title: Cachexia Index in Advanced Non-Small-Cell Lung Cancer Patients.
abstract: BACKGROUND
  Cancer cachexia affects many advanced non-small-cell lung cancer (NSCLC) patients. Cachexia index (CXI) was developed to assess the degree of cachexia in these patients.
  
  
  METHODS
  Patients with metastatic NSCLC diagnosed between January 1, 2000, and June 30, 2011, at our institution were retrospectively studied. Abdominal computed tomography scans done within 1 month of diagnosis were reviewed to estimate skeletal muscle area (SMA) and skeletal muscle index (SMI) at the L3 level. CXI was developed as follows: [Formula: see text] where SMI is the skeletal muscle index, Alb is the serum albumin, and NLR is the neutrophil-to-lymphocyte ratio. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Survival among various factors was calculated using the log-rank test. Multivariate Cox regression was used to perform survival analysis in order to estimate the effects of various factors.
  
  
  RESULTS
  Patients were divided into two groups around the median into stage I cachexia (CXI ≥35, n = 56) and stage II cachexia (CXI <35, n = 56). Groups did not differ in age, gender, ethnicity, or histology of cancer. Patients with stage II cachexia had significantly worse PFS (2.45 vs 5.43 months, P < 0.0001) and OS (3.45 vs 8.8 months, P = 0.0001) than those with stage I cachexia. On multivariate analysis adjusting for gender, race, and histology, patients with stage II cachexia were found to have worse PFS (hazard ratio [HR] 1.94, 95% confidence interval [CI] 1.27-2.95) and OS (HR 1.53, 95% CI 1.0009-2.34).
  
  
  CONCLUSIONS
  The CXI is a novel index for estimating cachexia that also correlates with prognosis in both men and women with advanced NSCLC.
authors.affiliation: University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Syed Hasan Raza
authors.initials: SH
authors.lastname: Jafri
authors.affiliation: Louisiana State University Health Science Center, Shreveport, LA, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Previgliano
authors.affiliation: Louisiana State University Health Science Center, Shreveport, LA, USA.
authors.forename: Keerti
authors.initials: K
authors.lastname: Khandelwal
authors.affiliation: Louisiana State University Health Science Center, Shreveport, LA, USA.
authors.forename: Runhua
authors.initials: R
authors.lastname: Shi
keywords: cancer cachexia; lung cancer; sarcopenia; systemic inflammation