Anthropometric indicators have been shown to be associated with the prognosis of patients with cancer. However, any single anthropometric index has limitation in predicting the prognosis.This study aimed to observe the predictive role of seven anthropometric indicators based on body size on the prognosis of patients with cancer.A principal component analysis (PCA) on seven anthropometric measurements: height, weight, body mass index (BMI), hand grip strength (HGS), triceps skinfold thickness (TSF), mid-upper arm circumference (MAC), and calf circumference (CAC) was conducted. Principal components (PCs) were derived from this analysis. Cox regression analysis was used to investigate the association between the prognosis of patients with cancer and the PCs. Subgroups and sensitivity analyses were also conducted.Through PCA, four distinct PCs were identified, collectively explaining 88.3% of the variance. PC1, primarily characterized by general obesity, exhibited a significant inverse association with the risk of cancer death (adjusted HR=0.86, 95% CI (0.83, 0.88)). PC2 (short stature with high TSF) was not significantly associated with cancer prognosis. PC3 (high BMI coupled with low HGS) demonstrated a significant increase with the risk of cancer-related death (adjusted HR=1.08, 95% CI (1.05, 1.11)). PC4 (tall stature with high TSF) exhibited a significant association with increased cancer risk (adjusted HR=1.05, 95% CI (1.02, 1.07)). These associations varied across different cancer stages. The stability of the results was confirmed through sensitivity analyses.Different body sizes are associated with distinct prognostic outcomes in patients with cancer. The impact of BMI on prognosis is influenced by both HGS and subcutaneous fat. This finding may influence the clinical care of cancer and improve the survival of cancer patients.Copyright © 2024. Published by Elsevier Inc.