Clinical nutrition (Edinburgh, Scotland) · 2026
Development of a multidimensional body composition grading system for cancer prognosis.
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Wei Lishuang, Xu Nuo, Yang Jiajun, Zhong Pei, Chen Yibo, Wang Shuyao, Lin Siyu, Xu Changhong, Shi Hanping, Xie Hailun
Аннотация
BACKGROUND AND AIMS: Sarcopenia, adipopenia, and body mass are recognized as prognostic factors in cancer, but their combined effects on survival remain unclear. This study aims to construct a comprehensive body composition grading system (BCS) and assess its prognostic value for cancer patients.
METHOD: Clinical case data from 5629 cancer patients were retrospectively analyzed. The BCS (Levels I-V) was constructed based on sarcopenia grading (defined by skeletal muscle index, ASMI), adiposity reduction (defined by fat mass index, FMI), and body mass index (BMI). Survival curves were analyzed using the Kaplan-Meier method, while Cox regression analysis explored associations between BCS and survival outcomes. Additionally, logistic regression analysis was utilized to examine the relationship between the BCS and severe malnutrition/cachexia.
RESULTS: The Kaplan-Meier method revealed a stepwise increase in survival probability from Grade I to Grade V (49.8% vs. 53.7% vs. 64.1% vs. 68.0% vs. 72.0%, Log-rank p < 0.001). In unadjusted Cox proportional hazards models, with Grade V as the reference, the risk of adverse prognosis increased progressively with lower grades. After adjusting for confounders, the BCS retained independent prognostic value: hazard ratios for Grades IV, III, II, and I relative to Grade V were 1.266, 1.404, 1.891, and 2.177, respectively. Subgroup analyses indicated that the BCS was universally applicable across various cancer stages and types. Logistic regression validated the BCS as a robust diagnostic tool for severe malnutrition and an effective method for risk stratification. Specifically, relative to Grade V, the odds of cachexia increased progressively with higher severity grades: odds ratios of 1.567 for Grade IV, 3.233 for Grade III, 8.099 for Grade II, and 10.508 for Grade I were observed. A higher BCS demonstrated significant correlations with multiple functional domains and symptom scales. Furthermore, multivariate logistic regression established the BCS as an independent factor associated with elevated risk of lower overall quality of life.
CONCLUSIONS: The BCS is an independent prognostic factor for cancer survival, closely related to severe malnutrition and cancer cachexia. It serves as a reference for clinical nutritional interventions and treatment decisions.
METHOD: Clinical case data from 5629 cancer patients were retrospectively analyzed. The BCS (Levels I-V) was constructed based on sarcopenia grading (defined by skeletal muscle index, ASMI), adiposity reduction (defined by fat mass index, FMI), and body mass index (BMI). Survival curves were analyzed using the Kaplan-Meier method, while Cox regression analysis explored associations between BCS and survival outcomes. Additionally, logistic regression analysis was utilized to examine the relationship between the BCS and severe malnutrition/cachexia.
RESULTS: The Kaplan-Meier method revealed a stepwise increase in survival probability from Grade I to Grade V (49.8% vs. 53.7% vs. 64.1% vs. 68.0% vs. 72.0%, Log-rank p < 0.001). In unadjusted Cox proportional hazards models, with Grade V as the reference, the risk of adverse prognosis increased progressively with lower grades. After adjusting for confounders, the BCS retained independent prognostic value: hazard ratios for Grades IV, III, II, and I relative to Grade V were 1.266, 1.404, 1.891, and 2.177, respectively. Subgroup analyses indicated that the BCS was universally applicable across various cancer stages and types. Logistic regression validated the BCS as a robust diagnostic tool for severe malnutrition and an effective method for risk stratification. Specifically, relative to Grade V, the odds of cachexia increased progressively with higher severity grades: odds ratios of 1.567 for Grade IV, 3.233 for Grade III, 8.099 for Grade II, and 10.508 for Grade I were observed. A higher BCS demonstrated significant correlations with multiple functional domains and symptom scales. Furthermore, multivariate logistic regression established the BCS as an independent factor associated with elevated risk of lower overall quality of life.
CONCLUSIONS: The BCS is an independent prognostic factor for cancer survival, closely related to severe malnutrition and cancer cachexia. It serves as a reference for clinical nutritional interventions and treatment decisions.