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The study aimed to evaluate the effect of muscle mass, alone and combined with muscle strength, in predicting survival in patients with incurable cancer. Muscle mass was assessed by computed tomography (CT).Low muscle mass and low muscle strength was defined, respectively, by skeletal muscle index (SMI) assessed by CT and handgrip strength (HGS) below the first tertile of the studied sample, as follow: SMI41.3 or34.9 cmA total of 386 patients were included, and the median OS was 43 [interquartile range (IQR): 15-96] days. Considering the appropriate SMI and HGS as the reference group, a significantly lower OS was observed in the group with low SMI + low HGS [54 (IQR: 38-69) versus 22 (IQR: 10-33) days; p 0.001]. Patients with low HGS alone presented lower OS than those of the appropriate group [52 (IQR: 42-61) versus 24 (IQR: 17-30) days; p 0.001], but no differences were observed in the groups with low SMI alone versus appropriate [46 (IQR: 35-56) versus 40 (IQR: 30-49) days; p = 0.365]. The adjusted Cox regression demonstrated that low HGS alone [hazard ratio (HR): 1.51; 95% confidence interval (CI): 1.20-1.91] and low SMI + low HGS group (HR: 1.77; 95% IC: 1.28-2.44) had higher risk of 180-day mortality. Muscle mass combined with muscle strength improved OS prediction compared to these measurements alone in patients with incurable cancer.

The aim of the present study was to evaluate the association between sarcopenia, diagnosed by different muscle mass measurement techniques, with nutritional status and overall survival in patients with advanced cancer under palliative care.To investigate the association of sarcopenia, according to distinct muscle mass measurement methods, with nutritional status and overall survival (OS).This observational and prospective study, including 334 patients, defined sarcopenia as reduced muscle mass and strength. Muscle mass was evaluated adopting 3 different methods, mid-upper arm muscle area (MUAMA), calf circumference (CC) and appendicular skeletal muscle mass (ASMI) described by Baumgartner (1998) and adjusted for height. Strength was defined using a handgrip dynamometer and OS was established based on a 90 days follow-up after inclusion date. Kaplan-Meier curves were conducted for survival analyzes and the association between sarcopenia and OS was evaluated by Cox regression model RESULTS: Prevalence of sarcopenia varied from 27-65% according to the method used to evaluate muscle mass. Malnutrition assessed by different parameters was significantly higher in patients with sarcopenia. Patients considered sarcopenic by MUAMA (43 versus 67 days, p0.001), CC (44 versus 77 days, p0.001) and ASMI (48 versus 75 days, p0.001) had significantly lower OS compared to non-sarcopenic patients. Sarcopenia evaluated by MUAMA (HR, 1.57; 95% CI, 1.12-2.18) and CC (HR, 2.00; 95% CI, 1.45-2.76) showed a higher risk of mortality.Sarcopenia diagnosed by MUAMA and CC could predict mortality and CC proved to be the best prognostic method for estimating OS in patients with advanced cancer in palliative care.

This study aimed to evaluate the prognostic value of nutritional and inflammatory status in patients with advanced cancer receiving palliative care.The systemic inflammatory response was assessed using the modified Glasgow Prognostic Score (mGPS), and nutritional status was evaluated according to the Patient-Generated Subjective Global Assessment (PG-SGA) in 172 patients evaluated on their first visit in the Palliative Care Unit at the National Cancer Institute in Brazil. The receiver operating characteristic (ROC) curve was used to define the best cutoff point for the death-related PG-SGA score in 90 d. Kaplan-Meier curves were conducted for survival analyses, and logistic regression analyses were performed using the Cox proportional hazards model.According to the PG-SGA, 83.6% of the patients (n = 143) were malnourished (B + C) and 34.8% (n = 53) had mGPS ≥1. The best cutoff of the PG-SGA score for death was ≥19 points (area under the curve, 0.69; P = 0.041). Patients with scores ≥19, mGPS ≥1, albumin3.5 g/dL, and C-reactive protein ≥10 mg/L had a significantly lower overall survival. According to the multivariate analysis, albumin3.5 g/dL (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.16-3.58), mGPS ≥1 (HR, 1.46; 95% CI, 1.09-2.22), and PG-SGA score ≥19 (HR, 1.66; 95% CI, 1.08-2.55) were independent prognostic factors for overall survival.The severity of the systemic inflammation and the poor nutritional status predict survival and were considered independent prognostic factors. Thus they can be useful tools for nutritional evaluation in palliative care.

Objectives Cancer cachexia (CC) is a multifactorial syndrome that is associated with worse outcomes. Several criteria for its diagnosis have been suggested, but notable disparities exist. This study compared different diagnostic criteria for CC in patients with incurable cancer who are in palliative care. Methods A prospective cohort study was conducted at the National Cancer Institute in Brazil. Patients were classified by three CC diagnostic criteria, and comparisons between clinical, nutritional, and functional variables were verified according to the CC stage identified. Kaplan-Meier survival curves and Cox regression were used for the survival analysis. Concordance statistics were used to test the prognostic predictive accuracy of the criteria. Results The prevalence of cachexia in the 1384 patients included in the study varied from 13.8% to 53.9% according to the classification criteria used. All criteria distinguished noncachectic patients from other categories according to the majority of the domains studied. However, the results were inconsistent in distinguishing patients with intermediate cachexia (mainly precachexia) from noncachectic and cachectic patients. Patients with cachexia or refractory cachexia faced a higher risk of 90-d mortality. The criteria described by Vigano et al. were found to be better at distinguishing the stages of CC regarding overall survival (hazard ratio increases according to CC severity: 1.87 to 2.87; concordance statistic: 0.74). Conclusions Our results demonstrate the disparities in existing CC diagnostic criteria and their inability to discriminate intermediate stages. Vigano et al.’s criteria is/was the most effective in predicting the prognosis. The development of new diagnostic criteria to improve CC classification requires future exploration.