Prognostic utility of cachexia in lung cancer: A multicenter cohort analysis

The clinical significance of the Asian Working Group on Cachexia (AWGC) criteria, as a novel diagnostic standard for cachexia, remains underexplored. This study aims to investigate the prognostic value of the AWGC criteria and to propose a scoring system for stratifying the severity of cachexia in lung cancer patients.

Survival curves were generated using Kaplan-Meier analysis with log-rank tests. Cox proportional hazards models were employed for survival analysis, providing hazard ratios (HRs) and corresponding 95 % confidence intervals (CIs). Logistic regression analysis was utilized to assess the independent association between cachexia and 90-day mortality, presenting the results as odds ratios (ORs) with 95 % CIs.

This study enrolled a total of 3,424 lung cancer patients, comprising 86.6 % with non-small cell lung cancer (NSCLC) and 13.4 % with small cell lung cancer (SCLC). Patients with AWGC-defined cachexia had significantly poorer survival (55.8 % vs. 39.3 %, p < 0.001). Cachectic patients exhibited considerably worse survival rates in both SCLC (42.9 % vs. 25.4 %, p < 0.001) and NSCLC (57.8 % vs. 41.4 %, p < 0.001). Cox regression analysis indicated that AWGC-defined cachexia is an independent risk factor for survival in lung cancer patients (HR: 1.436, 95 % CI: 1.306-1.580, p < 0.001). Moreover, AWGC-defined cachexia was significantly associated with poor prognosis in both SCLC (HR: 1.307, 95 % CI: 1.007-1.698, p = 0.044) and NSCLC (HR: 1.377, 95 % CI: 1.234-1.538, p < 0.001) patients. AWGC-defined cachexia was also found to be an independent risk factor for 90-day mortality in lung cancer patients (OR = 3.060, 95 % CI: 2.254-4.155, p < 0.001). We developed a severity grading system for categorizing cachexia into Mild, Moderate, and Severe. Survival rates gradually decreased as the severity grading score increased (63.2 % vs. 49.1 % vs. 37.0 % vs. 30.0 %, p < 0.001).

AWGC-defined cachexia is an independent risk factor for both long-term prognosis and 90-day mortality in lung cancer patients.