Influence of cachexia on immunotherapy efficacy and prognosis for malignant tumors of digestive system

Abstract

Abstract Background and aims: The incidence of malnutrition in patients with malignant tumors of the digestive system exceeds 30%. Advanced patients are more likely to develop cachexia. Cancer cachexia is a multifactorial syndrome characterized by a constant loss of skeletal muscles with or without a loss of weight leading to immune dysfunction. We performed a retrospective study to investigate the influence of cachexia on the immunotherapy efficacy and prognosis for malignant tumors of the digestive system. Methods The prognosis data of 98 patients with advanced cancer of the digestive system who received immunotherapy in Shanghai Provincial Dongfang Hospital from September 2021 to December 2022 were retrospectively analyzed. Cachexia was calculated using the change of the area of the psoas major muscle (PMMA) or the weight. Computed tomography (CT) reading software was utilized to calculate the PMMA at the level of the L3 upper margin. We measured the change at the beginning of immunotherapy and at least two cycles thereafter. According to the evaluation criteria, the participants were divided into cachexia group and control group. Kaplan–Meier and log-rank methods were applied for survival analysis. Cox proportional hazard model as a method was employed to assess the contribution of different clinical factors to the overall survival (OS) and progression-free survival (PFS). Spearman’s analysis was implemented for correlation assessment. Results A total number of 98 patients diagnosed with malignant tumors of the digestive system, including esophageal carcinoma, gastric, and colorectal and other cancer type, were enrolled. Sixty-two patients were male, with a mean age of 62 ± 13 years at the start of treatment. The objective response rate (ORR) and the disease control rate (DCR) of the 98 cases in the whole group were 5% and 47%, respectively. Neither ORR nor DCR differed between the two groups (ORR: p = 0.654, DCR: p = 0.417). The median PFS in the cachexia group was longer than that in the control group (212 days vs 130 days). However, their difference was not significant (P = 0.321). In the non-cachexia group, the six-month survival rate was 93.6%, and the one-year survival rate was 90.0%. The six-month and one-year survival rates in the cachexia group were 81.6% and 65.8%, respectively. The survival rate of the patients without cachexia was longer than of those with cachexia (p = 0.027). The level of albumin and the number of metastatic organs were related to PFS (p = 0.020, p = 0.029). The level of albumin also was associated with the OS of patients (p = 0.003). The level of albumin was an independent influencing factor of OS (p = 0.003). Conclusions Cachexia is a significant factor for poor prognosis of malignant tumors of the digestive system in patients undergoing immunotherapy.