New Cancer Cachexia Staging System for Use in Clinical Practice

Abstract Background : Previous attempts to classify cancer cachexia (CC) have demonstrated limitations regarding stages and diagnostic criteria. This study aims to develop and validate a new staging system for CC in incurable cancer patients. Methods : Analysis of a database from a prospective cohort study involving 1,325 advanced cancer patients referred for palliative care between 2016 and 2020. The cohort was randomly divided into two groups: a development set (882 patients) and a validation set (443 patients). Hierarchical cluster analysis was performed to distinguish different stages of CC in the development set. Next, the optimal cut-off points and ideal combinations of the most important factors associated with the CC groups (clusters) were ascertained. Finally, the relationship between the CC stages determined using the new system and body composition, quality of life (QoL), and overall survival (OS) was verified with the validation set. Results : The new system classified CC into three stages: pre-cachexia (10.8%), cachexia (57.8%), and refractory cachexia (RCa) (31.4%), based on a combination of: percentage weight loss in past 6 months ( 26.4 kg/m2), and mid-upper-arm muscle area (≥38.0/≥35.5 or Conclusion : This study presents a useful, valid system for CC staging in the clinical setting, and is also capable of predicting outcomes, including QoL and OS.