Cancer Cachexia: Its Mechanism and Clinical Significance

Abstract

The term “cachexia” is derived from the Greek words kakos (bad) and hexis (habit). Cachexia is a malnutrition associated with chronic diseases such as cancer, chronic heart failure, chronic renal failure, and autoimmune diseases, and is characterized by decreased skeletal muscle mass. Cancer cachexia is quite common in patients with advanced cancer. Weight loss is also a characteristic symptom of cancer cachexia, along with decreased skeletal muscle mass. As nutritional supplementation alone cannot improve cachexia, cytokines and tumor-derived substances have been attracting attention as its relevant factors. Cancer cachexia can be also associated with reduced chemotherapeutic effects, increased side effects and treatment interruptions, and even poorer survival. In 2011, a consensus definition of cachexia has been proposed, and the number of relevant research reports has increased significantly. However, the pathogenesis of cachexia is not fully understood, and there are currently few regulatory-approved standard treatments for cachexia. The main reason for this is that multiple etiologies are involved in the development of cachexia. In this review, we will outline the current status of cachexia, the mechanisms of which have been elucidated in recent years, especially from the perspective of advanced cancer.

Prognostic Impact of the SARC-F Score in Gastrointestinal Advanced Cancers

“…The ORs for the OS of GPS 1 and GPS 2 in this study were 1.953 (p = 0.0147, GPS 0 as a reference) and 3.460 (p < 0.0001, GPS 0 as a reference), which were consistent with previous reports [28,29,35]. Although BMI was not significant for the OS in our results, body weight loss was an important factor associated with cancer cachexia [10]. In our cohort, 86 patients (20.4%) had BMI < 18.5 kg/m 2 (underweight).…”

“…Malnutrition, reticence, advanced malignancy burden, and persistent inflammatory condition often identified in patients with gastrointestinal disorders are typical clinical characteristics associated with sarcopenia [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. Patients with advanced cancer are prone to muscle protein loss due to muscle proteolysis-inducing factors and inflammatory cytokines released by the cancer cells [ 10 ]. In addition, psychological anxiety and side effects of treatment for the underlying malignancies can lead to a loss of appetite, and numerous previous studies have reported that sarcopenia is an adverse predictor in patients with advanced cancer [ 11 , 12 , 13 ].…”

“…In addition, psychological anxiety and side effects of treatment for the underlying malignancies can lead to a loss of appetite, and numerous previous studies have reported that sarcopenia is an adverse predictor in patients with advanced cancer [ 11 , 12 , 13 ]. Cancer cachexia is a metabolic abnormality with a systemic inflammatory response, and it is associated with increased catabolism, such as insulin resistance and increased lipid degradation, as well as increased skeletal muscle degradation [ 10 ]. In Japan, anamorelin, a ghrelin (appetite stimulating peptide) receptor agonist, is currently the only drug approved for cancer cachexia [ 14 ].…”

The Relationship between the SARC-F Score and the Controlling Nutritional Status Score in Gastrointestinal Diseases

“…In the ROC analyses both for mild or more severe malnutrition and for the moderate or more severe malnutrition, CRP had the highest AUC. Proinflammatory cytokines include IL-1β, IL-6, TNF-α, and IFN-γ, and they cause decreased appetite and increased energy expenditure, which can be related to our results [36]. Cachexia is a common form of disease-related malnutrition associated with inflammation and loss of skeletal muscle mass.…”

The Relevance in the Neutrophil to Lymphocyte Ratio and the SARC-F Score in Gastrointestinal Diseases

“…On the other hand, lymphocytes are responsible for the immune function of the host, and a decrease in lymphocytes can damage the host’s anti-tumor immunity and worsen the prognosis [ 23 ]. Thus, in advanced cancer, NLR reflects the balance between tumor promotion and anti-tumor immune status [ 24 , 25 ].…”