BACKGROUND Weight loss (WL) has long been recognized as an important factor associated with reduced quality of life (QoL) and reduced survival in patients with cancer. The body mass index (BMI)-adjusted weight loss grading system (WLGS) has been shown to be associated with reduced survival. However, its impact on QoL has not been established. The aim of this study was to assess the relationship between this WLGS and QoL in patients with advanced cancer. METHODS A biobank analysis was undertaken of adult patients with advanced cancer. Data collected included patient demographics, Eastern Cooperative Oncology Group performance status, and anthropometric parameters (BMI and %WL). Patients were categorized according to the BMI-adjusted WLGS into one of five distinct WL grades (grades 0-4). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. The Kruskal-Wallis test and multivariate logistic regression analyses were used to assess the relationship between the WLGS and QoL scores. Overall survival was assessed using Kaplan-Meier curve and Cox proportional hazard models. RESULTS A total of 1027 patients were assessed (51% male, median age: 66 years). Gastrointestinal cancer was most prevalent (40%), and 87% of patients had metastatic disease. Half (58%) of patients had a WL grade of 0-1, while 12%, 20%, and 10% had WL grades of 2, 3, and 4, respectively. Increasing WL grades were significantly associated with poorer QoL functioning and symptoms scales (all P < 0.05). Physical, role, and emotional functioning decreased by a median of >20 points between WL grade 0 and WL grade 4, while appetite loss, pain, dyspnoea, and fatigue increased by a median score >20 points, indicative of a large clinical significant difference. Increasing WL grades were associated with deteriorating QoL summary score. WL grades 2, 3, and 4 were independently associated with a QoL summary score below the median (<77.7) [odds ratio (OR) 1.69, P = 0.034; OR 2.06, P = 0.001; OR 4.29, P < 0.001, respectively]. WL grades 3 and 4 were independently associated with reduced overall survival [hazard ratio 1.54 (95% confidence interval: 1.22-1.93), P < 0.001 and hazard ratio 1.87 (95% confidence interval: 1.42-2.45), P < 0.001, respectively]. CONCLUSIONS Our findings support that the WLGS is useful in identifying patients at risk of poor QoL that deteriorates with increasing WL grades. WL grade 4 is independently associated with a particularly worse prognosis and increased symptom burden. Identification and early referral to palliative care services may benefit these patients.

中文翻译：

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BMI调整的体重减轻分级系统与无法治愈的癌症患者的生活质量之间的关系。

背景长期以来，体重减轻（WL）被认为是与癌症患者生活质量（QoL）降低和生存率降低相关的重要因素。体重指数 (BMI) 调整的体重减轻分级系统 (WLGS) 已被证明与生存率降低有关。然而，它对生活质量的影响尚未确定。本研究的目的是评估 WLGS 与晚期癌症患者生活质量之间的关系。方法 对成年晚期癌症患者进行生物样本库分析。收集的数据包括患者人口统计数据、东部肿瘤协作组的表现状态和人体测量参数（BMI 和 %WL）。根据 BMI 调整的 WLGS 将患者分类为五个不同的 WL 等级（0-4 级）之一。使用欧洲癌症研究和治疗组织生活质量问卷-C30 收集生活质量。Kruskal-Wallis 检验和多变量逻辑回归分析用于评估 WLGS 和 QoL 评分之间的关​​系。使用 Kaplan-Meier 曲线和 Cox 比例风险模型评估总生存期。结果 共评估了 1027 名患者（51% 为男性，中位年龄：66 岁）。胃肠道癌最为普遍（40%），87% 的患者患有转移性疾病。一半 (58%) 的患者 WL 等级为 0-1，而 12%、20% 和 10% 的患者 WL 等级分别为 2、3 和 4。增加 WL 等级与较差的 QoL 功能和症状量表显着相关（所有 P < 0.05）。身体、角色和情感功能下降中位数 > WL 0 级和 WL 4 级之间增加了 20 分，而食欲减退、疼痛、呼吸困难和疲劳增加了中位数 > 20 分，表明临床显着差异很大。增加 WL 等级与恶化的 QoL 总分有关。WL 2、3 和 4 级与低于中位数 (<77.7) 的 QoL 总分独立相关[优势比 (OR) 1.69，P = 0.034；或 2.06，P = 0.001；OR 4.29，P < 0.001，分别]。WL 3 级和 4 级与总生存期降低独立相关[风险比 1.54（95% 置信区间：1.22-1.93），P < 0.001 和风险比 1.87（95% 置信区间：1.42-2.45），P < 0.001，分别]。结论 我们的研究结果支持 WLGS 可用于识别存在随着 WL 等级增加而恶化的 QoL 差风险的患者。WL 4 级与预后特别差和症状负担增加独立相关。识别和早期转诊到姑息治疗服务可能会使这些患者受益。