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]

Association of pectoralis muscle area on computed tomography with airflow limitation severity and respiratory outcomes in COPD: A population-based prospective cohort study

BACKGROUND

Previous studies have shown that patients with chronic obstructive pulmonary disease (COPD) of severe or very severe airflow limitation have a reduced pectoralis muscle area (PMA), which is associated with mortality. However, whether patients with COPD of mild or moderate airflow limitation also have a reduced PMA remains unclear. Additionally, limited evidence is available regarding the associations between PMA and respiratory symptoms, lung function, computed tomography (CT) imaging, lung function decline, and exacerbations. Therefore, we conducted this study to evaluate the presence of PMA reduction in COPD and to clarify its associations with the referred variables.

METHODS

This study was based on the subjects enrolled from July 2019 to December 2020 in the Early Chronic Obstructive Pulmonary Disease (ECOPD) study. Data including questionnaire, lung function, and CT imaging were collected. The PMA was quantified on full-inspiratory CT at the aortic arch level using predefined -50 and 90 Hounsfield unit attenuation ranges. Multivariate linear regression analyses were performed to assess the association between the PMA and airflow limitation severity, respiratory symptoms, lung function, emphysema, air trapping, and the annual decline in lung function. Cox proportional hazards analysis and Poisson regression analysis were used to evaluate the PMA and exacerbations after adjustment.

RESULTS

We included 1352 subjects at baseline (667 with normal spirometry, 685 with spirometry-defined COPD). The PMA was monotonically lower with progressive airflow limitation severity of COPD after adjusting for confounders (vs. normal spirometry; Global Initiative for Chronic Obstructive Lung Disease [GOLD] 1: β=-1.27, P=0.028; GOLD 2: β=-2.29, P<0.001; GOLD 3: β=-4.88, P<0.001; GOLD 4: β=-6.47, P=0.014). The PMA was negatively associated with the modified British Medical Research Council dyspnea scale (β=-0.005, P=0.026), COPD Assessment Test score (β=-0.06, P=0.001), emphysema (β=-0.07, P<0.001), and air trapping (β=-0.24, P<0.001) after adjustment. The PMA was positively associated with lung function (all P<0.05). Similar associations were discovered for the pectoralis major muscle area and pectoralis minor muscle area. After the 1-year follow-up, the PMA was associated with the annual decline in the post-bronchodilator forced expiratory volume in 1 s percent of predicted value (β=0.022, P=0.002) but not with the annual rate of exacerbations or the time to first exacerbation.

CONCLUSION

Patients with mild or moderate airflow limitation exhibit a reduced PMA. The PMA is associated with airflow limitation severity, respiratory symptoms, lung function, emphysema, and air trapping, suggesting that PMA measurement can assist with COPD assessment.

Correlation between cancer cachexia and psychosocial impact in older patients with advanced lung cancer undergoing chemotherapy

Objective

This study aimed to evaluate the association of cancer cachexia with psychosocial impact, nutrition impact symptoms (NIS), and geriatric assessment in older patients newly diagnosed with advanced lung cancer undergoing chemotherapy.

Methods

Older patients with advanced lung cancer scheduled to receive first-line chemotherapy between August 2021 and February 2022 were enrolled. Cachexia was diagnosed according to the International Consensus. NIS and psychosocial impacts were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ) C30, CAX24, and the Eating-Related Distress Questionnaire (ERD). Non-parametric tests evaluated the association between cachexia and its impacts. Patients with cachexia who consented to be interviewed were asked about their experiences with diet and weight changes. Three authors reviewed the interview data to ensure the analysis's veracity.

Results

Twenty-one of the 31 participants (68%) had cachexia at baseline. The cachexia group showed significantly greater severity of Food Aversion (P ​= ​0.035), Eating and Weight Loss Worry (P ​< ​0.001), and Loss of Control (P ​= ​0.005) compared to the non-cachexia group. There were no significant differences in the ERD and geriatric assessment (all P ​> ​0.05). The interview revealed that patients with cachexia perceived diet and weight changes early on and tried to manage their symptoms by themselves.

Conclusions

Cancer cachexia showed an association with NIS and psychosocial impacts. Older patients with advanced lung cancer scheduled to receive first-line chemotherapy should undergo a comprehensive assessment of cancer cachexia, including its potential physical and psychological impacts.

Trial registration

The trial registration number was UMIN 000053843.

Clinical impact of cancer cachexia on the outcome of patients with non-small cell lung cancer with PD-L1 tumor proportion scores of ≥50% receiving pembrolizumab monotherapy versus immune checkpoint inhibitor with chemotherapy

This retrospective, multicenter cohort study aimed to determine whether cancer cachexia serves as a biomarker for determining the most effective treatment for patients having non-small-cell lung cancer (NSCLC) with high programmed death ligand 1 (PD-L1) expression treated with immune checkpoint inhibitors (ICIs) alone or combined with chemotherapy (ICI/chemotherapy). We included 411 patients with advanced NSCLC with a PD-L1 tumor proportion score of ≥50%. The patients were treated with pembrolizumab monotherapy or ICI/chemotherapy. Cancer cachexia was defined as a weight loss of >5% of the total body weight or a body mass index of <20 kg/m2 coupled with an additional weight loss of >2% within 6 months before starting treatment. Eighty-five (21%) patients met the cancer cachexia criteria. Overall survival (OS) was significantly shorter in patients with cachexia than in those without cachexia in both the pembrolizumab monotherapy group (17.2 vs. 35.8 months, p < 0.001) and the ICI/chemotherapy group (27.0 months vs. not reached, p = 0.044). However, after stratifying by cancer cachexia status, no significant difference in OS was observed between the pembrolizumab monotherapy and chemoimmunotherapy groups, regardless of cachexia. In conclusion, ICI/chemotherapy offers limited benefits for NSCLC patients with high PD-L1 expression and concurrent cancer cachexia. Considering the frailty associated with cachexia, ICI monotherapy may be preferred to ICI/chemotherapy for these patients. New interventions that can better address the negative prognostic impact of cachexia in patients treated using ICIs with or without chemotherapy remain warranted.

Malnutrition defined by Controlling Nutritional Status score was independently associated with prognosis of diffuse large B-cell lymphoma primarily on elderly patients

OBJECTIVES

Controlling Nutritional Status (CONUT) Score is an effective tool for the assessment of malnutrition and proved to be associated with survival of Diffuse large B-cell lymphoma (DLBCL) patients. We investigated the impact of CONUT score on specific subgroups of DLBCL patients, including age and International prognostic Index (IPI) risk groups.

METHODS

Data of 287 newly diagnosed DLBCL in the Third Affiliated Hospital of Soochow University were retrospectively collected. Baseline CONUT score, clinical data and survival information were recorded.

RESULTS

With the standard cut-off value of 4 points, 88 (30.7%) patients were clarified as malnourished. During a median follow-up of 34 months, malnourished patients exhibited significant reduction in both progression-free survival (PFS) and overall survival (OS). The 3-year PFS rates for malnourished and well-nourished patients were 51.4% and 70.9% (p = 0.001), while the 3-year OS rates were 62.4% and 84.0% (p < 0.001). Malnutrition was demonstrated an independent predictor of OS in DLBCL patients (HR 2.220, 95% CI 1.307-3.772, p = 0.003). It could effectively identify patients with inferior OS in both low/intermediate-low risk and intermediate-high/high risk IPI groups. In the group of elderly patients aged over 60 years, malnutrition was independently associated with OS (HR 2.182, 95% CI 1.178-4.040, p = 0.024), but not PFS (HR 1.709, 95% CI 1.016-2.875, p = 0.070) after adjustment using the Benjamini-Hochberg procedure. Conversely, for younger patients, malnutrition did not demonstrate an independent impact on either PFS or OS.

CONCLUSION

Malnutrition evaluated by CONUT score was an independent predictor for the outcome of DLBCL patients, which is exclusively caused by its effect on elderly patients.

The role of branched-chain amino acids in cardio-oncology: A review

Cancer and cardiovascular diseases (CVDs) are global health challenges. In cancer patients, CVD is the second leading cause of death following disease progression. There are few specialized services for cardio-oncology patients worldwide currently. Branched-chain amino acids (BCAAs) are essential amino acids that promote protein synthesis and energy homeostasis. The disruption of BCAAs metabolism facilitates the development of cancer and CVDs while the benefit of BCAA supplement is full of controversy. In this review, we summarized BCAA-related studies in cardiometabolism, cancer and chemotherapy-induced cardiotoxicity, and provided our perspectives on the roles of BCAAs in cardio-oncology. We find that supplementation of BCAAs presents protective effects in cardiometabolic diseases, while the influence on cancer is intricate and varies across different types of cancers. Large-scale clinical studies are needed to understand the long-term effects of BCAA intake and its impact on different stages of the disease. BCAAs have potential to mitigate chemotherapy-induced cardiotoxicity. Continued research is still essential to understand the precise mechanisms, determine optimal dosage and timing, and assess the effectiveness of BCAA supplement in cardio-oncology, in particular clinical research.

Improving analysis of sexual dimorphism in body composition dynamics in the oncology setting: A scoping review

BACKGROUND AND AIMS

Chemotherapy treatments induce loss of skeletal muscle and adipose tissue each of which are important prognostic indicators after a cancer diagnosis. Males and females may respond differently to drugs used to treat cancer. Given the high degree of heterogeneity in the literature, the objective of this scoping review is to evaluate the methodological variability in reporting of muscle and adipose tissue changes comparing males and females during cancer-directed treatment.

METHODS

Relevant databases were searched for papers reporting longitudinal CT based body composition changes separately for males and females in solid tumors.

RESULTS

Of the 29 studies that met inclusion criteria, 22 were retrospective and 7 were prospective. The majority of studies reported on gastrointestinal cancers [n=24]. Among collective participants (n= 5139), 32% were females. Females were under represented in half the studies. For 21/29 studies, baseline characteristics were combined for males and females, hindering the ability to understand the effect of disease stage, chemotherapy type and co-morbidities on muscle and fat changes experienced by each sex. Multiple chemotherapy regimens were combined (n=24) and not reported in a sex-specific way (n=26).

CONCLUSION

While the literature reporting body composition changes during cancer treatment is abundant, study design and reporting is problematic and precludes metaanalysis. Disproportionate numbers of males and females, marked heterogeneity in cancer types and chemotherapy regimens evaluated within a single study collectively pose challenges in analysing the impact of specific chemotherapy regimens on muscle and adipose change by sex. Strategies to standardize this set of literature in a sex specific way are required to improve evidence synthesis.

The Weight of Nutrition on Post-Resection Oncologic Morbidity and Mortality: A Systematic Review and Meta-Analysis of Nutritional Indices

CONTEXT

Nutritional status is a critical factor in the selection of patients for solid tumor resection. A variety of indices have been developed to quantify nutritional status, and they have differing degrees of predictive power for various postoperative outcomes.

OBJECTIVE

This study aimed to comprehensively evaluate the predictive ability of commonly used nutritional indices in relation to postoperative complications (POCs), recurrence-free survival (RFS), and OS.

DATA SOURCES

We performed a systematic review of 14 established nutritional indices from January 2015 to July 2022.

DATA EXTRACTION

The primary end point was OS, while the secondary end points were POCs and RFS. A subsequent meta-analysis was performed to further assess the predictive ability of these indices for OS based on general index type, primary tumor site, and the patient's index status.

DATA ANALYSIS

In this evaluation, 38 articles reporting data on 23 970 patients were analyzed, focusing on 14 nutritional indices. The indices were categorized into phenotypic, metabolic, immunologic, and combined types. Patients within the cut-off range of any index were predicted to have lower OS (hazard ratio [HR] 2.14, 95% CI 1.84-2.49, P < .01). Lower gastrointestinal (GI) and "other" sites were less predictive than upper GI primary tumors (HR 1.63, HR 1.82, and HR 2.54, respectively; all with P < .01). Phenotypic indices were less predictive than combined indices (HR 1.73 vs HR 2.47, P < .01). Within the combined category, there was no significant difference in the predictive ability of Prognostic Nutritional Index (PNI) vs Geriatric Nutritional Risk Index (GNRI) vs Controlling Nutritional Index (CONUT) (HR 2.63 vs HR 2.42 vs HR 2.07, P = .07).

CONCLUSION

The predictive efficacy of a nutritional index was found to be highly dependent on the index type, the primary tumor site, and the outcome of interest. In the context of upper GI resections, nutritional status appeared to be more of a significant predictor of OS, compared with cases involving lower GI and hepatic malignancies. Indices that integrate phenotypic, metabolic, and immunologic patient factors potentially offer greater clinical utility in forecasting OS.

GL261 glioblastoma induces delayed body weight gain and stunted skeletal muscle growth in young mice

The survival rate for children and adolescents has increased to over 85%. However, there is limited understanding of the impact of pediatric cancers on muscle development and physiology. Given that brain tumors alone account for 26% of all pediatric cancers, this study aimed to investigate the skeletal muscle consequences of tumor growth in young mice. C2C12 myotubes were cocultured with GL261 murine glioblastoma cells to assess myotube size. GL261 cells were then injected subcutaneously into 4-wk-old male C57BL/6J mice. Animals were euthanized 28 days post-GL261 implantation. Muscle function was tested in vivo and ex vivo. Muscle protein synthesis was estimated via the SUnSET method, and gene/protein expression levels were assessed via Western blotting and qPCR. In vitro, the C2C12 cultures exposed to GL261 exhibited myotube atrophy, consistent with a disrupted anabolic/catabolic balance. In vivo, carcass, heart, and fat mass were significantly reduced in the tumor-bearing mice. Skeletal muscle growth was impeded in the GL261 hosts, along with a smaller muscle cross-sectional area (CSA). Both in vivo muscle torque and the ex vivo Extensor Digitorum Longus (EDL) muscle force were unchanged. At molecular level, the tumor hosts displayed reduced estimations of muscle protein synthesis and increased muscle protein ubiquitination, in disagreement with decreased muscle ubiquitin ligase mRNA expression. Overall, we showed that GL261 tumors impact the growth of pediatric mice by stunting skeletal muscle development, decreasing muscle mass, reducing muscle fiber size, diminishing muscle protein synthesis, and altering protein catabolism signaling.NEW & NOTEWORTHY This study shows that pediatric brain tumors stunt muscle development in young mice. GL261 glioblastoma cells caused myotube atrophy, reduced carcass, heart, and fat mass, and impeded skeletal muscle growth. Tumor-bearing mice had decreased muscle protein synthesis and increased protein ubiquitination. This is the first demonstration that GL261 tumors reduce muscle mass and fiber size, impair muscle function and innervation, and alter muscle protein turnover.

Body composition and chemotherapy toxicities in breast cancer: a systematic review of the literature

PURPOSE

Breast cancer is the most diagnosed cancer in women with chemotherapy being a common treatment. Toxicities due to chemotherapy can result in dose reduction, delay, and early cessation of treatment, which along with causing distress for individuals during their cancer treatment might also reduce the therapeutic effect. The purpose of this systematic review is to examine the role of body composition on chemotherapy toxicities in women with breast cancer.

METHODS

A systematic search of the literature was completed on electronic databases Pubmed, Embase, CINHAHL, and Cochrane. Studies were included if the direct effect of body composition on chemotherapy toxicities was reported and excluded if body composition could not be isolated. A critical appraisal of the studies included was performed using McMasters University Critical Review Form for Quantitative Studies.

RESULTS

Eleven studies were included with a total of 2881 female participants. All studies reported significant relationships between body composition and chemotherapy toxicities; however, individual parameters differed between the studies. Adding to the heterogeneity, different thresholds were reported to determine both sarcopenia and myosteatosis, making it difficult to identify a common finding.

CONCLUSION

This review suggests that body composition may be an important factor in predicting the severity of chemotherapy toxicities during treatment for breast cancer; however, the lack of international consensus as to thresholds in the literature for sarcopenia and myosteatosis may result in bias. The review supports the need for further prospective studies, allowing for more robust, pre-determined data collection, to better understand the implications of body composition on toxicities and benefits of using body composition to individualize chemotherapy dosing.

IMPLICATIONS FOR CANCER SURVIVORS

Toxicities due to chemotherapy can result in treatment being unable to be completed as planned, potentially resulting in poorer survival outcomes. Improved knowledge in this area may give rise to a more reliable way of individualizing chemotherapy dosage to help mitigate this risk.

Inflammation in cancer cachexia: still the central tenet or just another player?

Cancer cachexia, a multifactorial syndrome characterized by body weight loss, muscle, and adipose tissue wasting, affects patients with cancer. Over time, the definition of cachexia has been modified, including inflammation as one of the main causal factors. Evidence has suggested that a range of proinflammatory mediators may be involved in the regulation of intracellular signaling, resulting in enhanced resting energy expenditure, metabolic changes, and muscle atrophy, all of which are typical features of cachexia. Physiologically speaking, however, inflammation is a response aimed at facing potentially damaging events. Along this line, its induction in the cancer hosts could be an attempt to restore the physiological homeostasis. Interesting observations have shown that cytokines such as interleukins 4 and 6 could improve muscle wasting, supporting the view that the same mediator may exert pro- or anti-inflammatory activity depending on the immune cells involved as well as on the tissue metabolic demand. In conclusion, whether inflammation is crucial to the occurrence of cachexia or just one contributor among others, is still unclear. Indeed, while inflammation is a trigger of cachexia, the alterations of energy and protein metabolism and of the hormonal homeostasis occurring in cachexia likely act as inflammatory stimuli on their own. Whether the causative role prevails over the compensatory one likely depends on the tumor type and stage, patient lifestyle, the presence of comorbidities, and the response to anticancer treatments paving the way to a holistic, personalized approach to cancer cachexia.

GLP-1 receptor agonists in the context of cancer: the road ahead

A rapidly increasing proportion of the population in the United States is taking glucagon-like peptide-1 receptor agonists (GLP-1RAs) for type 2 diabetes or weight loss. Consequently, an increasing number of patients presenting with new cases of cancer also have a current prescription for GLP-1RAs. The impact of GLP-1RAs on metabolism is quite profound, and it is entirely reasonable to assume these agents are also very impactful on the metabolism of cancer cells, in addition to the general metabolism of the patient. Although these drugs are relatively recent on the market, the study of metabolism in cancer is a well-established field and we can make predictions about how GLP-1RAs will interface with cancer treatments. In fact, some evidence points to a possible neoadjuvant effect of these drugs for patients with cancer that would justify the initiation of GLP-1RAs to support therapy in a subset of patients. At the same time, there is a very present concern that drugs that induce weight loss may also precipitate the loss of muscle mass, cachexia, in patients. Here, we will provide an overview of the existing literature around diabetes and metabolism in the context of cancer and cachexia.

Potential framework of the Global Leadership Initiative in Sarcopenia (GLIS) criteria based on muscle mass and/or strength for predicting survival in cancer patients: A nationwide multicenter cohort study

BACKGROUND

The Global Leadership Initiative on Sarcopenia (GLIS) was proposed recently by creating a widely recognized conceptual definition of sarcopenia, however, the diagnostic framework of GLIS in cancer patients remains unclear. This study aims to evaluate the potential framework of GLIS based on muscle mass and/or strength in cancer patients.

METHODS

We performed a multicenter cohort study spanning from November 2012 to May 2020. Potential covariates were identified through univariate and multivariate analyses. The association between low muscle mass (LMM) and/or low muscle strength (LMS) with survival was estimated using Kaplan-Meier curves and Cox models. LMM was identified by lean mass index (LMI) or calf circumference (CC) while LMS was identified by hand grip strength (HGS).

RESULTS

A total of 6471 cancer patients were included, with a median follow-up of 50.0 months. Both LMM-LMI or LMS (HR = 1.56; 95%CI: 1.42, 1.71; p < 0.001) and LMM-LMI plus LMS (HR = 2.01; 95%CI: 1.65, 2.44; p < 0.001) were associated with a lower overall survival (OS) compared with patients without sarcopenia. Similarly, both LMM-CC or LMS group (HR = 1.51; 95%CI: 1.37, 1.67; p < 0.001) and LMM-CC plus LMS group (HR = 1.45; 95%CI: 1.28, 1.63; p < 0.001) were associated with a lower OS. Age, alcohol, Nutritional Risk Screening 2002 (NRS2002) score, Karnofsky Performance Status (KPS) score, Tumor Node Metastasis (TNM) stage, cancer category, albumin, direct bilirubin, anticancer therapy plus sex were introduced as covariates in fully-adjusted Cox model. Multivariable-adjusted Cox models revealed that LMM-LMI or LMS was an independent prognosis factor for cancer patients (HR = 1.18; 95%CI: 1.07, 1.31; p = 0.001). LMM-LMI plus LMS also was an independent predictor for survival among cancer patients (HR = 1.58; 95 % CI: 1.30, 1.94; p < 0.001).

CONCLUSION

The potential framework of GLIS based on muscle mass and/or strength was associated with survival in Chinese cancer patients. This research provides a simplified, clinically outcome-driven potential framework of sarcopenia, and offers new insights for the development of an operational definition of GLIS in the future.

The role of the hypothalamus in the development of cancer cachexia

Cachexia is a complex multiorgan syndrome associated with various chronic diseases, characterized by anorexia and increased tissue wasting in the context of chronic inflammation. A specific form of this syndrome, known as cancer cachexia (CC), occurs alongside different types of tumors. The pathogenesis of CC is multifactorial. Inflammatory mediators and hormones released by both tumor and host cells have a relevant role in driving the peripheral catabolic process through several direct mechanisms. Accumulating evidence indicates that the central nervous system (CNS) plays an integral role in the pathogenesis of CC. The hypothalamus has emerged as a critical brain region that senses and amplifies peripheral stimuli, generating inappropriate neuronal signaling and leading to the dysregulation of energy homeostasis under cachexia conditions. Circulating cytokines may act in concert with hormones and neurotransmitters and perturb critical hypothalamic neurocircuits shifting their activity towards the anorexigenic pathway and increase of energy expenditure. This review discusses the mechanisms mediating the hypothalamic homeostatic imbalance in the context of anorexia and cachexia associated with cancer.

Stool Microbiome Features and Weight Change Response to Treatment for cancer cachexia

BACKGROUND AND AIMS

Cancer cachexia is characterised by significant weight loss and muscle wasting that adversely affects patient outcomes. Nutritional interventions in cancer cachexia leads to improved outcomes, including improved weight change. However, there are wide variations in weight response to dietary interventions. Thus, it remains difficult to predict response to a given increase in dietary intake at an individual patient level. This study aimed to identify gut microbiome features that could serve as potential predictive biomarkers for response to individualized dietary intervention in patients with cancer cachexia attending the McGill Cancer Nutrition-Rehabilitation Program at the Jewish General Hospital (CNR-JGH).

METHODS

Participants were recruited from CNR-JGH clinic. Interventions included individualized nutritional counselling by a registered dietitian, to increase energy and protein intake to meet recommended levels. Stool DNA samples were collected at baseline (V1) and visit 2 (V2), and gut microbiome profiles were analysed to assess microbial diversity and identify differentially abundant genera in patients who lost weight (WL, N = 8) vs. maintained/gained weight (WSG, N = 29) at subsequent CNR-JGH clinic visits.

RESULTS

Greater alpha-diversity and higher Lachnospira genus abundance at baseline predicted higher likelihood that patients would have good response to CNR-JGH intervention (WSG at V2). Though predictors of poor response to nutritional intervention (WL at V2) were not identified, subjects in the WL group exhibited lower alpha-diversity and greater microbial population instability after CNR-JGH interventions.

CONCLUSIONS

In this cohort of patients with cancer-related weight loss attending a cancer cachexia clinic, certain gut microbiome features were associated with response to dietary interventions. Patients who lost weight after CNR-JGH intervention also developed a less diverse and less stable gut microbiome. Lachnospira genus abundance is a potential predictor of positive weight change response to dietary intervention as part of multimodal care for cancer cachexia, and further confirmatory studies are warranted. In addition, targeted dietary approaches to maintain diversity and gut microbiome population stability may have a role in improving the response to dietary interventions in cancer cachexia.

Exercise therapy: an effective approach to mitigate the risk of cancer metastasis

Cancer metastasis is a primary contributor to cancer-related mortality, and mitigating the risk of metastasis has emerged as a central concern in oncology research. In recent years, exercise therapy, as a non-pharmacological intervention, has received considerable attention for its ability to enhance patients' quality of life and prognosis. Exercise significantly inhibits cancer spread, diminishes cancer risk, and improves therapy outcomes. Nonetheless, the exact mechanisms via which exercise inhibits the dissemination and metastasis of cancer cells are not fully elucidated. This review seeks to examine the mechanisms and prospective research avenues of exercise treatment in mitigating the risk of cancer metastasis. Moreover, it methodically examines pertinent clinical and scientific data, along with the efficacy of exercise therapies in real-world applications. The evaluation moreover suggests future research avenues, including a more profound exploration of mechanisms, the augmentation of clinical trials, the advancement of personalized and precision exercise therapy, and enhanced multidisciplinary collaboration. Exercise therapy shows significant potential in mitigating the risk of cancer metastasis, and its incorporation into holistic cancer treatment frameworks is advised to improve patients' general health and prognostic results.

Impact of Body Composition on Dose Modifications and Prognosis in Locally Advanced Gastric Cancer Patients Undergoing Neoadjuvant Chemotherapy

BACKGROUND

Despite advances in treatment, locally advanced GC continues to be associated with poor prognosis. Body composition, specifically the distribution of skeletal muscle and adipose tissue, has emerged as a key factor influencing cancer prognosis, yet its impact on neoadjuvant chemotherapy (NACT) dose modifications and long-term survival in GC remains unclear. The primary aim of this study was to assess the relationship between body composition and dose delay/reduction during preoperative NACT in locally advanced gastric cancer patients. The secondary aim was to evaluate the impact of body composition on overall and disease-free survival.

METHODS

This retrospective study included 97 patients with locally advanced gastric adenocarcinoma treated with NACT at Liv Bona Dea Hospital, Baku, Azerbaijan, between 2018 and 2024. Body composition parameters-skeletal muscle index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT)-were analyzed using pre- and post-NACT CT imaging. Dose delay and reduction were defined as treatment delays of ≥5 days and dose reductions of ≥10% due to chemotherapy-related side effects. Survival outcomes were assessed using Kaplan-Meier analysis.

RESULTS

Of the 97 patients (mean age: 63), 33% experienced dose delays and 15% had dose reductions. Multivariate analysis revealed that lower pre-NACT VAT measurements were associated with both dose delay (p=0.01, OR=7.31) and dose reduction (p=0.01, OR=8.87). No significant correlation was found between body composition parameters and overall survival (OS) or disease-free survival (DFS). However, neural (p=0.013, HR=1.88) and venous invasion (p=0.03, HR=1.43) were independent predictors of poor OS, while poor histological grade (p=0.008, HR=2.01) and neural invasion (p=0.039, HR=1.61) independently predicted poor DFS. In addition, VAT loss during the NACT period increased the length of stay after operation in this cohort (p=0.004).

CONCLUSION

This study is the first to demonstrate that lower pre-NACT VAT is a significant predictor of dose reduction and delay in locally advanced gastric cancer patients. While body composition did not predict survival outcomes, tumor histological grade and invasion factors were significant for prognosis. These findings suggest that monitoring body composition, particularly VAT, could aid in optimizing chemotherapy dosing and improving treatment outcomes for GC patients undergoing NACT. Further prospective studies are needed to validate these results.

Integrative metabolic profiling of hypothalamus and skeletal muscle in a mouse model of cancer cachexia

Cancer cachexia is a multifactorial metabolic syndrome characterized by progressive weight loss, muscle wasting, and systemic inflammation. Despite its clinical significance, the underlying mechanisms linking central and peripheral metabolic changes remain incompletely understood. In this study, we employed a murine model of cancer cachexia induced by intraperitoneal injection of Lewis lung carcinoma (LLC1) cells to investigate tissue-specific metabolic adaptations. Cachectic mice exhibited reduced food intake, body weight loss, impaired thermoregulation, and decreased energy expenditure. Metabolomic profiling of serum, skeletal muscle, and hypothalamus revealed distinct metabolic shifts, with increased fatty acid and ketone body utilization and altered amino acid metabolism. Notably, hypothalamic metabolite changes diverged from peripheral tissues, showing decreased neurotransmitter-related metabolites and enhanced lipid-based energy signatures. Gene expression analysis further confirmed upregulation of glycolysis- and lipid oxidation-related genes in both hypothalamus and muscle. These findings highlight coordinated yet compartmentalized metabolic remodeling in cancer cachexia and suggest that hypothalamic adaptations may play a central role in the systemic energy imbalance associated with cachexia progression.

Cancer-induced FOXP1 disrupts and reprograms skeletal-muscle circadian transcription in cachexia

Cancer cachexia is a debilitating metabolic disorder characterized by involuntary loss of body and muscle mass, leading to increased morbidity and mortality. We previously found that forkhead box P1 (FoxP1) upregulation in skeletal muscle causes muscle wasting and is required for muscle wasting in response to cancer. However, transcriptional networks targeted by FoxP1 in skeletal muscles undergoing cancer-induced wasting remain largely unknown. Here, we identify FoxP1 as a key disruptor of the skeletal-muscle clock in response to cancer that reprograms circadian patterns of gene expression at cachexia onset. Specifically, we show that cancer-induced FoxP1 rewires the skeletal-muscle circadian transcriptome toward pathways associated with muscle wasting and disrupts the temporal patterning of pathways governing glucose, lipid, and oxidative metabolism. These findings thus implicate cancer/disease-specific functions of FOXP1 in the disruption and reprograming of the skeletal-muscle circadian transcriptome, which may contribute to muscle wasting and the development of cachexia.

The role of body composition and pulmonary function in predicting long-term survival after lung cancer surgery

BACKGROUND AND AIMS

The TNM Classification of Malignant Tumors is the primary tool for staging lung cancer, guiding treatment and prognosis. Host factors like body composition and pulmonary function are barely considered for treatment decisions and prognosis. Therefore, the objective of this study was to assess the association between body composition and pulmonary function with overall survival in patients undergoing surgery for lung cancer.

METHODS

Patients undergoing surgery for suspected lung cancer between 2012 and 2018 were included. Computed tomography (CT) scans were analyzed at the third lumbar (L3) vertebra. Skeletal muscle tissue (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) index and radiation attenuation (RA) were assessed. Lower RA indicates increased tissue triglycerides. Pulmonary function was defined as percentage of predicted forced expiratory volume in 1 s (FEV1%). Patients with a FEV1% lower than 80 % were considered to have a decreased pulmonary function according to literature. SM, VAT and SAT were corrected for sex and age by calculating Z-scores. Age groups were defined as < 60 years, ≥60 and ≤70 years, or >70 years. Means with standard deviation (SD) or medians with interquartile range (IQR) were reported. Multivariate cox-regression analysis with hazard ratios (HR) and 95 % confidence intervals (CI), and Kaplan-Meier analysis were used. Covariates were added to the model by backwards stepwise selection. Multivariate linear regression was used to study the association between body composition and pulmonary function.

RESULTS

We included 530 patients, with a mean age of 67 (SD 9.5) years, 57.5 % was male. Overall median survival was 64 months (IQR 30-96). Survival analysis was conducted on 441 patients with malignant disease and all covariates available. Z-SAT-RA (HR 1.182, 95 % CI 1.050-1.390, p = 0.006), FEV1% (HR 0.987 95 % CI 0.980-0.993, p < 0,001) and Z-SM-index (HR 0.865 95 % CI 0.757-0.988, p = 0.032) were associated with survival. The impact of high SAT-RA was particularly apparent in patients with high FEV1%. Kaplan-Meier analysis showed that patients with high, compared to low, FEV1% had significantly better overall survival in both localized and regional stage disease. Z-VAT-RA and Z-VAT-index were not associated with survival. ASA-III classification (B = -2.914, p = 0.005) and Z-SMRA (B = 3.007, p < 0.001) were associated with FEV1% in multivariate linear regression analysis.

CONCLUSIONS

Low FEV1%, low SM-index, and high SAT-RA were associated with decreased survival in patients that underwent surgery for lung cancer. Host phenotypes based on body composition and pulmonary function could play an important role in treatment decision making.

The Impact of Nutritional Support on Outcomes of Lung Cancer Surgery-Narrative Review

Background: Malnutrition is a prevalent yet often overlooked issue in lung cancer patients, significantly affecting surgical outcomes. This review examines the impact of nutritional status on lung cancer surgery and explores the role of nutritional assessment and intervention strategies. Methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. Key studies on nutritional status assessment, preoperative nutritional support, and their impact on surgical outcomes were analyzed. Results: Malnutrition in lung cancer patients is associated with increased postoperative complications, prolonged hospital stays, and reduced survival rates. Various assessment tools, including dietary interviews, physical examinations, laboratory tests, and body composition analyses, can help identify malnourished patients. Nutritional support strategies such as high-protein diets, oral supplements, enteral and parenteral nutrition, and perioperative immunomodulation improve clinical outcomes. Conclusions: Implementing standardized nutritional assessment and support protocols is crucial for optimizing surgical outcomes in lung cancer patients. Integrating these strategies into the Enhanced Recovery After Surgery (ERAS) protocol may further enhance recovery and long-term prognosis.

Unacylated Ghrelin Counteracts Contractile and Mitochondrial Dysfunction in Cancer Cachexia

Background

Cancer cachexia is a complex metabolic syndrome that severely impacts patient mobility, treatment strategies, and quality of life. However, no treatments are available to mitigate the debilitating consequences of cancer cachexia. Unacylated ghrelin (UnAG), the main circulating form of ghrelin, enhances muscle growth and mitochondrial function in various diseases, but its effects in cancer cachexia remain to be tested.

Methods

Male C57Bl6/N mice were assigned to one of three treatment groups: non-tumor-bearing (NTB), tumor-bearing (TB), or tumor-bearing treated with unacylated ghrelin (TB+UnAG). Over four weeks, we monitored body weight, food intake, and tumor size. We assessed muscle mass, contractility, mitochondrial oxygen consumption rate (OCR), and reactive oxygen species (ROS) production. Proteomic analysis was performed to elucidate the downstream effects of UnAG. Cell culture assays were performed to measure the in vitro effects of cancer cell-secreted factors and UnAG on myoblasts.

Results

Gastrocnemius and quadriceps muscle masses were reduced by 20-30% in TB mice compared to NTB controls; however, UnAG treatment prevented approximately 50% of this loss. Beyond muscle mass, UnAG enhanced the isometric maximum specific force of the extensor digitorum longus by 70% in TB mice. This improvement in muscle quality was associated with preferential upregulation of myosin heavy chain expression in TB+UnAG mice. UnAG also increased mitochondrial OCR while reducing ROS production. Mitochondrial DNA (mtDNA) copy number, which was reduced in TB mice, was restored by UnAG, while the reduced mtDNA mutation frequency in TB mice was maintained with treatment, indicating improved mtDNA integrity. Consistent with enhanced mitochondrial function, treadmill running time was significantly increased in TB+UnAG mice. Proteomic analysis revealed that UnAG downregulated proteins associated with proteolysis, while normalizing antioxidant enzyme thioredoxin and proteins involved in calcium handling. Cancer cell-conditioned medium reduced myotube width in vitro, but UnAG treatment preserved myotube structure..

Conclusion

UnAG protects against cancer cachexia by targeting multiple risk factors, including myosin heavy chain expression, mitochondrial bioenergetics, and modulation of protein degradation pathways.

Associations of dyadic appraisal of cancer cachexia symptoms with psychological distress and quality of life in dyads of palliative care patients: a longitudinal mixed-methods study protocol

BACKGROUND

Cancer cachexia (CC) is a fatal syndrome most prevalent in palliative care patients and is typically characterized by a progressive increase in weight loss and anorexia. The inability to detect and accurately appraise CC symptoms early can lead to a delayed diagnosis of CC and late initiation of symptom management, subsequently resulting in shorter survival. Research has shown that both patients and primary family caregivers are burdened by worsening CC symptoms, making them susceptible to reduced quality of life (QOL) and increased psychological distress in particular, and necessitating an exploration of ways to improve their well-being. Guided by the Theory of Dyadic Illness Management supplemented by the Symptom Appraisal Pathway Model, the study will be the first to provide a comprehensive understanding of the role of dyadic appraisal of patients' CC symptoms on psychological distress and QOL of palliative care patients and their primary family caregivers over an eight-week follow-up period.

METHODS

This study will adopt a longitudinal mixed-methods design, combining both quantitative and qualitative data collection at baseline and eight weeks after baseline. 281 dyads of patients with CC and caregivers will be recruited from palliative care units of three hospitals in Hong Kong. Both patients and caregivers will complete a set of questionnaires measuring appraisal of patients' CC symptoms and own psychological distress, and QOL, separately. Semi-structured joint interviews will also be conducted with the same dyads. Quantitative data will be analyzed using the actor-partner interdependence model and the polynomial regression with response surface analysis, while qualitative data will be subjected to qualitative content analysis and trajectory analysis. The findings of the two datasets will be integrated via joint displays.

DISCUSSION

Findings of this study are expected to advance the emerging science on dyadic symptom management by testing the utility of the theory of Dyadic Illness Management and the Symptom Appraisal Pathway Model, but also to inform the design and content of a theory- and evidence-based CC management intervention to reduce psychological distress and to achieve optimal QOL in CC dyads.

Resistance exercise combined with protein supplementation for skeletal muscle mass in people with pancreatic cancer undergoing neoadjuvant chemotherapy: Study protocol for the REBUILD trial

BACKGROUND

Pancreatic cancer patients' prognosis may be limited by two conditions, cachexia and sarcopenia. Resistance exercise and protein supplementation are safe non-pharmacological strategies that may increase or preserve skeletal muscle mass within this population. Therefore, the primary aim of this study is to examine the feasibility of a home-based virtually supervised resistance exercise intervention, with or without protein supplementation in pancreatic cancer patients initiating neoadjuvant chemotherapy. This intervention may also maintain skeletal muscle mass and improve plasma biomarkers associated with muscle tissue wasting, physical function and psychological measures.

METHODS

We aim to recruit 45 patients with locally advanced pancreatic cancer initiating neoadjuvant chemotherapy. Patients will be randomized to receive either Resistance Exercise (RE) (n = 15), Resistance Exercise and Protein Supplementation (RE + PS) (n = 15), or Attention Control (AC) (n = 15). Patients randomized to RE or RE + PS will receive 16-weeks of home-based virtually supervised resistance exercise. The AC will receive a 16-week stretching program. Primary and secondary outcomes will be measured at baseline and after 16 weeks during study visits.

DISCUSSION

The REBUILD trial is the first randomized controlled trial that combines resistance exercise with daily protein supplementation during neoadjuvant chemotherapy in pancreatic cancer patients. Our novel home-based virtually supervised exercise intervention seeks to mitigate barriers to participation in this vulnerable population. Furthermore, results of this trial will address important research gaps associated with pancreatic cancer-related cachexia, a condition closely connected with poor prognosis and mortality.

Clinical Implications of the C-Reactive Protein-Albumin Ratio as a Prognostic Marker in Terminally Ill Patients with Cancer

Background: Few studies investigated the clinical implications of C-reactive protein-albumin ratio (CAR) in palliative care. Objectives: To determine the association of CAR with overall survival among terminally ill patients with cance. Design: Datasets were obtained through two multicenter prospective cohort studies. Setting/Subjects: Patients newly referred to palliative care. Measurements: Physicians recorded measures at the baseline. Patients were followed up to their death or observed for 6 months. The patients in cohort 2 were divided using the CAR cutoffs detected using a piecewise linear hazards model in cohort 1. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests and univariate and multivariate Cox regression analyses for patients in cohort 2. Results: A total of 1554 patients in cohort 1 and 1517 patients in cohort 2 were eligible. The cutoffs were 0.1, 1.2, and 6.4. The patients in cohort 2 were divided into four categories (<0.1 [n = 103], 0.1-1.2 [n = 433], 1.2-6.4 [712], and ≥6.4 [n = 269]). The adjusted p values of the log-rank tests were <0.001. Significantly higher risks of mortality were observed in the Cox proportional hazard model for the higher categories than in the lowest category (CAR 0.1-1.2: adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.89; CAR 1.2-6.4: adjusted HR 2.08, 95% CI 1.65-2.62; CAR ≥6.4: adjusted HR 2.94, 95% CI 2.29-3.79). Conclusions: Patients with a higher CAR had significantly higher risks of mortality than those with a lower CAR.

The effects of a 3-month walking and dietary education program on the quality of life of patients with esophageal cancer: a 1-year follow-up randomized controlled trial

PURPOSE

To examine the effects of a 12-week rehabilitation program of exercise combined with diet education on the quality of life (QOL) and symptoms (anxiety, depression, rest/activity circadian rhythm (RACR), and sleep) of patients with esophageal cancer.

METHODS

We used a two-parallel-arms randomized controlled trial. The experimental group (EG) participated in a 12-week program involving walking exercise and diet education. The control group (CG) received standard care. The primary outcome was QOL, measured using the European Organisation for Research and Treatment of Cancer QOL core questionnaire (QLQ-C30) and esophageal module 18 (EORTC QLQ-OES18). Secondary outcomes were anxiety, depression, RACR, and sleep characteristics. Measurement time points were baseline and 3, 6, and 12 months after recruitment.

RESULTS

Of 85 enrolled patients with esophageal cancer (EG = 43, CG = 42), the majority were male, 59 years old on average, and had received surgery. The EG recorded significantly better 24-h autocorrelation coefficient (0.06 to 0.24, p = 0.002; Cohen's d = 0.98) of rest/activity rhythms parameters at 6 months. In the EG, total sleep time significantly increased at 3 months (16.36 to 86.07, p = 0.004; Cohen's d = 0.86).

CONCLUSIONS

The intervention improved the RACR and sleep of patients with esophageal cancer. Healthcare professionals may consider incorporating this rehabilitation program into routine care alongside cancer treatment for patients with esophageal cancer.  TRIAL REGISTRATION: Clinicaltrials.gov (registration number: NCT03161535). Prospectively registered on 17 May 2017.

Association of nutritional and inflammatory status with all-cause and cardiovascular mortality in adults with sarcopenia: Insights from NHANES

OBJECTIVE

Associations between scores on the advanced lung cancer inflammation index (ALI) and mortality among sarcopenic adults remains unknown. This study investigates the relationship between ALI and both all-cause and cardiovascular mortality among adults with sarcopenia.

METHODS

The study involved sarcopenic adults from the National Health and Nutrition Examination Survey (NHANES), conducted between 1999 and 2006 and 2011-2018. Mortality information was acquired from the National Death Index, which tracks deaths through to December 31, 2019. Weighted multivariable Cox proportional hazards regression was employed to calculate hazard ratios (HRs) for mortality in different models. Additionally, the restricted cubic spline (RCS) method was used to investigate non-linear associations. Subgroup analyses and sensitivity analyses were conducted to detect differences and examine the reliability of the findings.

RESULTS

This study included 2074 American adults with sarcopenia categorized into quartiles. 701 deaths occurred from all causes, with 236 linked to cardiovascular issues. Multivariate Cox regression models showed that those in the highest ALI quartile had a lower all-cause mortality rate than those in the lowest quartile (model 1: HR = 0.69, 95 % CI 0.55-0.87, P = 0.002; model 2: HR = 0.73, 95 % CI 0.56-0.94, P = 0.017). Likewise, those in the highest ALI quartile had a lower risk of death from cardiovascular causes (model 1: HR = 0.55, 95 % CI 0.36-0.85, P = 0.007; model 2: HR = 0.59, 95 % CI 0.37-0.95, P = 0.031). RCS results revealed an L-shaped correlation between ALI score and all-cause mortality.

CONCLUSIONS

A higher ALI score was strongly associated with lower rates of both all-cause and cardiovascular mortality among sarcopenic adults, particularly in the older population, males, smokers, and those with hypertension. This suggests that ALI may serve as a risk stratification tool.

Desensitizing Effect of Intra-Tumoral GDF-15 on Immunotherapy in Patients With Advanced Non-Small Cell Lung Cancer

BACKGROUND

Serum growth/differentiation factor 15 (GDF-15) suppresses anti-tumor immunity and predicts prognosis in several malignancies. Elevated GDF-15 levels are linked to cancer cachexia, characterized by weight loss and systemic inflammation, adversely affecting patient outcomes and therapy response. However, serum GDF-15 is not always derived from tumor tissues but also from multiple organs. Therefore, we evaluated whether intra-tumoral GDF-15 could be used as a biomarker for immunotherapy and its potential association with cancer cachexia.

METHOD

We retrospectively evaluated patients with advanced non-small cell lung cancer (NSCLC) who underwent treatment with programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) inhibitors at the Shizuoka Cancer Center between 2017 and 2021. Patients with histologically confirmed NSCLC (stage III-IV or postoperative recurrence) who had undergone biopsy or surgery within 6 months prior to initiating immunotherapy were included. Expression of tumor-derived GDF-15 was evaluated using immunohistochemical staining of archival biopsy and surgical specimens. We analyzed the correlation between intra-tumoral GDF-15 expression and the incidence of cancer cachexia, as well as its impact on progression-free survival (PFS) and overall survival (OS).

RESULT

In 6 of 35 cases, tumor cells highly expressed GDF-15. Patients with high intra-tumoral GDF-15 expression had a higher incidence of cancer cachexia (100% vs. 41.4%, p < 0.05), shorter PFS (3.4 vs. 13.4 months, p < 0.05), and shorter OS (9.5 vs. 26.5 months, p < 0.05) than those with low intra-tumoral GDF-15 expression.

CONCLUSION

Intra-tumoral GDF-15 expression may predict the presence of cancer cachexia and the efficacy of PD-1/PD-L1 inhibitors in patients with advanced non-small cell lung cancer.

Research progress on the mechanism and treatment of cachexia based on tumor microenvironment

Cachexia is a prevalent multifactorial syndrome characterized by a substantial decrease in food intake, which results from processes such as proteolysis, lipolysis, inflammatory activation, and autophagy, ultimately leading to weight loss. In cancer patients, this condition is referred to as cancer-related cachexia (CRC) and affects over 50% of this population. A comprehensive understanding of the intricate interactions between tumors and the host organism is essential for the development of effective treatments for tumor cachexia. This review aims to elucidate the role of the tumor microenvironment (TME) in the pathogenesis of tumor-associated cachexia and to summarize the current evidence supporting treatment modalities that target the TME.

Validating a Practical Correction for Intravenous Contrast on Computed Tomography-Based Muscle Density

OBJECTIVE

Computed tomography (CT) measured muscle density is prognostic of health outcomes. However, the use of intravenous contrast obscures prognoses by artificially increasing CT muscle density. We previously established a correction to equalize contrast and noncontrast muscle density measurements. While this correction was validated internally, the objective of this study was to obtain external validation using different patient cohorts, muscle regions, and CT series.

METHODS

CT images from 109 patients with kidney tumors who received abdominal CT scans with a multiphase intravenous contrast protocol were analyzed. Paraspinal muscle density measurements taken during noncontrast, venous phase, and delayed phase contrast scans were collected. An a priori correction of -7.5 Hounsfield units (HU) was applied to muscle measurements. Equivalence testing was utilized to determine statistical similarity.

RESULTS

In the sample of 109 patients (mean age: 63 years [SD: 14.3]; 41.3% female), densities in smaller regions of interest within the paraspinal muscles and the entire paraspinal muscle density (PS) in venous and delayed phase contrast scans were higher than in noncontrast. Equivalence testing showed that average corrected contrast and noncontrast muscle densities were within 3 HU for both muscle measures for the total patient sample, and for a majority of male and female subsamples. The correction is suitable for regions of interests of venous contrast (90% CI: -1.90, -0.69 HU) and delayed contrast scans (90% CI: 0.075, 1.29 HU) and within the PS measures of venous contrast (90% CI: -2.04, -0.94 HU) and delayed contrast scans (90% CI: -0.11, 0.89 HU).

CONCLUSIONS

The previously established correction for contrast of -7.5 HU was applied in a new patient population, axial muscle region, muscle measurement size, and expanded on previously studied contrast phases. The correction produced contrast-corrected muscle densities that were statistically equivalent to noncontrast muscle densities. The simplicity of the correction gives clinicians a tool that seamlessly integrates into practice or research to improve harmonization of data between contrast and noncontrast scans.

Effect of body composition parameters, including sarcopenia, myosteatosis, and adipose tissue, on overall survival of patients with mCRPC receiving 177Lu-PSMA PRRT

PURPOSE

This study aimed to examine the role of computed tomography (CT)-derived myosteatosis, sarcopenia, and other body composition parameters on overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) scheduled to receive lutetium (Lu)-177 treatment.

MATERIAL AND METHOD

Patients with mCRPC who underwent 68Ga-prostate-specific membrane antigen (PSMA) PET/CT imaging before [177Lu]Lu-PSMA-617 treatment and received at least two cycles of Lu-177 PSMA treatment between March 2017 and March 2023 were retrospectively reviewed in this study. Body composition including psoas muscle, skeletal muscle, subcutaneous adipose tissue, and visceral adipose tissue were evaluated at the third lumbar spine vertebra on CT axial sections.

RESULTS

Median age of the 76 patients enrolled in this study was 75 years (59-91 years), and the median Gleason score was 8 (6-10). All patients received two to six (median 4) cycles of 7.4 GBq Lu-177 PSMA treatment at 6-8 week intervals. Upon univariant Cox regression analysis, subcutaneous adipose tissue index, right psoas myosteatosis, left psoas myosteatosis, and skeletal muscle index were determined to be prognostic factors for OS (P = 0.03, P = 0.02, P < 0.001, and P = 0.04, respectively). However, the left psoas myosteatosis value was an independent prognostic factor for OS as determined by multivariant Cox regression analysis (P < 0.001).

CONCLUSION

Sarcopenia and myosteatosis before treatment were associated with shorter survival in mCRPC patients who were scheduled for Lu-177 PSMA treatment. Patients with left psoas myosteatosis value ≤26.85 HU had shorter OS, and we showed that OS is an independent prognostic factor.

Impact of body composition parameters, age, and tumor staging on gastric cancer prognosis

BACKGROUND

Research studies on gastric cancer have not investigated the combined impact of body composition, age, and tumor staging on gastric cancer prognosis. To address this gap, we used machine learning methods to develop reliable prediction models for gastric cancer.

METHODS

This study included 1,132 gastric cancer patients, with preoperative body composition and clinical parameters recorded, analyzed using Cox regression and machine learning models.

RESULTS

The multivariate analysis revealed that several factors were associated with recurrence-free survival (RFS) and overall survival (OS) in gastric cancer. These factors included age (≥65 years), tumor-node-metastasis (TNM) staging, low muscle attenuation (MA), low skeletal muscle index (SMI), and low visceral to subcutaneous adipose tissue area ratios (VSR). The decision tree analysis for RFS identified six subgroups, with the TNM staging I, II combined with high MA subgroup showing the most favorable prognosis and the TNM staging III combined with low MA subgroup exhibiting the poorest prognosis. For OS, the decision tree analysis identified seven subgroups, with the subgroup featuring high MA combined with TNM staging I, II showing the best prognosis and the subgroup with low MA, TNM staging II, III, low SMI, and age ≥65 years associated with the worst prognosis.

CONCLUSION

Cox regression identified key factors associated with gastric cancer prognosis, and decision tree analysis determined prognoses across different risk factor subgroups. Our study highlights that the combined use of these methods can enhance intervention planning and clinical decision-making in gastric cancer.

Impact of time to treatment initiation on the development of cachexia and clinical outcomes in lung cancer

BACKGROUND

Pre-cancer onset of cachexia raises uncertainties regarding the optimal timing for early intervention in lung cancer patients. We aimed to examine changes in physical function, nutritional status, and cachexia incidence in patients with lung cancer from the initial visit to treatment initiation and determine the effect of these changes on lung cancer treatment.

METHODS

This single-center retrospective cohort study enrolled patients suspected of having advanced lung cancer who visited Kansai Medical University Hospital between January and February 2023 and were definitely diagnosed with the disease. Patients were categorized into three groups based on their cachexia status: those with cachexia at initial diagnosis (group C), those who developed cachexia between the initial visit and treatment initiation (group OC), and those without cachexia (group NC).

RESULTS

Out of 61 patients, 21 had cachexia at their first outpatient visit (group C). The time between the first visit and treatment initiation was 42.5 days. The rate of cachexia in patients with stage IV lung cancer in group OC was significantly higher than that in patients with other stages (P = 0.008). Of the 33 patients with advanced lung cancer, 11 received supportive care only. The first-line treatment induction rate for the OC group was low. Half of the patients declined chemotherapy and received the best supportive care; their disease control rate (37.5%) was significantly worse than that of the other groups (P = 0.007).

CONCLUSIONS

Cachexia negatively impacts the effectiveness of initial cancer treatment, necessitating early anti-cachexia interventions at the first clinical visit.

Primary tumor location is a risk factor for postoperative development of sarcopenia as a predictive marker for unfavorable outcomes in patients with colorectal cancer

BACKGROUND

The impact of the skeletal muscle volume after colorectal cancer surgery is unclear. Thus, we investigated the change of skeletal muscle mass after surgery and its effects on long-term outcomes.

METHODS

This retrospective analysis included clinical stage I-IV colorectal cancer patients who underwent curative resection between April 2012 and March 2014 in our hospital. The psoas muscle area at the third lumbar vertebra level was evaluated by computed tomography and was divided by the square of height to obtain the psoas muscle mass index (PMI). Sarcopenia was defined using the PMI cut-off values for Asian adults of 6.36 cm2/m2 for males and 3.92 cm2/m2 for females.

RESULTS

Among eligible 354 patients, 166 and 145 had pre- and postoperative sarcopenia one year after surgery, respectively. Five-year disease-free survival (DFS) and overall survival (OS) rates were 81.7% and 94.5%, respectively. In multivariate analysis, postoperative sarcopenia was an independent risk factor for shorter DFS [hazard ratio (HR) 1.71, p = 0.0171] and OS (HR 2.42, p = 0.0455), respectively, but preoperative sarcopenia was not a prognosticactor for either. One year after colorectal resection, 24 patients (6.8%) were newly diagnosed with sarcopenia, while 45 (12.7%) recovered from sarcopenia. Rectal cancer was identified as an independent risk factor for the postoperative development of sarcopenia (odds ratio 3.12, p = 0.0440).

CONCLUSION

Postoperative sarcopenia one year after surgery was associated with poor DFS and OS. Thus, clinicians need to consider skeletal muscle loss during postoperative surveillance, particularly in rectal cancer patients without sarcopenia before surgery.

Subcutaneous adipose tissue [18F]FDG uptake and CT-derived body composition variables for predicting survival outcomes in patients with locally advanced gastric cancer

PURPOSE

This study aimed to investigate the impact of glucose metabolism in subcutaneous adipose tissue (SAT) and skeletal muscle (SM) variables on overall survival (OS) in patients with locally advanced gastric cancer.

METHODS

A retrospective study was conducted on 110 patients with advanced gastric cancer who underwent baseline [18F]FDG PET/CT. Demographic, clinical, and survival data were collected. Mean standardized uptake value (SUVmean) of SAT as well as skeletal muscle, and body composition measurement, including SAT area, SAT radiodensity, SM area, and SM radiodensity, were assessed on PET/CT. SM area was normalized for patient stature, resulting in the skeletal muscle index (SMI). Patients were stratified into subgroups with high and low SAT uptake based on the optimum cut-off value of the SAT SUVmean. The univariate, multivariate regression analysis, Kaplan-Meier survival analysis, and Spearman's correlation analysis were employed to evaluate the associations among metabolic activity and CT-derived body composition variables as well as OS.

RESULTS

Out of 110 patients with an average age of 62.65 ± 13.25 years, 58 (52.73%) patients died during follow-up. Cox regression analysis identified TNM stage, SAT SUVmean, and SMI as independent prognostic factors for OS (all p < 0.05). Notably, patients with elevated SAT uptake exhibited significantly poorer long-term survival compared to those with low SAT uptake (p < 0.001). Correlation analyses revealed a moderate positive association between SAT SUVmean and SAT radiodensity (p < 0.001, r = 0.47), whereas a significant inverse correlation was observed between SAT SUVmean and SAT area (p < 0.001, r = -0.465). Additionally, stratification by combined SAT SUVmean and SMI profiles showed that patients with low SAT uptake and high SMI exhibited a better prognosis than those with high SAT uptake and/or low SMI (p = 0.004 and p < 0.001).

CONCLUSION

Increased [18F]FDG uptake in SAT was correlated with higher SAT radiodensity as well as lower SAT area, and shortened survival in patients with advanced gastric cancer, underscoring its potential as a biomarker for adverse outcomes.

Myocellular adaptations to short-term weighted wheel-running exercise are largely conserved during C26-tumour induction in male and female mice

This study investigated whether performing a translatable murine model of concurrent training after tumour induction affects adaptations in juvenile male and female tumour-bearing mice. Male and female Balb/c mice were injected bilaterally with colon-26 adenocarcinoma (C26) cells or PBS at 8 weeks of age. Half the mice then performed 24 days of voluntary wheel running with progressively increased load (PoWeR training), whereas the rest remained sedentary. Deuterium oxide-based protein synthesis, muscle fibre-type composition and size, protein turnover and mitochondrial markers were assessed 25 days after tumour induction. Average gastrocnemius muscle fibre size was smaller with PoWeR regardless of tumour in males and females, concomitant with a pronounced faster-to-slower fibre-type transition. In male tumour-bearing mice, PoWeR training resulted in greater Redd1, Murf1 and Pgc1α mRNA content than all the other groups, along with lower overall running volume, food consumption and protein synthesis relative to control animals. Molecular measures followed a similar pattern in tumour-bearing female mice with PoWeR, but food consumption, running volume and muscle protein synthesis were maintained. PoWeR training lowered gonadal fat during cancer cachexia in both sexes, and greater heart weight was observed regardless of tumour presence. A negative correlation was found between tumour weight and running distance. Collectively, PoWeR has a similar effect on muscle cellular phenotype in both sexes regardless of tumour presence, and a training effect in male mice with cancer cachexia was present despite molecular and protein synthesis dysregulation.

New research progress of sarcopenia in surgically resectable malignant tumor diseases

With the aging global population, the decline in muscle mass and function among the elderly has emerged as a significant concern. This systemic progressive generalized loss of muscle function and mass is referred to as sarcopenia (SP). In recent years, a growing number of studies have investigated SP, revealing that many tumor diseases, especially in the digestive system, promote its occurrence due to the influence of the disease itself, diet, and other factors. Moreover, SP patients tend to have poorer postoperative recovery. At present, many diagnostic methods have been developed for SP, but no unified standard has been established. Furthermore, the cutoff values of many diagnostic methods for different populations are still in the exploratory stage, and additional clinical studies are required to explore these issues. This article comprehensively and systematically summarizes the diagnostic methods and criteria mentioned in previous research, focusing on the impact of SP on post-surgical patients with various malignant tumors.

Measuring the paraspinal muscles as an important tool for predicting the overall survival period after spine surgery in lung cancer patients with spine metastasis

STUDY DESIGN

Retrospective cohort study BACKGROUND: Metastatic lung cancer in the spine is difficult to determine whether to perform an additional surgical intervention, as patients at the end stage of lung cancer often have low performance status with significant muscle atrophy. This study aimed to demonstrate whether sarcopenia affects the prognosis after spine surgery in lung cancer patients by measuring the paraspinal muscles.

METHODS

A total of 65 lung cancer patients who underwent spine surgery were reviewed. Patients were divided into two groups based on the survival period after surgery (≤ 6 months; n = 33 and > 6 months; n = 32). Based on magnetic resonance imaging, the quantity and quality of the paraspinal muscles (psoas major, quadratus lumborum, erector spinae, and multifidus) were analyzed by an Image J program. Patient- and surgery-related factors were compared between the two groups.

RESULTS

The quantity of the erector spinae muscle was higher in the > 6 months group (11.5 ± 2.8 cm2/m2) than in the ≤ 6 months group (10.0 ± 2.3 cm2/m2, p = 0.013). The logistic regression analysis showed that the muscle quantity of the erector spinae (p = 0.026, odds ratio 1.343) and the number of vertebrae involved in metastasis (p = 0.016, odds ratio 0.199) were the main prognostic factors for the survival period after spine surgery.

CONCLUSIONS

Lung cancer patients with a low quantity of the erector spinae muscles are at a high risk of poor prognosis after spine surgery. Therefore, measuring the erector spinae muscle could be an important tool for distinguishing patients appropriate for palliative treatments and surgical interventions.

Different cutoff values of the skeletal muscle mass and myosteatosis result in different clinical impact on overall survival in oncology. A subanalysis of a clinical trial

BACKGROUND

Body composition analysis, particularly the assessment of sarcopenia and myosteatosis, has emerged as a potential prognostic tool in oncology. However, the clinical implication of body composition parameters remains inconsistent, largely due to the variability in cutoff values used across studies. This study examines the influence on prevalence and prognostic influence of different cutoff values for sarcopenia and myosteatosis in patients in a standardized cohort from a large clinical trial (SORAMIC).

METHODS

This study included 179 patients with unresectable liver cancer from the palliative arm of the SORAMIC trial. Skeletal muscle index (SMI) was calculated by measuring the cross-sectional area of skeletal muscle at the third lumbar vertebra (L3) on baseline CT scans. We then applied 14 published cutoff definitions for sarcopenia (SMI) and 7 for myosteatosis (muscle attenuation) to determine their prevalence in this cohort. Cox regression models were used to analyze the relationship between sarcopenia, myosteatosis, and OS.

RESULTS

The prevalence of sarcopenia ranged from 8.9% (Van der Werf et al.) to 69.8% (Lanic et al.). Overall, 3 of the 14 cutoffs [Van Vledder et al. (HR = 1.53, p = 0.03), Coelen et al. (HR = 1.46, p = 0.03), and Derstine et al. (HR = 1.47, p = 0.04)] showed a relevant association with OS. Other cut off values were not associated with OS. The prevalence of myosteatosis varied between 10.1% (Nachit et al.) and 53.1% (Zhang et al.). One of the 7 cutoffs (Chu et al.) demonstrated a relevant association with OS (HR = 1.53, p = 0.03).

CONCLUSION

The large variability in prevalence and prognostic impact observed across different cutoff definitions underscores the urgent need for standardized, cancer-specific cutoff values for SMI and muscle attenuation. Establishing uniform criteria will enhance the reliability and clinical applicability of body composition metrics as prognostic tools in oncology. Further research should focus on refining these cutoffs and validating them across diverse cancer populations.

The Prevalence and Prognostic Impact of Cancer Cachexia on Overall Survival in Patients with Gastrointestinal Cancer: A Meta-Analysis

Cancer cachexia is a multifactorial syndrome characterized by progressive weight loss, predominantly due to the depletion of skeletal muscle mass and adipose tissue. This meta-analysis aimed to evaluate the prognostic impact of cancer cachexia on overall survival in patients with gastrointestinal cancers. Two independent investigators conducted a systematic literature search across PubMed, Embase, and Web of Science. Eligible studies included cohort studies and post hoc analyses of clinical trials that examined the association between cancer cachexia and overall survival in gastrointestinal cancer patients. A total of 22 studies involving 10,480 patients were included in the analysis. The pooled prevalence of cachexia among gastrointestinal cancer patients was 50% (95% confidence interval [CI] 41-59). Meta-analysis demonstrated that cancer cachexia was significantly associated with reduced overall survival (hazard ratio [HR] 1.50; 95% CI 1.35-1.68). Subgroup analyses further confirmed that cancer cachexia remained a robust predictor of poorer survival, irrespective of study design, gastrointestinal cancer subtype, patients' age, country of origin, tumor stage, cachexia definition, or follow-up duration. These findings indicate that cancer cachexia is highly prevalent among gastrointestinal cancer patients and serves as a significant independent predictor of shortened overall survival.

A higher preoperative cachexia index can result in the sufficient administration of S-1 adjuvant chemotherapy and lead to a good prognosis for elderly patients with stage II/III gastric cancer

PURPOSE

This study aimed to clarify the significance of the relative dose intensity (RDI) of S-1 adjuvant chemotherapy (ACT) after gastrectomy in elderly patients with stage II/III gastric cancer (GC) and to determine whether the cachexia index (CXI) correlates with RDI.

METHODS

We enrolled 76 patients with stage II/III GC, aged > 70 years. The overall survival (OS) and disease-specific survival (DSS) of participants in the surgery alone, S-1 ACT completion (RDI ≥ 58%), and S-1 ACT non-completion (RDI < 58%) groups were compared. In addition, the clinicopathological determinants of RDI were examined.

RESULTS

The S-1 ACT completion group had better OS and DSS, while the prognoses of patients in the surgery alone and S-1 ACT non-completion groups did not differ significantly. S-1 ACT non-completion or surgery alone was identified as an independent poor prognostic factor for OS and DSS. Furthermore, a multivariate analysis revealed that a high preoperative CXI (≥ 75.5 for males and ≥ 79.4 for females) was an independent predictor of success in achieving an RDI ≥ 58%.

CONCLUSIONS

A higher preoperative CXI can result in a higher RDI and improve the prognosis of elderly patients with stage II/III GC who underwent S-1 ACT.

Transformer-based skeletal muscle deep-learning model for survival prediction in gastric cancer patients after curative resection

BACKGROUND

We developed and evaluated a skeletal muscle deep-learning (SMDL) model using skeletal muscle computed tomography (CT) imaging to predict the survival of patients with gastric cancer (GC).

METHODS

This multicenter retrospective study included patients who underwent curative resection of GC between April 2008 and December 2020. Preoperative CT images at the third lumbar vertebra were used to develop a Transformer-based SMDL model for predicting recurrence-free survival (RFS) and disease-specific survival (DSS). The predictive performance of the SMDL model was assessed using the area under the curve (AUC) and benchmarked against both alternative artificial intelligence models and conventional body composition parameters. The association between the model score and survival was assessed using Cox regression analysis. An integrated model combining SMDL signature with clinical variables was constructed, and its discrimination and fairness were evaluated.

RESULTS

A total of 1242, 311, and 94 patients were assigned to the training, internal, and external validation cohorts, respectively. The Transformer-based SMDL model yielded AUCs of 0.791-0.943 for predicting RFS and DSS across all three cohorts and significantly outperformed other models and body composition parameters. The model score was a strong independent prognostic factor for survival. Incorporating the SMDL signature into the clinical model resulted in better prognostic prediction performance. The false-negative and false-positive rates of the integrated model were similar across sex and age subgroups, indicating robust fairness.

CONCLUSIONS

The Transformer-based SMDL model could accurately predict survival of GC and identify patients at high risk of recurrence or death, thereby assisting clinical decision-making.

Creatinine-Cystatin C Ratio as a Promising Prognostic Biomarker in Patients With UTUC After Radical Nephroureterectomy

PURPOSE

The aim of this study was to determine the impact of the preoperative creatinine-cystatin C ratio (CCR) on the survival prognosis of patients following radical nephrectomy (RNU) for upper tract urothelial carcinoma (UTUC).

METHODS

The retrospective analysis was conducted on UTUC patients who underwent radical nephrectomy (RNU) at West China Hospital between January 2009 and December 2019. The endpoint of the study was cancer-specific survival (CSS). Kaplan-Meier curves were used to estimate survival, and Cox proportional hazards modelling was used to assess risk. Nomograms were developed to predict CSS at 3 and 5 years of age, and the predictive power was assessed.

RESULTS

A critical CCR of 59.61 µmol/mg was demonstrated to affect 504 patients with UTUC who had undergone RNU. A correlation was identified between a lower preoperative CCR and a considerably worse CSS. In patients with UTUC, CCR was identified as an independent risk factor for CSS, particularly in patients with locally advanced UTUC (pT ≥ 3) (HR: 1.84, 95% CI: 1.14, 2.97). Moreover, the CCR-based nomogram exhibited robust predictive capacity, with areas under the curve for the 3- and 5-year CSS reaching 0.823 and 0.793, respectively.

CONCLUSION

Preoperative CCR is an independent predictor of CSS in UTUC patients receiving RNU treatment. As such, it should be viewed as a potentially useful customized tool in therapeutic decision-making.

Sarcopenia defined by the global leadership initiative in sarcopenia (GLIS) consensus predicts adverse postoperative outcomes in patients undergoing radical gastrectomy for gastric cancer: analysis from a prospective cohort study

BACKGROUND

Global Leadership Initiative in Sarcopenia (GLIS) has recently established a conceptional definition of sarcopenia, which incorporated muscle strength, mass, and muscle-specific strength as three components of sarcopenia. The present study aimed to investigate the value of sarcopenia defined by the GLIS consensus in predicting the postoperative outcomes.

METHODS

Clinical data of 1654 patients who underwent radical gastrectomy for gastric cancer were prospectively collected. Muscle strength was measured by the grip strength test. Muscle mass was measured by calculating skeletal muscle index (SMI) using abdominal computed tomography images. Muscle-specific strength was determined by the ratio of grip strength to SMI. Sarcopenia was diagnosed by having low muscle-specific strength (criteria 1), or low muscle strength plus low muscle mass (criteria 2), or low muscle strength plus either low muscle mass or low muscle-specific strength (criteria 3).

RESULTS

The incidence of sarcopenia identified by criteria 1, 2, and 3 were 24.2%, 17.0%, and 32.5%, respectively. All three criteria showed significant association with postoperative total complications, overall survival (OS), and disease-free survival (DFS). However, criteria 1 showed no significant association with severe complications. Criteria 2 did not remain significant in predicting DFS in the multivariate analyses. Criteria 3 showed the largest Youden index and area under receiver operating characteristic curve (AUC) in predicting total complications, 3-year and 5-year mortality, and low physical performance.

CONCLUSION

Sarcopenia defined by low muscle strength plus either low muscle mass or low muscle-specific strength showed optimal predictive value for postoperative outcomes in patients with gastric cancer.

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.