[PDF][PDF] Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index

L Martin, L Birdsell, N MacDonald… - Journal of clinical …, 2013 - edisciplinas.usp.br
L Martin, L Birdsell, N MacDonald, T Reiman, MT Clandinin, LJ McCargar, R Murphy
Journal of clinical oncology, 2013edisciplinas.usp.br
Results Body mass index (BMI) distribution was 17% obese, 35% overweight, 36% normal
weight, and 12% underweight. Patients in all BMI categories varied widely in weight loss,
muscle index, and muscle attenuation. Thresholds defining associations between these
three variables and survival were determined using optimal stratification. High weight loss,
low muscle index, and low muscle attenuation were independently prognostic of survival. A
survival model containing conventional covariates (cancer diagnosis, stage, age …
Results
Body mass index (BMI) distribution was 17% obese, 35% overweight, 36% normal weight, and 12% underweight. Patients in all BMI categories varied widely in weight loss, muscle index, and muscle attenuation. Thresholds defining associations between these three variables and survival were determined using optimal stratification. High weight loss, low muscle index, and low muscle attenuation were independently prognostic of survival. A survival model containing conventional covariates (cancer diagnosis, stage, age, performance status) gave ac statistic of 0.73 (95% CI, 0.67 to 0.79), whereas a model ignoring conventional variables and including only BMI, weight loss, muscle index, and muscle attenuation gave ac statistic of 0.92 (95% CI, 0.88 to 0.95; P. 001). Patients who possessed all three of these poor prognostic variables survived 8.4 months (95% CI, 6.5 to 10.3), regardless of whether they presented as obese, overweight, normal weight, or underweight, in contrast to patients who had none of these features, who survived 28.4 months (95% CI, 24.2 to 32.6; P. 001).
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