Associations among hypogonadism, C-reactive protein, symptom burden, and survival in male cancer patients with cachexia: a preliminary report.

Abstract Context Cachexia is characterized by muscle wasting, anorexia, and elevated inflammatory markers. In patients without cancer, hypogonadism is associated with lower lean body mass, increased symptom burden, and decreased survival. Hypogonadism in cancer cachexia could exacerbate symptoms, facilitate a proinflammatory state, and decrease survival. Objectives To explore the relationships among these factors, a retrospective study of male cancer patients was conducted. Methods The charts of 98 consecutive male patients referred to a cachexia clinic at a comprehensive cancer center were reviewed. All patients reported weight loss of >5% within the preceding six months; the median age was 60 years. Fifty-seven (58%) had serum C-reactive protein (CRP), and 68 (69%) had total testosterone evaluated. Symptoms were evaluated by the Edmonton Symptom Assessment Scale. Results Median CRP was 20mg/L, and median testosterone level was 185ng/dL (6.42nmol/L) (normal ≥240ng/dL or 8.36nmol/L). There was an inverse correlation between testosterone and CRP levels ( P P P 185ng/dL (13 vs. 62 weeks, P =0.004). Patients with CRP levels >10mg/L had decreased survival compared with those with levels ≤10mg/L (15 vs. 46 weeks, P =0.01). The combination of hypogonadism and elevated CRP was associated with poorer prognosis. Elevated CRP levels were associated with increased symptom burden and decreased survival. Low testosterone was associated with decreased survival and correlated inversely with CRP levels, dyspnea, and insomnia. Conclusion Our preliminary results suggest that testosterone and CRP may be additive or synergistic as markers for survival in male patients and could be useful in future prognostic models.