Cachexia in gynecologic cancers: The role of biomarkers and cachexia index
Abstract
Background
Cancer cachexia, a metabolic syndrome causing muscle loss, inflammation, and malnutrition, adversely affects prognosis and treatment in cancer patients. Despite extensive studies in other malignancies, cachexia remains underexplored in gynecologic cancers, particularly in India. This study evaluates the cachexia index (CXI) in gynecologic cancer patients and its association with Activin A and Myostatin.
Methods
In this prospective observational study, 160 women with gynecologic malignancies were assessed for cachexia using Fearon's criteria, the global leadership initiative on malnutrition (GLIM) definition, and CXI, which integrates skeletal muscle index (SMI), albumin, and neutrophil‐to‐lymphocyte ratio (NLR). Serum Activin A and Myostatin were measured via enzyme‐linked immunosorbent assay. A subgroup of 30 ovarian cancer patients received nutritional and physical prehabilitation, with biomarker reassessment post‐intervention.
Results
Cachexia prevalence was 22.50% (Fearon's) and 56.25% (GLIM). The median CXI was 56.74, with 33.75% having CXI < 41, indicating severe cachexia. CXI < 41 was correlated with advanced disease ( P = 0.000), lower body mass index ( P = 0.034), reduced SMI ( P = 0.000), and elevated inflammatory markers. Activin A was significantly higher in severe cachexia ( P = 0.024), while Myostatin showed no correlation. Prehabilitation significantly improved CXI ( P = 0.0001) and reduced Activin A and Myostatin ( P = 0.0003, P < 0.0001). In multivariable analysis, platelet‐to‐lymphocyte ratio emerged as the only independent predictor of low CXI (odds ratio 1.0145; 95% confidence interval 1.0081–1.0210; P < 0.001), while Activin A showed a trend toward significance ( P = 0.088).
Conclusion
CXI provides a comprehensive cachexia assessment in gynecologic cancers. Elevated Activin A is linked to muscle degradation. Prehabilitation improves CXI and reduces cachexia biomarkers, emphasizing its therapeutic potential. Further validation of CXI and biomarkers may enhance cachexia diagnosis and management.