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DOI: 10.1055/s-0045-1802972
Eastern Cooperative Oncology Group Performance Status Scale as a Screening Tool for Sarcopenia in Onco-Hematology Patients
Funding The authors declare that they did not receive funding from agencies in the public, private, or non-profit sectors to conduct the present study.
Abstract
The present study aimed to assess the sensitivity of the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale for scores other than 0 as a screening tool for sarcopenia in onco-hematology patients. A retrospective cohort study of 104 onco-hematology patients aged > 19 years and treated at the Diagnostic and Imaging Center and at an outpatient clinic of a private tertiary hospital was conducted. Sarcopenia was defined as a skeletal muscle index (SMI) of ≤ 38.5 cm2/m2 for women and ≤ 52.4 cm2/m2 for men based on positron emission tomography-computed tomography scans. Functional status was assessed using an ECOG-PS score of 0 (indicating no dysfunction) or a score of ≥ 1 (indicating dysfunction). Accuracy analysis was conducted to determine the sensitivity and specificity of the ECOG-PS as a screening tool for sarcopenia. Sarcopenia was observed in 57.7% of patients. The median SMI was 43.3 (55.1) kg/m2. Sarcopenia diagnosis was positively associated with male sex (p = 0.027) and an ECOG-PS score of ≥ 1 (p = 0.048). As a screening tool for sarcopenia, the ECOG-PS had sensitivity and specificity of 40.7% (95% confidence interval [CI] 30.6–50.8) and 83.8% (95% CI 75.1–92.9), respectively. Sarcopenia is a challenge in cancer. The association of sarcopenia with an ECOG-PS score of ≥ 1 observed in this study reinforces the study hypothesis and importance of further studies on the subject.
Ethics Declaration
The current study was approved by the Research Ethics Committee (approval no.: 4.971.257) on September 13, 2021. Owing to the retrospective design study, the respective ethics committee waived the need for the Free and Informed Consent Form.
Clinical Trials
None.
Authors' Contribution
TG,: collection and assembly of data, conception and design, data analysis and interpretation, final approval of the manuscript, and writing of the manuscript; TTO, ACLS, and EYHN: conception and design, data analysis and interpretation, final approval of the manuscript, and writing of the manuscript; ALCCR: conception and design, data analysis and interpretation, and and final approval of the manuscript; DSR: collection and assembly of data, data analysis and interpretation, and final approval of the manuscript; TGR: conception and design, data analysis and interpretation, and final approval of the manuscript; LT, YN, and CAR: data analysis and interpretation, final approval of the manuscript, and provision of study materials or patient.
Ethics Committee Number
4.971.257.
Publikationsverlauf
Eingereicht: 03. September 2024
Angenommen: 25. November 2024
Artikel online veröffentlicht:
22. Mai 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil
Thamires Guarnieri, Tainá Teixeira Ortega, Ana Carolina Leão Silva, Ana Lúcia Chalhoub Chediac Rodrigues, Davi dos Santos Romão, Thais Giovaninni Roberto, Luciana Tucunduva, Yana Novis, Celso Arrais-Rodrigues, Erika Yuri Hirose Murahara. Eastern Cooperative Oncology Group Performance Status Scale as a Screening Tool for Sarcopenia in Onco-Hematology Patients. Brazilian Journal of Oncology 2025; 21: s00451802972.
DOI: 10.1055/s-0045-1802972
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References
- 1 Cruz-Jentoft AJ, Bahat G, Bauer J. et al; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48 (01) 16-31
- 2 Rinninella E, Cintoni M, Raoul P. et al. Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis. Clin Nutr 2020; 39 (07) 2045-2054
- 3 Pamoukdjian F, Bouillet T, Lévy V, Soussan M, Zelek L, Paillaud E. Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review. Clin Nutr 2018; 37 (04) 1101-1113
- 4 Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. Eur J Cancer 2016; 57: 58-67
- 5 Antoun S, Baracos VE, Birdsell L, Escudier B, Sawyer MB. Low body mass index and sarcopenia associated with dose-limiting toxicity of sorafenib in patients with renal cell carcinoma. Ann Oncol 2010; 21 (08) 1594-1598
- 6 Prado CM, Baracos VE, McCargar LJ. et al. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 2009; 15 (08) 2920-2926
- 7 Prado CM, Lieffers JR, McCargar LJ. et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 2008; 9 (07) 629-635 10.1016/S1470-2045(08)70153-0
- 8 Lanic H, Kraut-Tauzia J, Modzelewski R. et al. Sarcopenia is an independent prognostic factor in elderly patients with diffuse large B-cell lymphoma treated with immunochemotherapy. Leuk Lymphoma 2014; 55 (04) 817-823
- 9 Nakamura N, Hara T, Shibata Y. et al. Sarcopenia is an independent prognostic factor in male patients with diffuse large B-cell lymphoma. Ann Hematol 2015; 94 (12) 2043-2053
- 10 Jia S, Qiao R, Xiao Y. et al. Prognostic value of sarcopenia in survivors of hematological malignances undergoing a hematopoietic stem cell transplantation: a systematic review and meta-analysis. Support Care Cancer 2020; 28 (08) 3533-3542
- 11 Mika HL, Barrére APN, Castro MG. et al. BRASPEN guidelines on nutrition in cancer patients. BRASPEN J 2019; 34 (Suppl. 01) 2-32
- 12 Jabbour J, Manana B, Zahreddine A. et al. Sarcopenic obesity derived from PET/CT predicts mortality in lymphoma patients undergoing hematopoietic stem cell transplantation. Curr Res Transl Med 2019; 67 (03) 93-99
- 13 Brazil. Ordinance No. 9 of April 22, 2014. Publicly announces the decision to include
PET-CT for staging and assessing treatment response of Hodgkin and non-Hodgkin lymphoma
in the Brazilian Unified Health System - SUS. Brasília: Official Gazette [of the]
Federative Republic of Brazil, April 2014[c], Section 1, No. 76, p.79.
- 14 Barban JB, Simões BP, Moraes BDGC. et al. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults. Einstein (Sao Paulo) 2020; 18: AE4530
- 15 Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc 2013; 14 (08) 531-532
- 16 Kera T, Kawai H, Hirano H. et al. Limitations of SARC-F in the diagnosis of sarcopenia in community-dwelling older adults. Arch Gerontol Geriatr 2020; 87: 103959
- 17 Woo J, Leung J, Morley JE. Validating the SARC-F: a suitable community screening tool for sarcopenia?. J Am Med Dir Assoc 2014; 15 (09) 630-634
- 18 West HJ, Jin JO. JAMA Oncology Patient Page. Performance Status in Patients With Cancer. JAMA Oncol 2015; 1 (07) 998
- 19 Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 1996; 32A (07) 1135-1141
- 20 Oken MM, Creech RH, Tormey DC. et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5 (06) 649-655
- 21 Albain KS, Crowley JJ, LeBlanc M, Livingston RB. Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol 1991; 9 (09) 1618-1626
- 22 Schiller JH, Harrington D, Belani CP. et al; Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002; 346 (02) 92-98
- 23 Ludwig H, Van Belle S, Barrett-Lee P. et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 2004; 40 (15) 2293-2306
- 24 Carson JL, Stanworth SJ, Roubinian N. et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2016; 10 (10) CD002042
- 25 Birgegård G, Gascón P, Ludwig H. Evaluation of anaemia in patients with multiple myeloma and lymphoma: findings of the European CANCER ANAEMIA SURVEY. Eur J Haematol 2006; 77 (05) 378-386
- 26 Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med 2004; 116 (7, Suppl 7A) 11S-26S
- 27
Barban JB,
Simões BP,
Moraes BDGC.
et al.
(2020). Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation:
adults. Einstein (São Paulo), [S.L.], v. 18.
- 28 McMillen KK, Coghlin-Dickson T, Adintori PA. Optimization of nutrition support practices early after hematopoietic cell transplantation. Bone Marrow Transplant 2021; 56 (02) 314-326
- 29 World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii , 1–253
- 30 Barao K, Forones NM. Body mass index: different nutritional status according to WHO, OPAS and Lipschitz classifications in gastrointestinal cancer patients. Arq Gastroenterol 2012; 49 (02) 169-171
- 31 World Health Organization. Department of Nutrition for Health and Development. Haemoglobin concentrations for the diagnosis of anemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2011. (WHO/NMH/NHD/MNM/11.1). Available at: http://www.who.int/vmnis/indicators/haemoglobin.pdf . Accessed on 12.10.2021
- 32 Fearon K, Strasser F, Anker SD. et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011; 12 (05) 489-495
- 33 Surov A, Wienke A. Sarcopenia predicts overall survival in patients with malignant hematological diseases: A meta-analysis. Clin Nutr 2021; 40 (03) 1155-1160
- 34 Landi F, Liperoti R, Fusco D. et al. Sarcopenia and mortality among older nursing home residents. J Am Med Dir Assoc 2012; 13 (02) 121-126
- 35 Morishita S, Kaida K, Tanaka T. et al. Prevalence of sarcopenia and relevance of body composition, physiological function, fatigue, and health-related quality of life in patients before allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2012; 20 (12) 3161-3168
- 36 Shiroyama T, Nagatomo I, Koyama S. et al. Impact of sarcopenia in patients with advanced non-small cell lung cancer treated with PD-1 inhibitors: A preliminary retrospective study. Sci Rep 2019; 9 (01) 2447
- 37 Cortellini A, Bozzetti F, Palumbo P. et al. Weighing the role of skeletal muscle mass and muscle density in cancer patients receiving PD-1/PD-L1 checkpoint inhibitors: a multicenter real-life study. Sci Rep 2020; 10 (01) 1456
- 38 Morley JE, Abbatecola AM, Argiles JM. et al; Society on Sarcopenia, Cachexia and Wasting Disorders Trialist Workshop. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 2011; 12 (06) 403-409
- 39 Barbosa-Silva TG, Menezes AMB, Bielemann RM, Malmstrom TK, Gonzalez MC. Grupo de Estudos em Composição Corporal e Nutrição (COCONUT). Enhancing SARC-F: Improving Sarcopenia Screening in the Clinical Practice. J Am Med Dir Assoc 2016; 17 (12) 1136-1141