138 A Comparison of Established Diagnostic Criteria for Cachexia and Their Impact on Prognostication in Patients with Oesophagogastric Cancer

Abstract Background Cachexia is common in oesophagogastric cancer, yet heterogeneity in its definition has hindered clinical utilisation. This study compared the two established cachexia definitions (Fearon’s consensus definition and the Global Leadership Initiative on Malnutrition [GLIM] criteria) and their relationship with survival amongst patients with oesophagogastric cancer. Methods Consecutive patients newly diagnosed with oesophagogastric cancer (January 2019 to December 2020) were identified from a prospective regional database. Involuntary weight loss, BMI, CT body composition analyses and neutrophil-lymphocyte-ratio were recorded at diagnosis. These data were used to assess patients for cachexia according to Fearon and GLIM diagnostic criteria. The primary outcome was overall survival. Results Overall, 465 patients (66.9% male, median 71 years) were diagnosed with oesophagogastric cancer. Cachectic proportions differed between definitions (Fearon: 59.1% vs. GLIM: 44.1%). Patients who met either definition had shorter survival than those who met neither (p<0.001). Following adjustment for confounders, GLIM-defined cachexia was most strongly associated with reduced survival (aHR: 1.57 [95% CI:1.25-1.96], p<0.001). Patients with only Fearon-defined cachexia had prolonged survival (median: 363 days) when compared with those who met only GLIM (median: 158 days) or both criteria (median: 120 days). Low muscle mass was the GLIM phenotypical criterion with greatest prognostic effect. Conclusion Cancer cachexia is strongly associated with shortened survival in patients with oesophagogastric cancer. Classification using the GLIM criteria provides more effective prognostication and should be utilised in multidisciplinary patient care and future trials.