired regeneration. These phenotypes may be influenced by the accumulation of senescent cells, which secrete factors detrimental to skeletal muscle health. However, there is currently no comprehensive research on the senescent cell accumulation in the skeletal muscle of tumor-bearing hosts, with or without chemotherapy. To address this gap, we cross-referenced the SenMayo panel of 125 senescence-related genes with our RNA-seq dataset in mouse skeletal muscle during the initiation and progression of cancer cachexia, which revealed a differential expression of 39 genes at precachexia, 64 genes at cachexia onset, and 72 genes when cachexia is severe. Since p16 is a canonical marker of senescence, we subsequently orthotopically injected p16-tdTomato reporter mice with murine KPC pancreatic cancer cells and treated a subset of mice with chemotherapy. At experimental endpoint, when KPC treatment-naïve mice were cachectic, we observed an increased accumulation of p16+ cells, along with increased mRNA levels of hallmark senescence markers (Cdkn1a/p21, Cdkn2a/p16, Glb1/senescent-associated-β-galactosidase), which were exacerbated by chemotherapy. Finally, we demonstrate an increase in CDKN1A/p21 in the muscle of cachectic patients with pancreatic cancer, which associated with cachexia severity. These findings suggest that senescent cells accumulate in skeletal muscle of cachectic pancreatic tumor-bearing hosts and that chemotherapy can exacerbate this accumulation.NEW & NOTEWORTHY To the best of our knowledge, this study is the first to investigate senescent cell accumulation in skeletal muscle of tumor-bearing hosts and its exacerbation by chemotherapy. Our findings identify an accumulation of senescent cells and reveal a senescence-related transcriptional program in skeletal muscle during the initiation and progression of cancer cachexia that is exacerbated by chemotherapy treatment. This highlights a novel potential therapeutic mechanism that can be targeted for the prevention of cancer-induced muscle pathologies.

Association between body composition parameters and treatment-related toxicities in patients with metastatic breast cancer receiving cyclin-dependent kinase 4 and 6 inhibitors

BACKGROUND & AIMS

Nowadays, limited data or no data are available on body composition changes and the development of treatment-related toxicities in metastatic breast cancer (MBC) patients treated with innovative and promising anticancer therapies, including cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors. Therefore, we evaluated in MBC treated with CDK4/6 inhibitors changes in adiposity and muscularity before and after treatment and whether the changes in these parameters were associated with toxicities, dose reduction or treatment discontinuation.

METHODS

We considered ER+/HER2- MBC patients undergoing treatment with CDK 4/6 inhibitors, collected clinical data and registered the number and type of toxicities, dose reduction due to adverse events and the rate of discontinuation. We analyzed CT scan images before treatment (T0) and at the first follow-up visit (T1), calculating SAT, VAT, TAT (adipose tissue), SMA and SMI (skeletal muscle mass).

RESULTS

70 MBC patients were enrolled. Median time of observation at T1 was 4 months (3; 12); 68 (97 %) patients experienced at least one G1-G2 adverse event, whereas 37 (53 %) at least one G3-G4. Dose reduction due to toxicity was registered in 17 patients (24 %), whereas discontinuation in 24 (34 %) patients. SMA at baseline inversely correlated with the number of adverse events (G3-G4) (r = -0.30; p = 0.039). Changes in body composition were not associated with G3-G4 toxicities. However, in patients with dose reduction, we observed overtime (T0-T1) an increase in median VAT (118 vs 135; p = 0.023) (median Delta VATT0-T1 3.9 %). In patients not discontinuing the treatment, we observed overtime an increase in mean SMA (127 ± 23 vs 131 ± 22, p < 0.05) and median VAT (119 vs 131, p < 0.05). We observed greater reduction in median VAT (Δ%) in patients who discontinued the therapy (p < 0.05). ΔVAT (%) (reduction) was more pronounced in those patients who discontinued therapy for disease progression (p = 0.01).

CONCLUSION

Changes in muscularity and adiposity with not univocal direction were associated with toxicities, treatment discontinuation or dose reduction among patients with breast cancer treated with CDK4/6 inhibitors.

Does nutritional support prevent severe mucositis in patients with head and neck cancer treated with chemoradiotherapy? A systematic review and meta-analysis

BACKGROUND

For patients with advanced head and neck cancer (HNC) chemoradiotherapy (CHRT) is the main treatment option. CHRT is a severe treatment with a high ratio of side effects which may be even more pronounced due to mucosities related malnutrition. Nutritional intervention like nutritional counseling (NC) and oral nutritional supplements (ONS) may prevent malnutrition. A systematic review and meta-analysis was performed to assess the effect of NC with or without ONS (NC±ONS) on CHRT-related grade ≥3 mucositis in patients with HNC undergoing CHRT.

METHODS

PubMed/MEDLINE, Web of Science, and Scopus were searched to identify randomized and non-randomized clinical studies of HNC patients undergoing CHRT, where mucositis grade ≥3 data were provided. Comparative and proportional meta-analyses were performed to calculate the odds ratio (OR) and incidence of a mucositis grade ≥3 in the included studies (%) with 95% confidence intervals (95% CI).

RESULTS

There were seven studies fulfilling inclusion criteria with 655 participants included. NC±ONS revealed no risk reduction of grade ≥3 mucositis (OR: 1.2, 95%CI: 0.7-1.9). The overall mucositis rate was 38.3% (95% CI: 24.8%-52.6%) and 32.8% (95% CI: 14.9%-53.5%) (P = 0.67) in NC+ONS and NC-ONS respectively.

CONCLUSION

Despite the undeniable role of NC±ONS for patients with HNC undergoing CHRT, we found it insufficient to avoid grade ≥3 CHRT-related mucositis. Further research should be conducted to determine recomendations how to decrease the risk of oral mucosities and, in consequence, how to prevent malnutrition in patients with CHRT.

Multicomponent Interventions for Adults With Cancer Cachexia: A Systematic Review

BACKGROUND

Cancer cachexia has substantial impacts on people's quality of life. There is no current gold standard treatment, but the complex pathophysiology of cachexia suggests that a multitargeted and individualised treatment approach is needed. We aimed to evaluate the extent to which multicomponent interventions have targeted the key features of cachexia and been tailored to individuals, and differential effects on quality of life.

METHODS

We conducted a systematic review of multicomponent interventions for adults with cancer cachexia. We searched four databases, two clinical trial registers and MedRxiv on 20 June 2024. Intervention components were classified by intervention category (nutritional, exercise/physical activity, pharmacological and psychosocial), cachexia feature(s) targeted (reduced energy intake, altered metabolism, involuntary weight loss and decline in physical function) and level of tailoring. Within-arm standardised mean changes in quality of life over time, as well as standardised mean differences between study arms, were calculated.

RESULTS

Sixty-two multicomponent interventions were included, of which two combined components from all four intervention categories, and nine targeted all four key features of cachexia. Eighteen multicomponent interventions were fully tailored and 30 were partly tailored to individuals. Within-arm standardised mean changes in quality of life were calculated for thirteen studies; all had a high risk of bias or raised concerns. In eleven studies, quality of life scores improved following the intervention, whereas in two studies they declined. Standardised mean differences between study arms were calculated for four studies; in three, the intervention arm showed a greater improvement in quality of life scores than the usual care arm. Amongst these data, there was no indication that the number of cachexia features targeted, or the extent of tailoring, was associated with a greater improvement in quality of life scores; however, the heterogeneity prevented us from concluding on our hypothesis.

CONCLUSIONS

This review mapped out in detail the combinations of intervention categories used, the key features of cachexia targeted, and the extent of tailoring across multicomponent interventions for adults with cancer cachexia. Only a small proportion of the multicomponent interventions targeted all four key features of cachexia, but most were either partly or fully tailored to individuals. Despite sixty-two multicomponent interventions being investigated, only four studies compared these to usual care and reported quality of life outcomes. High risk of bias, low sample sizes and variable outcome data remain challenges to the interpretability of results in this field.

Muscle wasting in cancer cachexia: Mechanisms and the role of exercise

Cancer cachexia (CC) is a multifactorial disease marked by a severe and progressive loss of lean muscle mass and characterized further by inflammation and a negative energy/protein balance, ultimately leading to muscle atrophy and loss of muscle tissue. As a result, patients experiencing cachexia have reduced muscle function and thus less independence and a lower quality of life. CC progresses through stages of increasing severity: pre-cachexia, cachexia and refractory cachexia. Two proposed underlying mechanisms that drive cancer-induced muscle wasting are the autophagy-lysosome and ubiquitin-proteasome systems. An increase in autophagic flux and proteolytic activity leads to atrophy of both cardiac and skeletal muscle, ultimately mediated by tumour or immune-secreted inflammatory cytokines. These pathways occur at a basal level to maintain cellular homeostasis; therefore, it is the overactivation of the pathways that leads to muscle atrophy. Recent evidence demonstrates the ability of aerobic and resistance training to restore these pathways to their basal levels. The mechanism is not yet understood, and more research is needed to determine exactly how exercise influences each pathway. However, exercise has great promise as a therapeutic strategy for CC because of the evidence for it preserving muscle mass and function, and attenuating protein degradative pathways. The extent to which exercise affects the ubiquitin-proteasome and autophagy-lysosome systems is determined by the frequency, intensity and duration of the exercise protocol. As such, an ideal exercise prescription is lacking for individuals with CC.

The Impact of Oral Nutrition Supplementation and Dietary Education on Nutritional Status, Knowledge, Attitudes, and Behaviour in Cancer Patients: A Randomized Clinical Trial

Cancer patients often experience significant weight loss due to metabolic changes, increased resting energy expenditure (REE), and poor nutrient intake, particularly exacerbated by treatments like chemotherapy and radiation. This study aimed to determine whether combining Oral Nutrition Supplements (ONS) with dietary education is more effective than dietary education alone in improving nutritional outcomes for cancer patients. An open-label randomized clinical trial at Persahabatan Hospital in Jakarta, Indonesia, involved 108 patients with lung or gynecological cancer, with 87 completing the study. Participants were assigned to receive either dietary education plus ONS (intervention group) or dietary education alone (control group). Results indicated that while both groups improved their nutrition knowledge, the intervention group experienced significant increases in body weight (1.68 ± 3.96 kg) and body mass index (BMI) (0.86 ± 1.96 kg/m2), whereas the control group lost weight. Additionally, the intervention group had a lower rate of anemia (60% vs. 80.9%), though no significant differences were found in albumin levels or inflammation status. These findings suggest that ONS combined with dietary education may help improve weight and BMI in cancer patients, warranting further research to confirm these benefits and assess long-term effects.

Assessing the Impact of Nutritional Status on the Quality of Life in Head and Neck Cancer Patients-The Need for Comprehensive Digital Tools

Background/Objectives: Malnutrition is a key determinant of quality of life (QoL) in patients with head and neck cancers (HNCs), influencing treatment outcomes and the occurrence of adverse events (AEs). Despite there being numerous studies on nutritional status and QoL, there is no standardized risk or prognostic model integrating clinical and demographic factors. Methods: A literature search was conducted in September 2024 in Scopus, PubMed, and Web of Science, covering studies published between 2013 and 2024. Articles were selected based on their relevance to AEs, nutritional interventions, and QoL assessments in HNC patients. Results: The key factors influencing QoL in HNC patients include age, sex, weight, BMI, educational level, and tumor features. Mucositis was identified as the most significant food intake-impairing AE, contributing to malnutrition and reduced QoL. Current QoL assessments rely on descriptive questionnaires, which lack personalization and predictive capabilities. Digital tools, including machine learning models and digital twins, offer potential solutions for risk prediction and personalized nutritional interventions. Conclusions: Despite significant research efforts, QoL assessment in HNC patients remains non-uniform, and risk models integrating nutritional status are lacking. A comprehensive, personalized approach is needed, leveraging digital tools to improve nutritional intervention strategies.

Cachexia in oral squamous cell carcinoma Sudanese patients: an exploratory study

BACKGROUND

Cachexia status is a drastic issue in cancer patients. The main goal of this study; which is considered the first of its kind in Sudan, was to enhance our understanding of the clinical implications of oral cancer cachexia. Newly diagnosed Sudanese patients with oral squamous cell carcinoma (OSCC) were evaluated for the incidence and impact of cachexia.

METHODS

This is a longitudinal descriptive study conducted at Khartoum Teaching Dental Hospital before April 2023. A number of 40 OSCC participants above 18 years old were analyzed for Cachexia based on weight loss, low hemoglobin levels, albumin levels, elevated C-reactive protein, decreased mid-upper arm circumference, loss of appetite, and anorexia. Data were collected over three visits, and analyzed using descriptive and bivariate statistics.

RESULTS

The study included 40 newly diagnosed patients with OSCC, with a mean of age 56.8 years. The incidence of cachexia was 33.2% before surgery, 55% one month postoperatively, and 65% six months later. Cachexia was significantly correlated (p < 0.05) with delayed wound healing (p = 0.008), prolonged nasogastric feeding tube usage (p = 0.023), interrupted adjuvant therapy (p = 0.003), and mortality (p = 0.007). Low BMI, loss of appetite, food intake, low hemoglobin, and elevated CRP were significant diagnostic criteria as well (p < 0.05).

CONCLUSIONS

In this study, Cachexia was found to be a critical prognostic factor for OSCC patients. Larger-scale clinical research in Sudan is needed to provide definitive findings and strategies to support nutritional status during therapy.

The prognostic value of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin in patients with advanced lung cancer

BACKGROUND

Systemic inflammation has prognostic value in cancer and is considered aetiological of cachexia by the Global Leadership Initiative on Malnutrition (GLIM). Lactate dehydrogenase (LDH) also has recognized prognostic value. The present study aimed to evaluate the ability of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin, to identify cachexia and predict outcome in advanced lung cancer.

METHODS

Patients (n = 261) with serum LDH, CRP and albumin measurement receiving palliative radiotherapy for advanced lung cancer between 2009 and 2015 were identified. Subjects were stratified by LDH and LCAS. This was compared to GRIm and LIPI, two previously described LDH based prognostic scores, which do not incorporate CRP.

RESULTS

On follow up there were 201 deaths. LDH and LCAS were associated with 1-year survival independent of ECOG-PS, MUST, weight loss, BMI, SMI, SMD, metastases, mGPS or NLR (all p < 0.001). On multivariate analysis LCAS (1.36, 1.13-1.63, p = 0.001), LIPI (1.50, 1.17-1.92, p = 0.02), metastases (1.53, 1.15-2.04, p = 0.004) and ECOG-PS (1.28, 1.04-1.57, p = 0.019) were independently associated with poorer overall survival.

CONCLUSION

LCAS appears to identify cachexia and stratify survival. This may represent a useful aetiological criterion within the GLIM framework and a more powerful prognostic tool than the phenotypic criteria.

NCR as a biomarker for nutritional status and inflammation in predicting outcomes in patients with cancer cachexia: a prospective, multicenter study

BACKGROUND

Systemic inflammation and nutritional status are key factors affecting the prognosis of patients with cancer cachexia. This study aims to evaluate the prognostic value of a new nutritional and inflammatory index, Prognostic Nutritional CRP Ratio (NCR), in patients with cancer cachexia.

METHODS

This prospective multicenter study analyzed 3,447 patients diagnosed with cancer cachexia across over 40 clinical centers in China, from June 2012 to December 2023. The NCR was calculated as BMI × albumin / CRP. The Cox proportional hazards regression model was utilized to analyze hazard ratios (HRs) for all-cause mortality. The relationship between NCR and all-cause mortality was assessed using restricted cubic spline modeling. The optimal cutoff value for NCR was determined through maximally selected rank statistics.

RESULTS

Among the 3,447 individuals diagnosed with cancer cachexia in our study, 2,296 (66.6%) were men, and 1,151 (33.4%) were women. With a median follow-up duration of 45.33 months, the mean age of the participants was 63.8 ± 11.4 years. We observed that lower NCR levels were prevalent among cachexia patients across a spectrum of cancer types, including lung, colorectal, liver, esophageal, breast, ovarian, and cervical cancers. We observed that lower NCR levels were prevalent among cachexia patients across a spectrum of cancer types, including lung, colorectal, liver, esophageal, breast, ovarian, and cervical cancers. This correlation held true across diverse patient subgroups, delineated by gender, age, smoking status, BMI, TNM stage, and tumor types, underscoring the broad applicability of NCR as a prognostic marker. Moreover, our findings highlighted that cancer cachexia patients with higher NCR levels experienced a significantly improved quality of life.

CONCLUSION

The NCR, indicative of nutritional status and inflammation, is associated with reduced all-cause mortality and could be a valuable prognostic marker for patients with cancer cachexia.

Pre-cachectic changes in amino acid homeostasis precede activation of eIF2α signaling in the liver at the onset of C26 cancer-induced cachexia

The sequence of events associated with cancer cachexia induction needs to be further characterized. Using the C26 mouse model, we found that prior to cachexia, cancer progression was associated with increased levels of IL-6 and growth differentiation factor 15 (GDF15), highly induced production of positive acute phase proteins (APPs) and reduced levels of most amino acids in the systemic circulation, while signal transducer and activator of transcription 3 (STAT3) signaling was induced (1) in the growing spleen, alongside activation of ribosomal protein S6 (rpS6) and alpha subunit of eukaryotic translation initiation factor-2 (eIF2α) signalings, and (2) in the liver, alongside increased positive-APP expression, decreased albumin expression, and upregulation of autophagy. At the onset of cachexia, rpS6 and eIF2α signalings were concomitantly activated in the liver, with increased expression of activating transcription factor 4 (ATF4) target genes involved in amino acid synthesis and transport, as well as autophagy. Data show that pre-cachectic (pre-Cx) alterations in protein/aa homeostasis are followed by activation of eIF2α signaling in the liver, an adaptive mechanism likely regulating protein/amino acid metabolism upon progression to cachexia.

Advanced High-Content Phenotypic Screening to Identify Drugs That Ameliorate the Inhibition of Skeletal Muscle Cell Differentiation Induced by Cancer Cachexia Serum

Background/Objectives: Cancer cachexia (CC) is a prevalent and debilitating syndrome in cancer patients, characterized by severe muscle and weight loss, leading to increased mortality and reduced quality of life. Despite the significant impact, effective treatments are lacking due to an incomplete understanding of its underlying mechanisms. In this study, we aim to develop drugs that ameliorate the inhibition of muscle differentiation induced by CC. We established an advanced, high-content phenotypic screening system using the serum of cancer patients and identified potential compounds. Methods: We used cancer patients' sera as pathophysiological stimuli in our screening system to evaluate their effects on muscle atrophy and differentiation. Various histone deacetylase (HDAC) inhibitors were tested for their efficacy. The system's translational relevance was validated by comparing results with clinical data and in vivo cachexia models. Results: Using our screening system, we evaluated several cancer patients' sera and found that they reflect clinical features of cancer cachexia. In addition, HDAC inhibitors, particularly those with broad-spectrum inhibition, showed promise as agents to ameliorate the inhibition of muscle differentiation induced by CC sera. This system's findings were consistent with clinical and in vivo data, highlighting its potential for identifying new drugs. Conclusions: The high-content phenotypic screening system effectively mimics some key aspects of CC pathophysiology on skeletal muscle, providing a valuable tool for drug discovery and understanding CC mechanisms. The translational relevance of our system offers a promising avenue for therapeutic advancements in the management of cancer cachexia, with the potential to improve patient outcomes and quality of life.

The Nutritional Phenotyping of Idiopathic Pulmonary Fibrosis Through Morphofunctional Assessment: A Bicentric Cross-Sectional Case-Control Study

There is increasing evidence supporting the use of morphofunctional assessment (MFA) as a tool for clinical characterization and decision-making in malnourished patients. MFA enables the diagnosis of malnutrition, sarcopenia, obesity, and cachexia, leading to a novel phenotype-based classification of nutritional disorders. Bioelectrical impedance analysis (BIVA), nutritional ultrasound® (NU) and computed tomography (CT) are included, along with functional tests like the Timed Up and Go test (TUG). Myoesteatosis, detectable via CT, can occur independently from nutritional phenotypes and has been identified as a significant mortality predictor in idiophatic pulmonary fibrosis (IPF). Our aim is to analyze the prevalence and overlap of nutritional phenotypes in IPF and evaluate the prognostic value of myoesteatosis. Our bicenter cross-sectional study included 82 IPF patients (84.1% male and with a medium age of 71.1 ± 7.35 years). MFA was performed using BIVA, NU, CT at the T12 level (CT-T12), the handgrip strength (HGS) test, and the TUG. CT-T12 BC parameters were analyzed using FocusedON® software, while statistical analyses were conducted with JAMOVI version 2.3.22. All four major nutritional phenotypes were represented in our cohort, with significant overlap. A total of 80.5% met the GLIM criteria for malnutrition, 14.6% had cachexia, 17% were sarcopenic, and 28% were obese. Of the obese patients, 70% were also malnourished, while 100% of sarcopenic obese patients (5.9% of total) had malnutrition. A total of 55% of sarcopenic patients with available CT also had myosteatosis, suggesting muscle quality deterioration as a potential driver of functional impairment. The presence of myosteatosis > 15% in T12-CT was an independent predictor of 12-month mortality (HR = 3.13; 95% CI: 1.01-9.70; p = 0.049), with survival rates of 78.1% vs. 96.6% in patients with vs. without myosteatosis, respectively. To conclude, this study underscores the relevance of MFA in the nutritional characterization of patients with IPF, demonstrating its potential to identify specific phenotypes associated with malnutrition, functional impairment, and the presence of myoesteatosis, thereby providing a valuable tool for clinical decision-making.

Multicenter phase II study on the efficacy of an oral nutritional supplement containing eicosapentaenoic acid in advanced gastric cancer patients with cachexia

BACKGROUND

Cachexia is a common complication in advanced gastric cancer (AGC). Eicosapentaenoic acid (EPA) may ameliorate cachexia. This single-arm, phase II study assessed the potential benefit of an oral nutritional supplement containing EPA (ONS-EPA) for cachexia in AGC patients.

METHODS

Chemotherapy-naive AGC patients with cachexia, defined by serum albumin < 3.5 g/dl and C-reactive protein ≥ 0.5 mg/dl, were included. Patients received an EPA-enriched supplement (Prosure®, 1.056 g EPA/pack) twice daily during first-line chemotherapy. The primary endpoint was time to treatment failure (TTF) in patients adhering to ≥ 25% of the planned ONS-EPA dose in the first two weeks (per-protocol set, PPS). Secondary analyses evaluated adherence impact on treatment outcomes.

RESULTS

Of 72 enrolled patients, 65 were evaluated. Median adherence was 42.8%. Median TTF in the PPS group was 4.8 months (95% CI 3.6-5.5), below the pre-set 4-month threshold. The PPS group had a higher proportion of patients who improved their nutritional and inflammatory status during treatment, along with better TTF and overall survival (OS) compared to those with poor adherence. Adjusted median TTF was 4.6 vs. 2.5 months (hazard ratio: 0.56; 95% CI 0.28-1.12, p = 0.105).

CONCLUSIONS

Although the primary endpoint was not achieved, the study suggests that ONS-EPA may benefit AGC patients with cachexia.

Synergic value of 3D CT-derived body composition and triglyceride glucose body mass for survival prognostic modeling in unresectable pancreatic cancer

Background

Personalized and accurate survival risk prognostication remains a significant challenge in advanced pancreatic ductal adenocarcinoma (PDAC), despite extensive research on prognostic and predictive markers. Patients with PDAC are prone to muscle loss, fat consumption, and malnutrition, which is associated with inferior outcomes. This study investigated the use of three-dimensional (3D) anthropometric parameters derived from computed tomography (CT) scans and triglyceride glucose-body mass index (TyG-BMI) in relation to overall survival (OS) outcomes in advanced PDAC patients. Additionally, a predictive model for 1 year OS was developed based on body components and hematological indicators.

Methods

A retrospective analysis was conducted on 303 patients with locally advanced PDAC or synchronous metastases undergoing first-line chemotherapy, all of whom had undergone pretreatment abdomen-pelvis CT scans. Automatic 3D measurements of subcutaneous and visceral fat volume, skeletal muscle volume, and skeletal muscle density (SMD) were assessed at the L3 vertebral level by an artificial intelligence assisted diagnosis system (HY Medical). Various indicators including TyG-BMI, nutritional indicators [geriatric nutritional risk index (GNRI) and prealbumin], and inflammation indicators [(C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR)] were also recorded. All patients underwent follow-up for at least 1 year and a dynamic nomogram for personalized survival prediction was constructed.

Results

We included 211 advanced PDAC patients [mean (standard deviation) age, 63.4 ± 11.2 years; 89 women (42.2) %)]. Factors such as low skeletal muscle index (SMI) (P = 0.011), high visceral to subcutaneous adipose tissue area ratio (VSR) (P < 0.001), high visceral fat index (VFI) (P < 0.001), low TyG-BMI (P = 0.004), and low prealbumin (P = 0.001) were identified as independent risk factors associated with 1 year OS. The area under the curve of the established dynamic nomogram was 0.846 and the calibration curve showed good consistency. High-risk patients (> 211.9 points calculated using the nomogram) had significantly reduced survival rates.

Conclusion

In this study, the proposed nomogram model (with web-based tool) enabled individualized prognostication of OS and could help to guide risk-adapted nutritional treatment for patients with unresectable PDAC or synchronous metastases.

Impact of Cancer Cachexia Progression on OATP1B1 Transport Activity: Quantitative Analysis Using Coproporphyrin-I as an Endogenous Biomarker

Genetic factors, inflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor-α (TNF-α), and uremic substances such as 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF) have been reported to affect organic anion transporting polypeptide (OATP)1B1 transport activity. However, the relationship between OATP1B1 transport activity and these factors in patients with cancer cachexia has not been reported. This study aimed to identify the factors contributing to individual differences in OATP1B1 transport activity in patients with cancer cachexia, using coproporphyrin-I (CP-I) as an endogenous biomarker of OATP1B1 transport activity. The study recruited 114 patients with cancer cachexia who satisfied the selection criteria. The subjects were classified into pre-cachexia, cachexia, and refractory cachexia. Median [interquartile range] plasma CP-I level was higher in patients with pre-cachexia (0.91 [0.67-1.12] ng/mL) compared with the data in the general population reported previously and tended to be higher in patients with refractory cachexia (1.06 [0.78-1.64] ng/mL) than in those with cachexia (0.87 [0.62-1.07] ng/mL), suggesting that OATP1B1 transport activity may decrease with the progression of cancer cachexia. Plasma CP-I correlated positively with IL-6 and TNF-α concentrations but did not correlate with OATP1B1 polymorphisms or CMPF concentration, which have been reported to reduce transport activity. Multiple regression analysis using the forced entry method identified refractory cachexia as a significant factor independently affecting plasma CP-I concentration. These findings suggest that the reduction in OATP1B1 transport activity in patients with cancer cachexia may be attributed to inflammatory cytokines or some other factors that are elevated by cancer cachexia progression, rather than OATP1B1 polymorphisms and CMPF.

Landscape of Clinical Trials in Cancer Cachexia: Assessment of Trends From 1995-2024

Cancer cachexia (CC), a multifactorial syndrome characterized by unintentional weight loss, is a frequent complication of cancer that impacts patients' quality of life and survival. In this retrospective review, we evaluated the landscape of clinical trials (CTx) registered on ClinicalTrials.gov for the consideration of potential factors contributing to human heterogeneity in their design and analyses. Among CTx registered from 1995-2024, we observed a trend toward equality in including female participants, but lack of reporting of sex as a biological variable. Limited demographic diversity was observed with ~93% White population participation. There was a substantial divergence in the diagnostic criteria and a wide range of tools employed to measure CC. Lastly, few studies considered cancer type and stage as clinical variables. Overall, a substantial gap remains in our knowledge of CC in non-white and female populations. Ultimately, these underreported data across CC CTx complicate the comparison and interpretation of CTx results, both within understudied populations and in specific cancer types. The current evolution of knowledge and new methodologies used for CC assessment reinforce the need for a constant revision of the CC consensus definition and diagnosis criteria to align with current advances in our understanding of human heterogeneity in CC.

Polygonatum cyrtonema Hua polysaccharides alleviate muscle atrophy and fat lipolysis by regulating the gut microenvironment in chemotherapy-induced cachexia

Introduction: Polygonatum cyrtonema Hua (PC) is an essential herbal medicine in China, known for improving muscle quality and enhancing physical function; its active ingredients are polysaccharides (PCPs). A previous study revealed the anti-atrophy effects of PCPs in cachectic mice. However, whether the effects of PCPs on anti-atrophy are associated with gut microenvironment remain elusive. This research endeavored to assess the medicinal efficacy of PCPs in alleviating muscle atrophy and fat lipolysis and explore the potential mechanisms. Methods: A cancer cachexia model was induced by male C57BL/6 mice bearing Lewis lung tumor cells and chemotherapy. The pharmacodynamics of PCPs (32 and 64 mg/kg/day) was investigated through measurements of tumor-free body weight, gastrocnemius muscle weight, soleus muscle weight, epididymal fat weight, tissue histology analysis, and pro-inflammatory cytokines. Immunohistochemistry and Western blotting assays were further used to confirm the effects of PCPs. 16S rRNA sequencing, LC-MS and GC-MS-based metabolomics were used to analyze the gut microbiota composition and metabolite alterations. Additionally, the agonist of free fatty acid receptor 2 (FFAR2)-a crucial short-chain fatty acid (SCFA) signaling molecule-was used to investigate the role of gut microbiota metabolites, specifically SCFAs, in the treatment of cancer cachexia, with comparisons to PCPs. Results: This study demonstrated that PCPs significantly mitigated body weight loss, restored muscle fiber atrophy and mitochondrial disorder, alleviated adipose tissue wasting, strengthened the intestinal barrier integrity, and decreased the intestinal inflammation in chemotherapy-induced cachexia. Furthermore, the reversal of specific bacterial taxa including Klebsiella, Akkermansia, norank_f__Desulfovibrionaceae, Enterococcus, NK4A214_group, Eubacterium_fissicatena_group, Eubacterium_nodatum_group, Erysipelatoclostridium, Lactobacillus, Monoglobus, Ruminococcus, Odoribacter, and Enterorhabdus, along with alterations in metabolites such as amino acids (AAs), eicosanoids, lactic acid and (SCFAs), contributed to the therapeutic effects of PCPs. Conclusion: Our findings suggest that PCPs can be used as prebiotic drugs targeting the microbiome-metabolomics axis in cancer patients undergoing chemotherapy.

Mechanisms, assessment, and exercise interventions for skeletal muscle dysfunction post-chemotherapy in breast cancer: from inflammation factors to clinical practice

Chemotherapy remains a central component of breast cancer treatment, significantly improving patient survival rates. However, its toxic side effects, along with cancer-related paraneoplastic syndromes, can lead to the loss of skeletal muscle mass and function, impairing physical abilities and increasing the risk of complications during treatment. Chemotherapeutic agents directly impact skeletal muscle cells by promoting protein degradation, inhibiting protein synthesis, and triggering systemic inflammation, all of which contribute to muscle atrophy. Additionally, these drugs can interfere with the proliferation and differentiation of stem cells, such as satellite cells, disrupting muscle regeneration and repair while inducing abnormal differentiation of intermuscular tissue, thereby worsening muscle wasting. These effects not only reduce the effectiveness of chemotherapy but also negatively affect patients' quality of life and disease prognosis. Recent studies have emphasized the role of exercise as an effective non-pharmacological strategy for preventing muscle loss and preserving muscle mass in cancer patients. This review examines the clinical manifestations of muscle dysfunction following breast cancer chemotherapy, the potential mechanisms underlying these changes, and the evidence supporting exercise as a therapeutic approach for improving muscle function.

Prognostic impact of visceral and subcutaneous fat area in stage I-III colon cancer patients with cachexia: a population-based multicenter study

Background

Adipose tissue reduction is one of the features in patients with cancer cachexia. However, it remains unclear whether visceral fat area (VFA) and subcutaneous fat area (SFA) contribute differently to the progression of cancer cachexia in colon cancer patients. This study aims to investigate the prognostic impact of VFA and SFA in stage I-III colon cancer patients with cachexia.

Methods

Patients diagnosed with stage I-III colon cancer were preoperatively measured for VFA and SFA and then divided into VFA-high (VFA-H) and VFA-low (VFA-L) groups, as well as SFA-high (SFA-H) and SFA-low (SFA-L) groups. The prognostic impact of VFA and SFA for colon cancer patients with cachexia were analyzed using the Kaplan-Meier method and Cox regression analysis.

Results

A total of 916 colon cancer patients (377 with cachexia and 539 without) were included in the study. In patients with cachexia, the estimated five-year overall survival (OS) was higher in the VFA-H group compared to the VFA-L group (p < 0.001). There was no significant difference in five-year OS between the SFA-L and SFA-H groups (p = 0.076). Cox regression analysis indicated that VFA (hazard ratio [HR] = 0.55, 95% confidence interval [CI] 0.40 to 0.76; p < 0.001) was an independent prognostic factor for patients with cachexia. SFA (HR = 0.78, 95% CI 0.59 to 1.03; p = 0.076) was not an independent prognostic factor for patients with cachexia.

Conclusion

Preoperative VFA, but not SFA was a useful prognostic factor for long-term outcomes in stage I-III colon cancer patients with cachexia. More attention should be paid to VFA in colon cancer patients with cachexia.

Sex-related differences in eating-related distress experienced by patients with advanced cancer

BACKGROUND

Sex-related differences in eating-related distress (ERD) experienced by cancer patients have not previously been clarified.

METHODS

We conducted a multicenter survey among advanced cancer patients referred to palliative care. Data on patient characteristics were collected from the electronic medical records, and data on measurement outcomes were obtained from a questionnaire. Patients were categorized into male and female groups. We measured ERD using the Questionnaire for Eating-Related Distress among Patients with advanced cancer (QERD-P). The QERD-P comprises 3 items in each of the 7 factors, for a total of 21 items, and each item is rated on a 7-point Likert scale. High scores indicate worse distress. Comparisons were calculated using the Mann-Whitney U test. To assess associations between sexes and ERD, multivariate logistic regression analysis was performed.

RESULTS

A total of 192 patients were enrolled and divided into the male (n = 92) and female (n = 100) groups. The total score of the QERD-P was significantly higher in the male group (p = 0.018). The subtotal scores of "reasons why I cannot eat," "insufficient information," and "arguments with my family" were significantly higher in the male group (p = 0.035, 0.032, and 0.003, respectively). The male group had significantly higher risks for ERD associated with "arguments with my family" and "time with my family" (odds ratio [OR] 2.69, 95% confidence interval [CI] 1.38-5.24; OR 2.28, 95% CI 1.15-4.53).

CONCLUSIONS

Males had significantly worse ERD and were at higher risk of ERD in family relationships than females.

Skeletal Muscle Index-Based Cachexia Index as a Predictor of Prognosis in Patients With Cancer: A Meta-Analysis and Systematic Review

CONTEXT

Cachexia is associated with poor survival rates. In the clinical setting, the diagnosis of cancer cachexia is challenging. The cachexia index (CXI), a new index for predicting survival time, is a promising tool for diagnosing cancer cachexia; however, its efficacy in predicting patient survival has not been validated.

OBJECTIVE

This meta-analysis and systematic review aimed to explore the CXI's prognostic value in patients with cancer.

DATA SOURCES

The PubMed, Embase, MEDLINE, and Cochrane Library databases were searched for relevant studies to determine the association between CXI findings and prognosis.

DATA EXTRACTION

The outcomes were overall survival (OS), progression-, disease-, and recurrence-free survival (PFS/DFS/RFS) rates, and the rate of complete response.

DATA ANALYSIS

The QUality In Prognostic Studies (QUIPS) tool was used to evaluate the quality of the included trials. This meta-analysis comprised 14 studies involving 2777 patients. A low CXI was associated with decreased OS (hazard ratio [HR] 2.34, 95% confidence interval [CI] 2.01-2.72; P < .001), PFS/DFS/RFS (HR 1.93, 95% CI 1.68-2.22; P < .001), and complete response (odds ratio [OR] 0.49, 95% CI 0.36-0.66; P < .001). Patients with a low CXI had a lower body mass index (mean difference [MD] -0.75, 95% CI -1.00 to 0.50; P < .001), skeletal muscle index (standardized MD -0.80, 95% CI -0.98 to -0.61; P < .001), and serum albumin level (MD -0.23, 95% CI -0.26 to -0.20; P < .001); and a higher neutrophil-lymphocyte ratio (MD 1.88, 95% CI 1.29-2.47; P < .001) and more advanced disease stages (OR 0.80, 95% CI 0.71-0.91; P = .001).

CONCLUSION

A low CXI was found to be associated with poor survival in patients with cancer. While the CXI is a promising marker for predicting cancer cachexia, further studies are required to verify its usefulness.

Central mechanisms of emesis: A role for GDF15

BACKGROUND

Nausea and emesis are ubiquitously reported medical conditions and often present as treatment side effects along with polymorbidities contributing to detrimental life-threatening outcomes, such as poor nutrition, lower quality of life, and unfavorable patient prognosis. Growth differentiation factor 15 (GDF15) is a stress response cytokine secreted by a wide variety of cell types in response to a broad range of stressors. Circulating GDF15 levels are elevated in a range of medical conditions characterized by cachexia and malaise. In recent years, GDF15 has gained scientific and translational prominence with the discovery that its receptor, GDNF family receptor α-like (GFRAL), is expressed exclusively in the hindbrain. GFRAL activation may results in profound anorexia and body weight loss, effects which have attracted interest for the pharmacological treatment of obesity.

PURPOSE

This review highlights compelling emerging evidence indicating that GDF15 causes anorexia through the induction of nausea, emesis, and food aversions, which encourage a perspective on GDF15 system function in physiology and behavior beyond homeostatic energy regulation contexts. This highlights the potential role of GDF15 in the central mediation of nausea and emesis following a variety of physiological, and pathophysiological conditions such as chemotherapy-induced emesis, hyperemesis gravidarum, and cyclic vomiting syndrome.

An excessive weight loss percentage over the two years before treatment is an independent prognostic factor for operated patients with advanced oral squamous cell carcinoma

The aim of this study was to assess the prognostic value of the weight loss percentage (WLP) over the 2 years pre-treatment for operated patients with advanced oral squamous cell carcinoma (OSCC). This cohort study included 506 operated patients who were diagnosed with advanced primary OSCC between October 2001 and March 2022, and who were followed up until July 2022. Fine-Gray models, marginal structural models with stabilized inverse probability of treatment weighting, and Cox proportional hazards models were utilized to evaluate the prognostic significance of pre-treatment WLP for disease-specific survival (DSS). The median follow-up time was 32.6 months (interquartile range 13.0-71.6 months). A high pre-treatment WLP (>9.23%) was significantly associated with worse DSS (multivariate Fine-Gray model: hazard ratio (HR) 2.04, 95% confidence interval (CI) 1.29-3.22, P = 0.002; multivariate Cox: HR 2.01, 95% CI 1.28-3.16, P = 0.002). In the weighted cohort, a similar association pattern was observed (marginal structural model: HR 2.26, 95% CI 1.28-3.98, P = 0.005; multivariate Cox: HR 2.28, 95% CI 1.38-3.76, P = 0.001). In subgroup analyses, high WLP could predict worse DSS among patients with buccal mucosa/other cancer sites (not including the oral tongue), moderate tumor differentiation, and larger cancer size (>1.8 cm) (all P < 0.05). Pre-treatment WLP over 2 years might be a useful tool to predict the prognosis of operated patients with advanced OSCC.

Tumor metabolism as a factor affecting diversity in cancer cachexia

Cancer cachexia is a multifaceted metabolic syndrome characterized by muscle wasting, fat redistribution, and metabolic dysregulation, commonly associated with advanced cancer but sometimes also evident in early-stage disease. More subtle body composition changes have also been reported in association with cancer, including sarcopenia, myosteatosis, and increased fat radiodensity. Emerging evidence reveals that body composition changes including sarcopenia, myosteatosis, and increased fat radiodensity, arise from distinct biological mechanisms and significantly impact survival outcomes. Importantly, these features often occur independently, with their combined presence exacerbating poor prognoses. Tumor plays a pivotal role in driving these host changes, either by acting as a metabolic parasite or by releasing mediators that disrupt normal tissue function. This review explores the diversity of tumor metabolism. It highlights the potential for tumor-specific metabolic phenotypes to influence systemic effects, including fat redistribution and sarcopenia. Addressing this tumor-host metabolic interplay requires personalized approaches that disrupt tumor metabolism while preserving host health. Promising strategies include targeted pharmacological interventions and anticachexia agents like growth differentiation factor 15 (GDF-15) inhibitors. Nutritional modifications such as ketogenic diets and omega-3 fatty acid supplementation also merit further investigation. In addition to preserving muscle, these therapies will need to be evaluated for their capability to improve survival and quality of life. This review underscores the need for further research into tumor-driven metabolic effects on the host and the development of integrative treatment strategies to address the interconnected challenges of cancer progression and cachexia.

Clinical significance of cachexia index determined by bioelectrical impedance analysis in patients with gastrointestinal cancer

Cancer cachexia is a complex disorder characterized by skeletal muscle loss, which may influence the prognosis of patients with cancer. The cachexia index (CXI) is a new index for cachexia. The present study aimed to assess whether the CXI determined by bioelectrical impedance analysis (BIA) is valuable for predicting survival in patients with gastrointestinal cancer. A total of 54 patients with gastrointestinal cancer undergoing BIA at the time of diagnosis at Fukuchiyama City Hospital (Kyoto, Japan) were retrospectively recruited. CXI values were calculated as follows: CXI=skeletal muscle index (SMI) × serum albumin concentration/neutrophil-to-lymphocyte ratio. The SMI was measured using BIA values. The patients were classified into low- and high-CXI groups. The median patient age was 72 years and 63.0% of patients were male. A total of 20 patients with colorectal cancer were enrolled, 12 with pancreatic cancer, 11 with gastric cancer, 6 with esophageal cancer, 4 with biliary tract cancer and 1 with liver cancer. The cumulative one-year overall survival (OS) rate was significantly worse in the low-CXI group compared with that in the high-CXI group (58.3 vs. 88.5%; P=0.012). By contrast, the SMI had no significant effect on OS. Thus, CXI values using BIA may predict survival in patients with gastrointestinal cancer.