A comparison of inflammatory markers’ potential to predict weight loss in advanced cancer: a prospective observational study

Abstract

Background: Systemic inflammation is crucial in cancer cachexia, but the optimal measurement method remains unclear. This study compares markers of systemic inflammation (MoSI) in predicting weight loss in patients with metastatic cancer. Methods: This prospective, observational multi-center study involved patients undergoing radiotherapy for bone metastases. Baseline assessments included demographics, clinical characteristics, previous weight loss, and appetite loss. MoSI included: C-reactive protein (CRP), albumin, white blood cells, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, interleukin-6 (IL-6), modified Glasgow Prognostic Score (mGPS), and Prognostic Nutritional Index. Body weight was recorded at baseline, 3, and 8 weeks post-radiotherapy. Multiple linear regression assessed MoSI’s predictive ability for weight loss, adjusting for previous weight loss, appetite loss, and primary tumour type. Goodness-of-fit was assessed using adjusted R2. Results: Out of 574 recruited patients, 540 and 470 were analyzed at 3 and 8 weeks, respectively. The median age (IQR) was 67 (15), 330 (61%) were male, and 397 (74%) had a Karnofsky performance status ≥70. In a base model without MoSI, significant predictors of weight loss at 3 weeks were appetite loss and urological, lung, and gastrointestinal cancer (adjusted R2 of 0.064), while at 8 weeks, urological and lung cancer were significant (adjusted R2 of 0.035). At 3 weeks, all MoSI significantly improved the base model, with adjusted R2 between 0.078 and 0.091. At 8 weeks: CRP, mGPS, albumin and IL-6 improved the model; however only CRP and mGPS retained an adjusted R2 of ~0.09. Conclusions: All MoSI predicted weight loss, but CRP and mGPS were the most optimal.