A Promising Prognostic Grading System Incorporating Weight Loss and Inflammation in Patients with Advanced Cancer.

Background: Involuntary weight loss and increased systemic response are frequently observed in patients with cancer, especially in advanced stages. This study aimed to develop a powerful weight loss and inflammation grading system (WLAIGS) and investigate its prognostic performance in patients with advanced cancer.Methods: This multicentre prospective cohort study included 11 423 patients with advanced cancer. A 4 x 4 matrix representing four different per cent weight loss (WL%) categories within each of the four different neutrophil-to-lymphocyte ratio (NLR) categories (16 possible combinations of WL% and NLR) was constructed. The WLAIGS consisted of four grades, with hazard ratios (HRs) for overall survival (OS) gradually increasing from grade 1 to grade 4. Survival analyses, including Kaplan-Meier curve, Cox proportional hazards regression, and sensitivity analysis, were performed to investigate the association between WLAIGS and OS. The secondary outcomes were short-term survival, malnutrition, and quality of life. Two internal validation cohorts with a 7:3 ratio were used to validate the results.Results: The median age of patients with advanced cancer in our study was 59.00 (interquartile range, 50.00-66.00) years. There were 6877 (60.2%) and 4546 (39.8%) male and female participants, respectively. We totally recorded 5046 death cases during the median follow-up of 17.33 months. The Kaplan-Meier curve showed that the survival rate decreased from grade 1 to grade 4 in patients with advanced cancer (log-rank P < 0.001). The WLAIGS was an independent risk factor associated with OS adjusting for confounders, with HRs increasing from 1.20 (95% confidence interval (CI), 1.11-1.29; P < 0.001) in grade 2, 1.48 (95% CI, 1.38-1.60; P < 0.001) in grade 3 to 1.73 (95% CI, 1.58-1.89; P < 0.001) in grade 4. In each weight loss% group (2.5 <= WL% < 6.0; 6.0 <= WL% < 11.0, WL% >= 11.0), a NLR above 3 was associated with shorter survival and served as an independent prognostic predictor. The risk of short-term mortality, malnutrition, and poor quality of life increased with WLAIGS grade. Two internal validation cohorts confirmed that the WLAIGS independently identified the survival of patients with advanced cancer.Conclusions: The WLAIGS, which reflects malnutrition and systemic inflammation status, is a robust and convenient tool for predicting the prognosis of patients with advanced cancer.