Simple SummaryCancer cachexia is associated with a loss of skeletal muscle. The analysis of CT images has facilitated the measurement of such changes. Whether these measurements have prognostic value for survival in patients with advanced cancer when adjusted for inflammation has recently been questioned. Therefore, the aim of the present study was to examine if CT-derived skeletal muscle measures were related to survival, independent of how inflamed the patient is. Our results suggest that CT-derived muscle measurements do not have independent prognostic value for survival in patients with advanced cancer when the inflammatory status of the patients is considered.AbstractThe present study examined the relationships between CT-derived muscle measurements, systemic inflammation, and survival in advanced cancer patients with good performance status (ECOG-PS 0/1). Data was collected prospectively from patients with advanced cancer undergoing anti-cancer therapy with palliative intent. The CT Sarcopenia score (CT-SS) was calculated by combining the CT-derived skeletal muscle index (SMI) and density (SMD). The systemic inflammatory status was determined using the modified Glasgow Prognostic Score (mGPS). The primary outcome of interest was overall survival (OS). Univariate and multivariate Cox regressions were used for survival analysis. Three hundred and seven patients met the inclusion criteria, out of which 62% (n = 109) were male and 47% (n = 144) were ≥65 years of age, while 38% (n = 118) were CT-SS ≥ 1 and 47% (n = 112) of patients with pre-study blood were inflamed (mGPS ≥ 1). The median survival from entry to the study was 11.1 months (1–68.1). On univariate analysis, cancer type (p< 0.05) and mGPS (p< 0.001) were significantly associated with OS. On multivariate analysis, only mGPS (p< 0.001) remained significantly associated with OS. In patients who were ECOG-PS 0, mGPS was significantly associated with CT-SS (p< 0.05). mGPS may dominate the prognostic value of CT-derived sarcopenia in good-performance-status patients with advanced cancer.