SP4.9 - Relationship Between Classifications for Cancer Cachexia and Overall Survival in Patients with Oesophagogastric Cancer Free

Classifications for cancer cachexia remain heterogenous within the existing literature. The aim of this study is to compare prognostication using three established descriptors: the Fearon et al. consensus definition, Martin et al.’s weight loss grading system and the Global Leadership Initiative on Malnutrition (GLIM) criteria, in patients with oesophagogastric cancer.

Consecutive patients with newly diagnosed oesophagogastric cancer between 2019-2020 were identified from a prospectively maintained regional database. Data were retrieved regarding involuntary weight loss, body mass index, CT body composition analyses and neutrophil-lymphocyte-ratio at the time of clinical staging. This allowed comparison based on Fearon, Martin and GLIM classifications. The primary outcome of interest was overall survival.

Overall, 465 patients (66.9% male, median 71 years) were diagnosed with oesophageal (72.0%) or gastric cancer (28.0%). Greater proportions of advanced stage disease were associated with Fearon (p=0.019), Martin (p=0.004) and GLIM (p<0.001) defined cachexia. Patients who met the GLIM criteria were also older and had poorer ECOG performance status (both p<0001). Each cachexia classifier was associated with worsened overall survival (all p<0.001). Following adjustment for clinicopathological confounders, Fearon (aHR: 1.54 (95%CI:1.24-1.92) and GLIM defined cachexia (aHR: 1.74 (95%CI:1.40-2.17) were both adversely associated with overall survival. Grade 4 weight-loss, as per Martin et al., had the greatest prognostic effect (aHR: 2.11 (95%CI:1.52-2.93).

Cancer cachexia is strongly associated with poorer survival in oesophagogastric cancer. The GLIM criteria and high Martin et al. weight loss grade appear to have the greatest prognostic value.