Comparação entre dois métodos de diagnóstico para caquexia e sobrevida de pacientes em cuidados paliativos

Abstract

Cancer cachexia (CC) is observed in patients with advanced cancer and is associated with worse outcomes. Various diagnostic methods for CC have been proposed; however, some discrepancies among them have been noted. This study aimed to compare the overall survival (OS) of patients with incurable cancer under palliative care using two diagnostic methods for CC. A prospective cohort study conducted at the Palliative Care Center outpatient clinic of Pedro Ernesto University Hospital in Rio de Janeiro, from May 2022 to July 2023. Patients were classified according to the diagnostic methods for cancer cachexia (CC) proposed by Wiegert et al. and Vigano et al., using adapted versions. CC was categorized into stages: non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca), and refractory cachexia (CaR). Clinical, nutritional, and functional variables were assessed according to these stages. Kaplan-Meier survival curves and Cox regression were used for survival analysis. A total of 171 patients were included in the study, with variations in the diagnosis of CC according to the diagnostic method used (Vigano: PCa 14.38%, Ca 27.50%, and CaR 28.75%; Wiegert: PCa 5.88%, Ca 37.06%, and CaR 28.4%). Both methods showed different OS between patients with Ca and NCa (Vigano – HR: 2.04; CI: 1.33-3.15; Wiegert – HR: 2.04; CI: 1.33-3.15). However, only Wiegert’s adapted method showed cachexia as a remaining risk factor after adjustments in the multivariate regression models (HR: 1.79; CI: 1.11-2.89). Our results demonstrated that Wiegert’s adapted method showed clear OS risk among CC stages thus evidencing high sensitivity to predict survival risk. Further studies are needed to detect and predict the risk of intermediate stages of CC, as well as to provide longitudinal follow-up in these patients.