BackgroundCancer cachexia is manifested by loss in muscle, adipose, weight, and appetite. PET 18F‐FDG uptake identifies tumour metabolic and inflammatory changes, potentially associated with cachexia development. We examined if primary gastroesophageal tumour 18F‐FDG uptake correlates with cachexia development and survival in cancer patients.MethodsOne hundred twenty‐six oesophageal (n = 87) and gastroesophageal junction (n = 39) cancer patients, with a median age at diagnosis of 63 years (IQR 54–71), evaluated between 2006 and 2014 with pre‐treatment PET imaging and cachexia determination at diagnosis were included in the study cohort (22.1% female; 6.7%, 24.4%, 50.4%, and 18.5% with tumour stage I, II, III, and IV, respectively). Maximum primary tumour standardized uptake values were obtained and dichotomized based off the calculated cut‐point SUVMax of 8.5 (P = 0.0018). Associations between survival, cachexia development, and primary tumour 18F‐FDG uptake were evaluated using univariate and multivariate analyses.ResultsCancer‐associated weight loss (cachexia) and primary tumour SUVMax at or above the statistically determined cut‐point of 8.5 were present in 54% and 57% of patients, respectively. Primary tumour SUVMax above the cut‐point was significantly associated with pre‐treatment cancer‐associated weight loss (P = 0.0033) and, in multivariate analysis, correlated with a 2.3‐fold increased risk of death (95% CI 1.4, 3.7; P = 0.0010). When divided into cohorts defined by their combined cachexia and high versus low SUVMax tumour status, positive cachexia status or/and high SUVMax tumours were associated with similar significant decrements in survival.ConclusionA positive association was present between cancer‐associated weight loss and SUVMax of the primary tumour, suggesting greater glycolytic metabolism in gastroesophageal tumours that induce cachexia. This interpretation of routinely administered PET scans could lead to earlier categorization of patients with cachexia‐inducing tumours. Both cachexia and high SUVMax status were independently associated with worsened survival outcomes, further supporting their prognostic relevance in patients with gastroesophageal cancer.

AimTo investigate the diagnostic potential of and associations between tumor 18F‐FDG uptake on PET imaging and cancer-associated weight loss.Methods774 non-small cell lung cancer (NSCLC) patients with pre-treatment PET evaluated between 2006 and 2014 were identified. Using the international validated definition of cachexia, the presence of clinically significant pretreatment cancer-associated weight loss (WL) was retrospectively determined. Maximum Standardized Uptake Value (SUVMax) of 18F‐FDG was recorded and dichotomized based on 3 experimental cutpoints for survival analyses. Each SUVMax cutpoint prioritized either survival differences, total cohort comparison sample sizes, or sample size by stage. Patient outcomes and associations between SUVMax and cancer-associated weight loss were assessed by multivariate, categorical, and survival analyses.ResultsPatients were found to have an increased likelihood of having WL at diagnosis associated with increasing primary tumor SUVMax after controlling for potentially confounding patient and tumor characteristics on multivariate logistic regression (OR 1.038; 95% CI: 1.012, 1.064; P=0.0037). After stratifying the cohort by WL and dichotomized SUVMax, both factors were found to be relevant in predicting survival outcomes when the alternative variable was constant. Of note, the most striking survival differences contributed by WL status occurred in high SUVMax groups, where the presence of WL predicted a median survival time detriment of up to 10 months, significant regardless of cutpoint determination method applied to categorize high SUVMax patients. SUVMax classification was found to be most consistently relevant in both WL and no WL groups.ConclusionsThe significant positive association between significant pretreatment cancer-associated weight loss and primary tumor SUVMax underscores increased glucose uptake as a component of catabolic tumor phenotypes. This substantiates 18F‐FDG PET analysis as a prospective tool for assessment of cancer-associated weight loss and corresponding survival outcomes. Furthermore, the survival differences observed between WL groups across multiple SUVMax classifications supports the importance of weight loss monitoring in oncologic workups. Weight loss in the setting of NSCLCs with higher metabolic activity as determined by 18F‐FDG PET signal should encourage more aggressive and earlier palliative care interventions.

BackgroundCachexia is an inflammatory and metabolic syndrome of unintentional weight loss through depletion of muscle and adipose tissue. There is limited knowledge of how chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids affect cachexia development. The purpose of this study was to investigate associations between prior long-term use of NSAIDs or glucocorticoids with cachexia incidence and post-diagnosis weight loss progression in a retrospective cancer patient cohort.MethodsOf 3,802 lung or gastrointestinal cancer patient records, 3,180 comprised our final cohort. Patient demographic information, tumor qualities, medication histories, and comorbidities were assessed. Cachexia was defined as having developed prior to oncologic treatment. Statistical evaluations included categorical, multivariate logistic regression, and log-rank survival analyses. Development of substantial post-diagnosis weight loss was calculated and interpreted for patients without cachexia at diagnosis.ResultsChronic prior use of any NSAID or glucocorticoid medication was associated with approximate absolute and relative reductions in cachexia incidence at diagnosis of 10 and 25 percent (P<0.0001). In multivariate analyses, NSAID medications demonstrated a 23 percent reduction in cachexia incidence likelihood (OR=0.770; 95% CI=0.594, 0.998; P=0.0481). Patients without cachexia at diagnosis were significantly more likely to develop substantial post-diagnosis weight loss from pre-diagnosis use groups of glucocorticoids (OR= 1.452; 95% CI=1.065, 1.979; P=0.0183) or NSAIDs (OR=1.411; 95% CI=1.082, 1.840; P=0.011).ConclusionsOur findings suggest a protective effect of prior anti-inflammatory medications, primarily NSAIDs, against manifestations of the cachexia phenotype at cancer diagnosis. These observations support further exploration of potential therapeutic benefits from anti-inflammatory medications early in cancer management.