Predictors of Survival in Patients with Incurable Cancer

Background: The aim of the present study was to investigate predictors of survival in a cohort of patients with incurable cancer. This may highlight areas of care which can be addressed to optimise outcomes. Methods: Patient demographics, performance status (ECOG), inflammatory markers (modified Glasgow Performance Score (mGPS)), and nutritional parameters [BMI, % weight loss (WL)] were recorded. Baseline body composition were examined using computed tomography (CT) images. Sarcopenia and low muscle attenuation (MA) were defined using published cut-offs. Cancer cachexia (CC) was defined using the consensus definition (2011). Cox models were used to estimate mortality hazard ratios, adjusted for known prognostic covariates – age, sex & site. Results: In total, 1027 patients were recruited (51% male, median age 66 years). Gastrointestinal cancer was most common (40%) and metastatic disease was present in 87% of patients. In total, 86% were on active chemotherapy treatment. On multivariate analysis, primary site, ECOG-PS, WL and mGPS predicted survival. Lung and GI cancer patients had higher risk of death compared to other tumour groups [HR:1.769 (95% CI:1.305–2.398), p < 0.001 and HR:1.576 (95% CI:1.211–2.053), p = 0.001, respectively]. mGPS score of 1 or 2 were associated with increased risk of death versus mGPS of 0 [HR:1.399 (95% CI:1.024–1.910), p = 0.035 & HR:1.831 (95% CI:1.442–2.324), p < 0.001, respectively]. WL > 10% in the preceding 3 months was associated with reduced survival [HR:2.501 (95% CI:1.425–4.389), p = 0.001]. Sarcopenia, CC and low MA were significant predictors of survival on univariate analysis, but not on multivariate analysis. Conclusions: Independent predictors of survival in this cohort of advanced cancer patients were cancer site, ECOG, WL > 10% and mGPS, the latter two being important components of the cancer cachexia syndrome. Attenuation of weight loss and inflammation may improve outcomes for patients undergoing palliative treatment for cancer