title: Associations among hypogonadism, C-reactive protein, symptom burden, and survival in male cancer patients with cachexia: a preliminary report.
abstract: BACKGROUND
  Cachexia is characterized by muscle wasting, anorexia, and elevated inflammatory markers. In patients without cancer, hypogonadism is associated with lower lean body mass, increased symptom burden, and decreased survival. Hypogonadism in cancer cachexia could exacerbate symptoms, facilitate a proinflammatory state, and decrease survival.
  
  
  OBJECTIVE
  To explore the relationships among these factors, a retrospective study of male cancer patients was conducted.
  
  
  METHODS
  The charts of 98 consecutive male patients referred to a cachexia clinic at a comprehensive cancer center were reviewed. All patients reported weight loss of >5% within the preceding six months; the median age was 60 years. Fifty-seven (58%) had serum C-reactive protein (CRP), and 68 (69%) had total testosterone evaluated. Symptoms were evaluated by the Edmonton Symptom Assessment Scale.
  
  
  RESULTS
  Median CRP was 20mg/L, and median testosterone level was 185 ng/dL (6.42 nmol/L) (normal > or = 240 ng/dL or 8.36 nmol/L). There was an inverse correlation between testosterone and CRP levels (P<0.01). Lower testosterone was associated with increased dyspnea and insomnia (P<0.05). Poor appetite and insomnia (P<0.05) correlated with elevated CRP. Survival of patients with testosterone levels < or = 185 ng/dL (6.42 nmol/L) was decreased compared with that of those with levels >185 ng/dL (13 vs. 62 weeks, P=0.004). Patients with CRP levels >10mg/L had decreased survival compared with those with levels < or = 10mg/L (15 vs. 46 weeks, P=0.01). The combination of hypogonadism and elevated CRP was associated with poorer prognosis. Elevated CRP levels were associated with increased symptom burden and decreased survival. Low testosterone was associated with decreased survival and correlated inversely with CRP levels, dyspnea, and insomnia.
  
  
  CONCLUSIONS
  Our preliminary results suggest that testosterone and CRP may be additive or synergistic as markers for survival in male patients and could be useful in future prognostic models.
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. edelfabbro@mdanderson.org
authors.forename: Egidio
authors.initials: E
authors.lastname: Del Fabbro
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Zohra I
authors.initials: ZI
authors.lastname: Nooruddin
authors.forename: Shalini
authors.initials: S
authors.lastname: Dalal
authors.forename: Rony
authors.initials: R
authors.lastname: Dev
authors.forename: Gina
authors.initials: G
authors.lastname: Freer
authors.forename: Lynn
authors.initials: L
authors.lastname: Roberts
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D002100:Cachexia / Q000150:complications / Q000401:mortality*; D017281:Cost of Illness; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000150:complications*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D013534:Survival; D016019:Survival Analysis; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013739:Testosterone; D002097:C-Reactive Protein