Nutrition in Clinical Practice

The cachexia index as a prognostic indicator in patients with cervical cancer treated with radiotherapy: A retrospective study

Abstract Objective The cachexia index (CXI) demonstrates potential as both a diagnostic tool for cachexia and a prognostic tool for survival in cancer. However, CXI's predictive value has not been verified in cervical cancer. The purpose of this study is to investigate the prognostic value of the CXI in patients with cervical cancer treated with radiotherapy. Methods We retrospectively screened patients diagnosed with cervical cancer who underwent radiotherapy in a single institution between September 2013 to September 2015. The CXI was calculated as the skeletal mass index (SMI) × albumin/neutrophil‐to‐lymphocyte ratio. SMI was measured by computed tomography using the muscles of the third lumbar vertebra. Survival times were evaluated using the Kaplan‐Meier method and Cox proportional hazards regression. A nomogram for predicting survival was developed. Results A total of 81 patients with cervical cancer were included. The cutoff value of the CXI was set at 59.7 using receiver operating characteristic (ROC) analyses. According to this cutoff value, 47 patients were assigned to the high‐CXI group, and 34 were assigned to the low‐CXI group. The Cox regression analysis showed that a low CXI was associated with decreased overall survival (hazard ratio [HR]: 3.15; 95% confidence interval [CI]: 1.24–8.00; P  = 0.016). Patients in the low‐CXI group also had shorter progression‐free survival than those in the high‐CXI group, but the difference was of borderline significance (HR: 2.26; 95% CI: 1.00–5.11; P  = 0.05). Conclusion The pretreatment CXI is an independent prognostic factor in patients with FIGO II–III cervical cancer treated with radiotherapy.

Sarcopenia as a Predictor of Survival Among Patients With Organ Metastatic Cervical Cancer

AbstractBackgroundThis study was conducted to investigate the prognostic significance of sarcopenia in patients with organ metastatic cervical cancer.MethodsAccordingly, the data of 40 patients with organ metastatic cervical cancer treated at our institute from December 2004 to December 2017 were retrospectively analyzed. The correlation between clinicopathological characteristics and survival was then evaluated using univariate and multivariate analyses. Psoas muscle index (PMI), calculated from the psoas muscle area at the L3 vertebral‐body level using computed tomography images obtained for pretreatment evaluation, was adopted as an index of sarcopenia.ResultsThe median follow‐up period was 14 months (range, 1–91 months). Kaplan‐Meier analysis showed a 3‐ and 5‐year overall survival (OS) rate of 46.1% and 35.8% for all patients, respectively. Receiver operating characteristic curve maximizing the area under the curve showed that the optimal PMI for predicting 1‐year survival was 3.72 cm2/m2. Patients with a PMI > 3.72 cm2/m2 had significantly better OS than those with a PMI ≤ 3.72 cm2/m2 (P = .046). Multivariate analysis revealed that only PMI was significantly associated with OS in patients with organ metastatic cervical cancer. Furthermore, patients with a PMI > 3.72 cm2/m2 who underwent concurrent chemoradiotherapy (CCRT) had a longer OS than those receiving other therapies (P < .001).ConclusionsHigh PMI was determined to be a favorable prognostic factor for patients with organ metastatic cervical cancer. Moreover, patients with organ metastatic cervical cancer who have a PMI > 3.72 cm2/m2 may benefit from CCRT as an initial treatment.