Explore the vast range of titles available.

•Patients with gastric cancer and a high C-reactive protein–albumin–lymphocyte (CALLY) index have better overall survival.•The CALLY index could be used as an independent prognostic factor for patients with gastric cancer.•The nomogram combining TNM stage, body mass index, and the CALLY index has better prediction ability. The new C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is an immune nutrition scoring system based on serum CRP) serum albumin, and lymphocyte counts. The aim of this study was to verify the prognostic value of the CALLY index in patients with gastric cancer and to evaluate the superiority of this new system. We retrospectively analyzed the data of patients with gastric cancer who were followed up from the INSCOC database between May 2013 and December 2018. Through simple random sampling, patients with gastric cancer were placed into one of two groups: the training group (n = 684) or the verification group (n = 290) in a ratio of 7:3. Correlation analysis, Kaplan-Meier method, and cubic spline function were used to analyze the relationship between the CALLY index and overall survival (OS) in these patients. Based on the results of Cox regression analysis of the training cohort, a nomogram model for predicting 1 -, 2 -, 3-, and 5-y OS was established and verified internally. The prediction accuracy and benefit of the nomogram in gastric cancer were evaluated by calibration and clinical decision curve and compared with the traditional TNM gastric cancer staging system. The CALLY index was negatively correlated with the age of patients with gastric cancer (men, r = –0.1; women, r = –0.1), but positively correlated with body mass index (BMI; men, r = 0.063; women, r = 0.058), and the cutoff value of the CALLY index was determined as 1.12. The OS of patients with gastric cancer and a CALLY index >1.12 was significantly higher than that of patients with gastric cancer and a CALLY index ≤1.12 (P < 0.0001). There was an L-shaped dose-response relationship between the CALLY index and OS in patients with gastric cancer, and age, TNM stage, surgical treatment, chemotherapy, BMI, and the CALLY index were significantly correlated with the prognosis of patients with gastric cancer. Tumor TNM stage, BMI, and the CALLY index were independent risk factors affecting the prognosis of patients with gastric cancer. The CALLY index was a protective factor in the following patient factors: diagnosis of gastric cancer; <65 y of age; male; TNM 3 stage; BMI 18.5 to 23.9 kg/m2; smoker; consumer of alcohol; no radio- or chemotherapy; surgery; presence of diabetes, hypertension, or both; no family history of cancer; experienced a significant interaction with chemotherapy and surgery. A nomogram based on TNM staging, BMI, and the CALLY index has good predictive ability and clinical application value. Compared with traditional TNM staging systems, the nomogram has better resolution and accuracy in predicting 1 -, 2 -, 3-, and 5-year OS. The CALLY index can be used as an independent prognostic factor for patients with gastric cancer, and constructs a nomogram prediction model combining TNM staging, BMI, and CALLY index, which yields better predictions than traditional TNM staging.

Colorectal cancer (CRC) is among the most common malignant cancers worldwide, and its development is influenced by inflammation, nutrition, and the immune status. Therefore, we combined C-reactive protein (CRP), albumin, and lymphocyte, which could reflect above status, to be the CRP-albumin-lymphocyte (CALLY) index, and evaluated its association with overall survival (OS) in patients with CRC. The clinicopathological and laboratory characteristics of 1260 patients with CRC were collected from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) study. Cox regression analysis was performed to assess the association between the CALLY index and OS. A nomogram including sex, age, the CALLY index and TNM stage was constructed. The Concordance Index (C-index) was utilized to evaluate the prognostic value of the CALLY index and classical CRC prognostic factors, such as modified Glasgow prognostic score (mGPS), neutrocyte to lymphocyte ratio (NLR), systemic immune inflammation index (SII), and platelet to lymphocyte ratio (PLR), as well as to assess the prognostic value of the nomogram and TNM stage. Multivariate Cox regression analyses demonstrated that the CALLY index was independently associated with OS in patients with CRC [Hazard ratio (HR) = 0.91, 95% confidence interval (CI) = 0.87-0.95, <0.001]. The CALLY index showed the highest prognostic value (C-index = 0.666, 95% CI = 0.638-0.694, <0.001), followed by mGPS, NLR, SII, and PLR. The nomogram demonstrated higher prognostic value (C-index = 0.784, 95% CI = 0.762-0.807, <0.001) than the TNM stage. The CALLY index was independently associated with OS in patients with CRC and showed higher prognostic value than classical CRC prognostic factors. The nomogram could provide more accurate prognostic prediction than TNM stage.

Background Handgrip strength (HGS) is associated with poor clinical outcomes, including all‐cause, non‐cardiovascular, and cardiovascular mortalities. The published cut‐off points for HGS are mostly based on community populations from Western countries, lacking information on cancer patients from China. The objective of this study was to establish sex‐specific cut‐off points for Chinese cancer patients and investigate the effect of low HGS on cancer mortality. Methods We did a retrospective cohort study of patients who were diagnosed with malignant cancer from June 2012 to December 2018. HGS was measured using a hand dynamometer in 8257 cancer patients. Optimal stratification was used to solve threshold points. The hazard ratio (HR) of all cancer mortality and cancer‐specific mortality was calculated using Cox proportional hazard regression models. Results Among all participants, there were 3902 (47.3%) women and 4355 (52.7%) men. The median age was 58 years old. The cut‐off points of HGS to best classify patients with respect to time to mortality were <16.1 kg for women and <22 kg for men. Low HGS was associated with overall cancer mortality in both women and men [HR = 1.339, 95% confidence interval (CI) = 1.170–1.531, P < 0.001; HR = 1.346, 95% CI = 1.176–1.540, P < 0.001, respectively]. For specific cancer types, low HGS was associated with breast cancer (HR = 1.593, 95% CI = 1.230–2.063, P < 0.001) in women, and lung cancer (HR = 1.369, 95% CI = 1.005–1.866, P = 0.047) and colorectal cancer (HR = 1.399, 95% CI = 1.007–1.944, P = 0.045) in men. Conclusions On the basis of our sex‐specific cut‐off points, low HGS was strongly associated with cancer mortalities. These results indicate the usefulness of HGS measurement in routine clinical practice for improving patient assessments, cancer prognosis, and intervention.

Background Although systemic inflammation is an important feature of the cancer cachexia, studies on the association between systemic inflammation and prognostic of cancer cachexia are limited. The objective of this study is to evaluate whether the neutrophil‐to‐lymphocyte ratio (NLR) is associated with outcome and quality of life for patients with cancer cachexia and investigated any interaction between NLR and the clinical parameters. Methods This is a multicentre cohort study of 2612 cancer patients suffering from cachexia diagnosed between June 2012 and December 2019. The main parameters measured were overall survival (OS) time and all‐cause mortality. The association between NLR and all‐cause mortality was evaluated using hazard ratios (HRs) and the restricted cubic spline model with a two‐sided P‐value. Optimal stratification was used to solve threshold points. We also evaluated the cross‐classification of NLR for each variable of survival. Results Of the 2612 participants diagnosed with cancer cachexia, 1533 (58.7%) were male, and the mean (SD) age was 58.7 (11.7) years. Over a median follow‐up of 4.5 years, we observed 1189 deaths. The overall mortality rate for patients with cancer cachexia during the first 12 months was 30.2% (95%CI: 28.4%–32.0%), resulting in a rate of 226.07 events per 1000 patient‐years. An increase in NLR had an inverted L‐shaped dose–response association with all‐cause mortality. The optimal cut‐off point for NLR as a predictor of mortality in cancer patients with cachexia was 3.5. An NLR of 3.5 or greater could independently predict OS (HR, 1.51, 95%CI: 1.33–1.71). These associations were consistent across subtypes of cancer. Several potential effect modifiers were identified including gender, BMI, tumour type, KPS score and albumin in content. Increasing NLRs were independently associated with a worsening in the majority of EORTC QLQ‐C30 domains. Elevated baseline NLR was associated with low response and poor survival in patients treated with immunotherapy. Conclusions The baseline NLR status was found to be a significant negative prognostic biomarker for patients with cachexia; this effect was independent of other known prognostic factors.

Background The obesity paradigm has been a health concern globally for many years, its meaning is controversial. In this study, we assess the characteristics and causes of obesity paradigm and detail the mediation of obesity and inflammation on survival. Methods The original cohort included participants from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, a prospective cohort of a nationally representative sample of adult participants; the oncology validation cohort included patients from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) from 2013 to 2021, a prospective cohort of Chinese patients with cancer. Survival analysis was performed using weighted (NHANES) or unweighted (INSCOC) Cox survival analyses. The normal BMI group was used as a reference for all comparisons. Systemic inflammation was defined as neutrophil‐to‐lymphocyte ratio (NLR) > 3. Model‐based causal mediation analysis was used to identify the mediators. Results A total of 52 270 (weighted population: 528506229) participants of the NHANES [mean follow‐up times: 10.2 years; mean age (SD): 47 (19.16) years] were included in the original cohort; and a total of 17 418 patients with cancer of INSCOC [mean follow‐up times: 2.9 years; mean age (SD): 57.37 (11.66) years] were included in the validation cohort. In the subgroups of all the participants, the obesity paradigm was more apparent in older participants and participants with disease [HR (95% CI): age ≥ 65 years, 0.84 (0.76, 0.93); with cancer, 0.84 (0.71, 0.99); with CVD, 0.74 (0.65, 0.85)]. As aged, the protective effect of a high BMI on survival gradually increased and a high BMI showed the effect of a protective factor on older participants [for obese II, HR (95% CI): young adults, 1.91 (1.40, 2.62); middle age, 1.56 (1.28, 1.91); old adults, 0.85 (0.76, 0.96]). The aged‐related obesity paradigm in patients with cancer from the NHANES was verified in the INSCOC cohorts [for obese, HR (95%CI): 0.65 (0.52, 0.81)]. The NLR is an important mediator of the effect of BMI on survival (proportion of mediation = 15.4%). Conclusions The obesity paradigm has a strong correlation with age. Relative to normal weight, obese in young people was association with higher all‐cause mortality, and obese in elderly people was not association with higher mortality. The protection of obesity is association with systemic inflammation.

Background Systemic inflammation and cachexia are associated with adverse clinical outcomes in elderly patients with cancer. The Geriatric Nutritional Risk Index (GNRI) is a simple and useful tool to assess these conditions, but its predictive ability for elderly patients with cancer cachexia (EPCC) is unknown. Methods This multicentre cohort study included 746 EPCC with an average age of 72.00 ± 5.24 years, of whom 489 (65.5%) were male. The patients were divided into two groups (high GNRI group ≥91.959 vs. low GNRI group <91.959) according to the optimal cut‐off value of the ROC curve. The calibration curves were performed to analyse the prognostic, predictive ability of GNRI. Comprehensive survival analyses were utilized to explore the relationship between GNRI and the overall survival (OS) of EPCC. Interaction analysis was used to investigate the comprehensive effects of low GNRI and subgroup parameters on the OS of EPCC. Results In this study, a total of 2560 patients were diagnosed with cancer cachexia, including 746 cases of EPCC. During the 3.6 year median follow‐up, we observed 403 deaths. The overall mortality rate for EPCC at 12 months was 34.3% (95% CI: 62.3% to 69.2%), and resulting in rate of 278 events per 1000 patient‐years. The GNRI score of EPCC was significantly lower than those of young patients with cancer cachexia (P < 0.001). The 1, 3, and 5 year calibration curves showed that the GNRI score had good survival prediction in the OS of EPCC. The GNRI could predict the OS of EPCC, whether as a continuous variable or a categorical variable. Particularly, we also found that low GNRI score (<91.959) of EPCC had a worse prognosis than those with a high GNRI score (≥91.959, P = 0.001, HR = 1.728, 95% CI: 1.244–2.401). Consistent results were observed in the tumour subgroups of gastric cancer and colorectal cancer. Notably, similar results were observed in the sensitivity analysis. In the subgroup analysis, the low GNRI has a combined effect with age (<70 years) on poor OS of EPCC. The results of the prognostic risk model found that the lower the GNRI score, the greater the prognostic risk score, and the greater the risk of death in EPCC. Conclusions For the first time, this study found that the GNRI score can serve as an independent prognostic factor for the OS of EPCC.

Background Systemic inflammation and nutritional status are key factors affecting the prognosis of patients with cancer cachexia. This study aims to evaluate the prognostic value of a new nutritional and inflammatory index, Prognostic Nutritional CRP Ratio (NCR), in patients with cancer cachexia. Methods This prospective multicenter study analyzed 3,447 patients diagnosed with cancer cachexia across over 40 clinical centers in China, from June 2012 to December 2023. The NCR was calculated as BMI × albumin / CRP. The Cox proportional hazards regression model was utilized to analyze hazard ratios (HRs) for all-cause mortality. The relationship between NCR and all-cause mortality was assessed using restricted cubic spline modeling. The optimal cutoff value for NCR was determined through maximally selected rank statistics. Results Among the 3,447 individuals diagnosed with cancer cachexia in our study, 2,296 (66.6%) were men, and 1,151 (33.4%) were women. With a median follow-up duration of 45.33 months, the mean age of the participants was 63.8 ± 11.4 years. We observed that lower NCR levels were prevalent among cachexia patients across a spectrum of cancer types, including lung, colorectal, liver, esophageal, breast, ovarian, and cervical cancers. We observed that lower NCR levels were prevalent among cachexia patients across a spectrum of cancer types, including lung, colorectal, liver, esophageal, breast, ovarian, and cervical cancers. This correlation held true across diverse patient subgroups, delineated by gender, age, smoking status, BMI, TNM stage, and tumor types, underscoring the broad applicability of NCR as a prognostic marker. Moreover, our findings highlighted that cancer cachexia patients with higher NCR levels experienced a significantly improved quality of life. Conclusion The NCR, indicative of nutritional status and inflammation, is associated with reduced all-cause mortality and could be a valuable prognostic marker for patients with cancer cachexia.

Background Hepatic proteins, including albumin, prealbumin, and transferrin have been confirmed to be prognostic predictors in various cancers. This study aimed to comprehensively assess the prognostic value of these three serum markers in patients with cancer cachexia. Methods This multicenter prospective cohort study included 1303 cancer cachexia patients, among whom 592 deaths occurred during a median follow-up of 20.23 months. The definition of cachexia was based on the 2011 international consensus. Concordance index (C-index) and receiver operating characteristic (ROC) curves were applied to compare the prognostic performance. The primary outcome was overall survival, which was calculated using the Kaplan–Meier method generated by log-rank test. A Cox proportional hazard regression model was used to identify independent predictors associated with survival. The secondary outcomes included 90-days mortality and quality of life (QoL). Results C-index and ROC curves showed that albumin had the most accurate predictive capacity for survival, followed by transferrin and prealbumin. Multivariate Cox analysis confirmed that low albumin (hazard ratio [HR] = 1.51, 95% confidence interval [95%CI] = 1.28–1.80, P  < 0.001), prealbumin (HR = 1.42, 95%CI = 1.19–1.69, P  < 0.001), and transferrin (HR = 1.50, 95%CI = 1.25–1.80, P  < 0.001) were independent risk factors for long-term survival in cancer patients with cachexia. In subgroup analysis, the prognostic value of low albumin was significant in patients with upper gastrointestinal, hepatobiliary and pancreatic, and colorectal cancers; low prealbumin was significant in colorectal cancer; and low transferrin was significant in patients with upper gastrointestinal and colorectal cancer. All three hepatic proteins were valuable as prognostic predictors for patients with advanced (Stage III and IV) cancer with cachexia. The risks of 90-days mortality and impaired QoL were higher in cachexia patients with low albumin, prealbumin, and transferrin levels. Conclusion Low albumin, prealbumin, and transferrin levels were all independent prognostic factors affecting patients with cancer cachexia, especially in patients in the advanced stages. These results highlight the value of routinely checking serum hepatic proteins in clinical practice to predict the prognosis of patients with cancer cachexia.

Background The relationship between muscle and prognosis, especially that between muscle distribution across different body parts, and the related prognosis is not well established. Objective To investigate the relationship between muscle distribution and all-cause and cause-specific mortality and their potential modifiers. Design Longitudinal cohort study. C-index, IDI, and NRI were used to determine the best indicator of prognosis. COX regression analysis was performed to explore the relationship between variables and outcomes. Interaction and subgroup analyses were applied to identify the potential modifiers. Participants A total of 5052 participants (weighted: 124,841,420) extracted from the NHANES 2003–2006 of median age 45 years and constituting 50.3% men were assessed. For validation, we included 3040 patients from the INSCOC cohort in China. Main measures Muscle mass and distribution. Key Results COX regression analysis revealed that upper limbs (HR = 0.41, 95% CI 0.33–0.51), lower limbs (HR = 0.54, 95% CI 0.47–0.64), trunk (HR = 0.71, 95% CI, 0.59–0.85), gynoid (HR = 0.47, 95% CI 0.38–0.58), and total lean mass (HR = 0.55, 95% CI 0.45–0.66) were all associated with the better survival of participants (P trend < 0.001). The changes in the lean mass ratio of the upper and lower limbs and the lean mass ratio of the android and gynoid attenuated the protective effect of lean mass. Age and sex acted as potential modifiers, and the relationship between lean mass and the prognosis was more significant in men and middle-aged participants when compared to that in other age groups. Sensitive analyses depicted that despite lean mass having a long-term impact on prognosis (15 years), it has a more substantial effect on near-term survival (5 years). Conclusion Muscle mass and its distribution affect the prognosis with a more significant impact on the near-term than that on the long-term prognosis. Age and sex acted as vital modifiers.

Background The cachexia index is a useful predictor for cancer cachexia and prognostic assessment. However, its use is limited because of high testing costs and complicated testing procedures. Thus, in this study, we aimed to develop a hand grip strength (HGS)‐based cancer cachexia index (H‐CXI) as a potential predictor of cancer cachexia and prognosis in patients with cancer. Methods Here, 14 682 patients with cancer were studied, including the discovery (6592), internal validation (2820) and external validation (5270) cohorts. The H‐CXI was calculated as [HGS (kg)/height (m)2 × serum albumin (g/L)]/neutrophil‐to‐lymphocyte ratio. The Kaplan–Meier method was used to create survival curves, and the log‐rank test was used to compare time–event relationships between groups. A Cox proportional hazard regression model was used to determine independent risk factors for overall survival (OS). Logistic regression analysis was used to assess the association of the H‐CXI with short‐term outcomes and cancer cachexia. Results There was a significant non‐linear relationship between the H‐CXI and OS in all cohorts. Patients with a low H‐CXI had significantly lower OS than those with a high H‐CXI in the discovery cohort (6‐year survival percentage: 55.72% vs. 76.70%, log‐rank P < 0.001), internal validation cohort (6‐year survival percentage: 55.81% vs. 76.70%, log‐rank P < 0.001), external validation cohort (6‐year survival percentage: 56.05% vs. 75.48%, log‐rank P < 0.001) and total cohort (6‐year survival percentage: 55.86% vs. 76.27%, log‐rank P < 0.001). Notably, the prognostic stratification effect of the H‐CXI in patients with advanced‐stage disease was more significant than that in patients with early‐stage disease. The multivariate Cox proportional risk regression model confirmed that a low H‐CXI negatively affected the prognosis of patients with cancer in the discovery cohort [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.71–0.80, P < 0.001], internal validation cohort (HR 0.79, 95 %CI 0.72–0.86, P < 0.001), external validation cohort (HR 0.84, 95% CI 0.79–0.89, P < 0.001) and total cohort (HR 0.80, 95% CI 0.77–0.83, P < 0.001). Multivariate logistic regression models showed that a low H‐CXI was an independent risk factor predicting adverse short‐term outcomes and cancer cachexia in patients with cancer. Conclusions The simple and practical H‐CXI is a promising predictor for cancer cachexia and prognosis in patients with cancer.