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The patient-generated subjective global assessment is a promising screening tool for cancer cachexia
  1. Minghua Cong1,
  2. Chenxin Song1,
  3. Hongxia Xu2,
  4. Chunhua Song3,
  5. Chang Wang4,
  6. Zhenming Fu5,
  7. Yi Ba6,
  8. Jing Wu7,
  9. Conghua Xie8,
  10. Gongyan Chen9,
  11. Zihua Chen10,
  12. Lan Zhou11,
  13. Tao Li12,
  14. Li Deng3,
  15. Lin Xin2,
  16. Liuqing Yang13,
  17. Jiuwei Cui4 and
  18. Hanping Shi13
  19. The Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group
  1. 1Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2Department of Nutrition, Third Military Medical University Daping Hospital and Research Institute of Surgery, Chongqing, China
  3. 3Department of Epidemiology, Zhengzhou University, Zhengzhou, China
  4. 4Cancer Center, The First Hospital Of Jilin University, Changchun, China
  5. 5Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
  6. 6Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
  7. 7Department of Clinical Nutrition, The First People's Hospital of Kashi, Xinjiang, China
  8. 8Department of Radiation and Medical Oncology, Wuhan University Zhongnan Hospital, Wuhan, China
  9. 9Department of Oncology, Tumor Hospital of Harbin Medical University, Harbin, China
  10. 10Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
  11. 11Department of Nutrition, Third Affiliated Hospital of Kunming Medical College, Tumor Hospital of Yunan Province, Kunming, China
  12. 12Department of Radiotherapy, Sichuan Cancer Hospital and Institute/Sichuan Cancer Center, School of Medicine/University of Electronic Science and Technology of China, Chengdu, China
  13. 13Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
  1. Correspondence to Professor Hanping Shi, Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, China; shihp{at}


Background Cancer cachexia is a complex metabolic syndrome characterised by a loss of muscle with or without loss of fat mass, and is associated with high morbidity and mortality. Despite its clinical importance, there is a lack of simple tools to screen patients for cancer cachexia. The aim of this study was to evaluate and validate the patient-generated subjective global assessment (PG-SGA) as a screening tool for cancer cachexia.

Methods This is a secondary analysis of a multicentre, cross-sectional, observational study. Cancer cachexia was diagnosed when there was weight loss ≥5% during the past 12 months and at least three of the five following conditions were present: decreased muscle strength, fatigue, anorexia, low Fat-Free Mass Index (FFMI) and abnormal laboratory findings. A quadratic discriminant analysis was conducted for the ability of PG-SGA to predict cachexia.

Results A total of 4231 patients with cancer were included in this analysis, and 351 patients (8.3%) were diagnosed as having cachexia. The highest incidence of cachexia was found among patients with pancreatic cancer (32.5%), oesophageal cancer (21.5%) and gastric cancer (17.9%). Compared with patients without cachexia, patients with cachexia had a lower body mass index, FFMI, hand grip strength, total protein, prealbumin, albumin, haemoglobin and Karnofsky performance status (p<0.05), while they had a higher C reactive protein level and PG-SGA Score (4.71±3.71 vs 10.87±4.84, p<0.05). The best cut-off value for PG-SGA was 6.5, with 79.8% of sensitivity and 72.3% specificity for cachexia, and the area under the receiver operating characteristic curve was 0.846 (95% CI 0.826 to 0.866, p<0.001).

Conclusions PG-SGA is a highly specific tool that can be used to screen patients for cancer cachexia.

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  • MC, CS and HX contributed equally.

  • Collaborators Ming-Hua Cong1, Chen-Xin Song1, Hong-Xia Xu2, Chun-Hua Song3, Chang Wang4, Zhen-Ming Fu5, Yi Ba6, Jing Wu7, Cong-Hua Xie8, Gong-Yan Chen9, Zi-Hua Chen10, Lan Zhou11, Tao Li12, Li Deng3, Xin Lin2, Liu-Qing Yang13, Jiu-Wei Cui4, Han-Ping Shi13; The Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group

  • Contributors All authors made contributions to data acquisition and interpretation. HS designed the INSCOC Study. HS and JC were involved in the development of study concept. MC, CXS, HX and CHS were major contributors in the data analysis, and MC drafted the manuscript. CS and HX revised the manuscript critically for important intellectual content. Authors MC, CXS, HX, CHS, CW, ZF, YB, JW, CX, GC, ZC, LZ, TL, LD, LX, LY, JC and HS read and approved the final manuscript.

  • Funding The present study was supported by grants from the National Key Research and Development Programme of China (No: 2017YFC1309200).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The protocol and procedures were approved by the Ethical Committee of the First Affiliated Hospital of SunYat-sen University on 7 May 2013 ((2013) 82).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The processed data required to reproduce these findings cannot be shared at this time as the data also form part of an ongoing study.