101P - Cachexia index and sarcopenia in patients with advanced gastrointestinal cancer treated with chemotherapy during exercise intervention

Background

Sarcopenia is poor prognostic factor in cancer patients. The exercise intervention is one of the treatments to improve sarcopenia. The cachexia index (CXI) was developed to assess the degree of cancer cachexia. We estimated CXI in patients with advanced gastrointestinal cancer treated with palliative chemotherapy during exercise intervention.

Methods

Between 2020 and 2021, 30 patients were enrolled to a program of resistance and aerobic exercise for 6 weeks in advanced gastrointestinal cancer. The exercise intervention consisted of three levels of intensity exercise: low, intermediate, and high levels. Abdominal pelvic computed tomography scans done at baseline and after 6 weeks were reviewed to estimate skeletal muscle area (SMA) and skeletal muscle index (SMI) at the L3 level. CXI was developed as follows: CXI = SMI x Alb / NLR where SMI is the skeletal muscle index, Alb is the serum albumin, and NLR is the neutrophil-to-lymphocyte ratio.

Results

The median age was 60 years (range: 30 – 77 years). The mean SMI was 43.5 ± 6.5 cm2/m2. The mean SMI was 40.2 ± 4.9 cm2/m2 for female and 46.4 ± 6.5 cm2/m2 for male. The incidence of sarcopenia at time of diagnosis was 30.0% (9 patients). The mean CXI was 93.7 ± 54.5 cm2/m2. The mean CXI was 108.8 ± 53.1 cm2/m2 for female and 80.8 ± 54.2 cm2/m2 for male. The cutoff time for analyses was November 2021, resulting in a median follow-up of 8.6 months (range: 3.8 – 12.2 months), and 6 patients (20.0%) died. 12-month overall survival rate was 76.6%. The patients with sarcopenia had no significantly different 12-month OS rate than patients without sarcopenia (76.2 % vs. 69.8%, HR=1.084, 95% CI 0.198-5.938, P=0.926) in advanced gastrointestinal cancer. Patients were divided into two groups around the median into stage I cachexia (CXI ≥35, n = 23) and stage II cachexia (CXI <35, n = 3). The stage I cachexia group had no significantly different 12-month OS rate compared to the stage II cachexia group (73.8% vs. 66.7%, HR 0.558, 95% CI 0.065-0.4.788, P=0.594).

Conclusions

The CXI is a novel index for estimating cachexia. There was no difference in survival when exercise therapy was performed in patients with poor prognostic factors, such as sarcopenia and poor cachexia index. Further research on this is needed.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.