Loss of adipose tissue and plasma phospholipids: Relationship to survival in advanced cancer patients

Background & aims: Extensive loss of adipose tissue is a key feature of cancer cachexia. Advanced cancer patients also exhibit low plasma phospholipids. It is not known whether these processes coincide across the cancer trajectory nor has their relationship with survival been defined. Changes in adipose tissue mass and plasma phospholipids were characterized within 500. days prior to death and prognostic significance assessed. Methods: Adipose tissue rate of change was determined in a retrospective cohort of patients who died of colorectal and lung cancers (n=108) and who underwent >2 computed tomography scans in the last 500. days of life. Plasma phospholipid fatty acids were measured prospectively in a similar cohort of patients with metastatic cancer (n=72). Results: Accelerated loss of adipose tissue begins at 7. months from death reaching an average loss of 29% of total AT 2. months from death. Plasma phospholipid fatty acids were 35% lower in patients closest to death versus those surviving >8. months. Losses of phospholipid fatty acids and adipose tissue occur in tandem and are predictive of survival. Conclusions: Depletion of plasma phospholipids likely indicates a deficit of essential fatty acids in the periphery which may contribute to loss of adipose tissue.