A convenient calf proportion index calculator for survival prediction in overweight and obese patients with cancer - 25/07/24

Doi : 10.1016/j.orcp.2024.07.003

Jia-Xin Huang ^a,^{^{1
These authors contributed equally to this work.}}, Xi Zhang ^a,^b,^c,^{^{1
These authors contributed equally to this work.}}, Wen-Jie Zhu ^a,^{^{1
These authors contributed equally to this work.}}, Meng Tang ^a,^b,^c, Chun-Hua Song ^d, Jiu-Wei Cui ^e, Min Yang ^a, Cong Zhao ^a, Chao Wang ^a, Han-Ping Shi ^b,^c,^f,^⁎ , Ming-Hua Cong ^a,^⁎
^a Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
^b Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
^c Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
^d Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
^e Cancer Center of the First Hospital of Jilin University, Changchun, China
^f Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China

^⁎Corresponding author at: Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical UniversityBeijingChina^⁎⁎Corresponding author.

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Abstract

Objective

This study aimed to define the calf proportion index (CPI) and investigate its association with malnutrition and survival in overweight and obese patients with cancer.

Methods

This multicenter observational cohort study included 3499 patients diagnosed with cancer, including 3145 overweight and 354 obese individuals. The CPI was defined as the ratio of the cross-sectional area of the calf circumference (CC) to the body surface area (BSA). A CPI calculator that automatically calculated the CPI and survival probability based on the patient’s sex, height, weight, and CC was developed.

Results

During a median follow-up of 44.1 months, 935 deaths were recorded. Receiver operating characteristic curves revealed that the CPI was better than CC and BSA as a predictor of survival, with AUCs for the 3-year mortality rate were 0.574, 0.553 and 0.529, respectively. In overweight and obese patients with cancer, the optimal CPI cut-off value was 0.65 % for men and 0.57 % for women. The Kaplan–Meier curve revealed that patients with a low CPI had lower survival. After adjusting confounding factors, a low CPI was an independent risk factor for overweight (hazard ratio [HR]: 1.29, 95 % confidence interval [CI]: 1.11–1.51, P < 0.001) and obesity (HR: 1.92, 95 % CI: 1.20–3.09, P = 0.007) in patients with cancer. The CPI exhibited significant prognostic value in patients with lung and digestive system cancers. The risk of malnutrition was significantly higher in patients with a low CPI (HR: 1.25, 95 % CI: 1.04–1.50, P = 0.019).