LOW cachexia index (CXI) was associated with poorer disease-free survival (DFS) and overall survival (OS) in patients with surgically treated gastrointestinal cancer, supporting its potential role in prognostic assessment and survival risk stratification. The findings, based on 822 patients and externally validated in a further 3,101, highlighted the value of combining skeletal muscle, albumin, and systemic inflammation measurements when assessing cancer outcomes.
The study investigated the prognostic value of the cachexia index (CXI), a measure integrating skeletal muscle, albumin, and systemic inflammation, in patients with gastrointestinal cancer. Sex-specific thresholds were established at 90.80 for men and 106.52 for women.
Patients with a low CXI experienced poorer survival outcomes than those with higher scores. The follow-up-averaged adjusted hazard ratio for DFS was 1.84 (95% confidence interval [CI]: 1.45–2.33), while the corresponding figure for OS was 1.94 (95% CI: 1.38–2.72).
At five years, DFS was 50.4% in the low-CXI Group, compared with 70.9% in the higher-CXI Group. Similarly, five-year OS was 70.4% and 87.0%, respectively, demonstrating a substantial difference in outcomes between the two groups.
Researchers also developed survival nomograms incorporating CXI, weight loss, tumour site, and tumour-node-metastasis (TNM) Stage to support individualised prognostic assessment.
Internal validation using bootstrap correction produced concordance indices (C-indices) of 0.738 for DFS and 0.799 for OS. In the external validation cohort, these values were 0.681 and 0.639, respectively.
Further assessment of predictive performance demonstrated external areas under the curve (AUC) for DFS of 0.706, 0.689, and 0.692 at two, three, and five years. For OS, the corresponding AUC values were 0.829, 0.707, and 0.638.
The association between low CXI and poorer survival persisted following adjustment for age and sex, as well as after excluding patients with second primary malignancies. These findings suggest that the prognostic relationship was not solely attributable to these factors.
The results support CXI as a potential prognostic marker in surgically treated gastrointestinal cancer. Its integration into survival nomograms alongside established clinical and tumour-related characteristics may offer an additional approach to identifying patients at greater risk of poorer outcomes.
Reference
Ding Z et al. Cachexia index as a prognostic marker in gastrointestinal cancer with nomogram development and external validation. Sci Rep. 2026;DOI:https://doi.org/10.1038/s41598-026-79411-3.
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