Cancer cachexia onset and survival outcomes in metastatic colorectal cancer: Comparative assessment of the asian working group for cachexia and the European palliative care research collaborative criteria, and utility of modified glasgow prognostic score.

Abstract

Objective: Cachexia substantially affects the prognosis of patients with advanced cancer. While both the Asian Working Group for Cachexia (AWGC) and European Palliative Care Research Collaborative (EPCRC) criteria are widely used for diagnosis, their comparative effectiveness in diagnostic timing and prognostic value remain understudied.

Methods: This retrospective study included patients with metastatic colorectal cancer (mCRC) who received first-line chemotherapy between 2013 and 2023. Cachexia was assessed using three distinct criteria: AWGC criteria, defined as either weight loss > 2%, or body mass index (BMI) < 21 kg/m² accompanied by at least one of the following: anorexia or elevated C-reactive protein level; EPCRC criteria, requiring weight loss > 5% (or weight loss > 2% if BMI is < 20); and Modified Glasgow Prognostic Score (mGPS). Analyses were performed using cumulative incidence and survival with a time-dependent Cox regression model.

Results: We enrolled 313 patients with metastatic CRC. The 1-year cumulative incidence of cachexia showed marked variation across the different diagnostic criteria. Using the AWGC criteria, the incidence rate was 69%, whereas the EPCRC criteria identified 44% of the cases. The mGPS evaluation revealed incidence rates of 73% and 39% for scores of 1 and 2, respectively. Both AWGC- and EPCRC-defined cachexia correlated with significantly shorter overall survival (AWGC: hazard ratio (HR) = 2.41, P < 0.001; EPCRC: HR = 2.02, P < 0.001). Similarly, the mGPS scores indicated a poor prognosis.

Conclusion: The AWGC criteria identified a higher incidence of cachexia earlier in the disease course compared to the EPCRC criteria and showed a stronger association with overall survival. The mGPS shows promise as an alternative diagnostic tool to traditional weight-based assessments. These findings suggest new opportunities for early diagnosis of cachexia and intervention strategies in patients with mCRC.