Validation of the CAchexia SCOre (CASCO). Staging Cancer Patients: The Use of miniCASCO as a Simplified Tool

Josep M Argilés, Angelica Betancourt, Joan Guàrdia-Olmos, Maribel Peró-Cebollero, Francisco J López-Soriano, Clelia Madeddu, Roberto Serpe, Sílvia Busquets, Josep M Argilés, Angelica Betancourt, Joan Guàrdia-Olmos, Maribel Peró-Cebollero, Francisco J López-Soriano, Clelia Madeddu, Roberto Serpe, Sílvia Busquets

Abstract

The CAchexia SCOre (CASCO) was described as a tool for the staging of cachectic cancer patients. The aim of this study is to show the metric properties of CASCO in order to classify cachectic cancer patients into three different groups, which are associated with a numerical scoring. The final aim was to clinically validate CASCO for its use in the classification of cachectic cancer patients in clinical practice. We carried out a case -control study that enrolled prospectively 186 cancer patients and 95 age-matched controls. The score includes five components: (1) body weight loss and composition, (2) inflammation/metabolic disturbances/immunosuppression, (3) physical performance, (4) anorexia, and (5) quality of life. The present study provides clinical validation for the use of the score. In order to show the metric properties of CASCO, three different groups of cachectic cancer patients were established according to the results obtained with the statistical approach used: mild cachexia (15 ≤ × ≤ 28), moderate cachexia (29 ≤ × ≤ 46), and severe cachexia (47 ≤ × ≤ 100). In addition, a simplified version of CASCO, MiniCASCO (MCASCO), was also presented and it contributes as a valid and easy-to-use tool for cachexia staging. Significant statistically correlations were found between CASCO and other validated indexes such as Eastern Cooperative Oncology Group (ECOG) and the subjective diagnosis of cachexia by specialized oncologists. A very significant estimated correlation between CASCO and MCASCO was found that suggests that MCASCO might constitute an easy and valid tool for the staging of the cachectic cancer patients. CASCO and MCASCO provide a new tool for the quantitative staging of cachectic cancer patients with a clear advantage over previous classifications.

Keywords: anorexia; cachexia; classification; physical performance; quality of life; score; wasting; weight loss.

Figures

Figure 1
Figure 1
Flow diagram of excluded participants in the CASCO Study with missing or implausible data.
Figure 2
Figure 2
Box plot of CASCO total score for each group (patient and control groups).
Figure 3
Figure 3
Scatter plots of CASCO against other values of clinical assessment. (A) Correlation between CASCO and the subjective diagnosis of specialized oncologists. (B) Correlation between CASCO and the Eastern Cooperative Oncology Group (ECOG) scale.
Figure 4
Figure 4
CASCO distribution for each of the groups set for the diagnosis of the severity of cachexia.
Figure 5
Figure 5
Scatterplot of CASCO against MCASCO.

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