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01-02-2023 | Underweight | Original Article

Prognostic significance of the cachexia index in patients with stage I–III colorectal cancer who underwent laparoscopic surgery

Authors: Teppei Kamada, Koichiro Haruki, Keigo Nakashima, Junji Takahashi, Yuichi Nakaseko, Norihiko Suzuki, Hironori Ohdaira, Ken Eto, Toru Ikegami, Yutaka Suzuki

Published in: Surgery Today | Issue 9/2023

Abstract

Purpose

The prognostic significance of the cachexia index, a novel biomarker of cancer cachexia, remains unclear in colorectal cancer; we, therefore, evaluated this relationship.

Methods

This retrospective cohort study included 306 patients with stage I–III colorectal cancer who underwent R0 resection between April 2010 and March 2020. The cachexia index was calculated as (skeletal muscle index [cm²/m²] × serum albumin level [g/dL])/neutrophil-to-lymphocyte ratio. The overall and disease-free survival rates were analyzed using a Cox proportional hazards model.

Results

A low cachexia index was found in 94 patients. This group had significantly lower disease-free survival and overall survival than the high-cachexia index group (5-year survival, 86.3% vs. 63.1%, p < 0.01; 87.9% vs. 67.2%, p < 0.01). Multivariate analyses showed that T3 or T4 (hazard ratio [HR]: 2.56; 95% confidence interval CI 1.04–6.25, p = 0.039), stage III (HR: 3.77; 95% CI 1.79–7.93, p < 0.01), and a low cachexia index (HR: 2.27; 95% CI 1.31–3.90, p = 0.003) were significant independent predictors of the disease-free survival. CA19-9 ≥ 37.0 ng/mL (HR: 2.68; 95% CI: 1.37–5.24, p = 0.004), stage III (HR: 2.57; 95% CI 1.34–4.92, p = 0.004), and a low cachexia index (HR: 2.35; 95% CI 1.31–4.21, p = 0.004) were significant independent predictors of the overall survival.

Conclusion

A low cachexia index might be a long-term prognostic factor of colorectal cancer.

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Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. https://doi.org/10.3322/caac.21492.CrossRefPubMed

Kasprzak A. The role of tumor microenvironment cells in colorectal cancer (CRC) cachexia. Int J Mol Sci. 2021;22:1565. https://doi.org/10.3390/ijms22041565.CrossRefPubMedPubMedCentral

Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95. https://doi.org/10.1016/S1470-2045(10)70218-7.CrossRefPubMed

Argilés JM, Busquets S, Stemmler B, López-Soriano FJ. Cancer cachexia: understanding the molecular basis. Nat Rev Cancer. 2014;14:754–62. https://doi.org/10.1038/nrc3829.CrossRefPubMed

Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33:90–9. https://doi.org/10.1200/JCO.2014.56.1894.CrossRefPubMed

Jafri SH, Previgliano C, Khandelwal K, Shi R. Cachexia index in advanced non-small-cell lung cancer patients. Clin Med Insights Oncol. 2015;9:87–93. https://doi.org/10.4137/CMO.S30891.CrossRefPubMedPubMedCentral

Go SI, Park MJ, Lee GW. Clinical significance of the cachexia index in patients with small cell lung cancer. BMC Cancer. 2021;21:563. https://doi.org/10.1186/s12885-021-08300-x.CrossRefPubMedPubMedCentral

Go SI, Park MJ, Park S, Kang MH, Kim HG, Kang JH, et al. Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B-cell lymphoma. J Cachexia Sarcopenia Muscle. 2021;12:2211–9. https://doi.org/10.1002/jcsm.12837.CrossRefPubMedPubMedCentral

Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1–42. https://doi.org/10.1007/s10147-019-01485-z.CrossRefPubMed

10.

Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal, appendiceal, and anal carcinoma: the 3rd. English ed. J Anus Rectum Colon 2019 3 175–95

11.

Cremolini C, Antoniotti C, Lonardi S, Bergamo F, Cortesi E, Tomasello G, et al. Primary tumor sidedness and benefit from FOLFOXIRI plus bevacizumab as initial therapy for metastatic colorectal cancer Retrospective analysis of the TRIBE trial by GONO. Ann Oncol. 2018. https://doi.org/10.1093/annonc/mdy140.CrossRefPubMed

12.

Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003;89:1028–30. https://doi.org/10.1038/sj.bjc.6601242.CrossRefPubMedPubMedCentral

13.

Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Hammad A, Tamai Y, et al. Proposal for new diagnostic criteria for low skeletal muscle mass based on computed tomography imaging in Asian adults. Nutrition. 2016;32:1200–5. https://doi.org/10.1016/j.nut.2016.04.003.CrossRefPubMed

14.

Durand F, Buyse S, Francoz C, Laouénan C, Bruno O, Belghiti J, et al. Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography. J Hepatol. 2014;60:1151–7.CrossRefPubMed

15.

Masuda T, Shirabe K, Ikegami T, Harimoto N, Yoshizumi T, Soejima Y, et al. Sarcopenia is a prognostic factor in living donor liver transplantation. Liver Transpl. 2014;20:401–7.CrossRefPubMed

16.

Malietzis G, Giacometti M, Kennedy RH, Athanasiou T, Aziz O, Jenkins JT. The emerging role of neutrophil to lymphocyte ratio in determining colorectal cancer treatment outcomes: a systematic review and meta-analysis. Ann Surg Oncol. 2014;21:3938–46. https://doi.org/10.1245/s10434-014-3815-2.CrossRefPubMed

17.

Meyerhardt JA, Kroenke CH, Prado CM, Kwan ML, Castillo A, Weltzien E, et al. Association of weight change after colorectal cancer diagnosis and outcomes in the Kaiser permanente Northern California population. Cancer Epidemiol Biomarkers Prev. 2017;26:30–7. https://doi.org/10.1158/1055-9965.EPI-16-0145.CrossRefPubMed

18.

Catalano V, Turdo A, Di Franco S, Dieli F, Todaro M, Stassi G. Tumor and its microenvironment: a synergistic interplay. Semin Cancer Biol. 2013;23:522–32. https://doi.org/10.1016/j.semcancer.2013.08.007.CrossRefPubMed

19.

Roma-Rodrigues C, Mendes R, Baptista PV, Fernandes AR. Targeting tumor microenvironment for cancer therapy. Int J Mol Sci. 2019;20:840. https://doi.org/10.3390/ijms20040840.CrossRefPubMedPubMedCentral

20.

Hanash SM, Pitteri SJ, Faca VM. Mining the plasma proteome for cancer biomarkers. Nature. 2008;452:571–9. https://doi.org/10.1038/nature06916.CrossRefPubMed

21.

Pinto I, Carnier N, Oyama J, Otoch JP, Alcântara PS, Tokeshi F, et al. Cancer as a pro-inflammatory environment: metastasis and cachexia. Mediat Inflam. 2015. https://doi.org/10.1155/2015/791060.CrossRef

22.

Onesti JK, Guttridge DC. Inflammation based regulation of cancer cachexia. BioMed Res Int. 2014. https://doi.org/10.1155/2014/168407.CrossRefPubMedPubMedCentral

23.

Cabal-Manzano R, Bhargava P, Torres-Duarte A, Marshall J, Bhargava P, Wainer IW. Proteolysis-inducing factor is expressed in tumours of patients with gastrointestinal cancers and correlates with weight loss. Br J Cancer. 2001;84:1599–601. https://doi.org/10.1054/bjoc.2001.1830.CrossRefPubMedPubMedCentral

24.

Schäfer M, Oeing CU, Rohm M, Baysal-Temel E, Lehmann LH, Bauer R, et al. Ataxin-10 is part of a cachexokine cocktail triggering cardiac metabolic dysfunction in cancer cachexia. Mol Metab. 2016;5:67–78. https://doi.org/10.1016/j.molmet.2015.11.004.CrossRefPubMed

25.

Toyoshima Y, Kitamura H, Xiang H, Ohno Y, Homma S, Kawamura H, et al. IL6 modulates the immune status of the tumor microenvironment to facilitate metastatic colonization of colorectal cancer cells. Cancer Immunol Res. 2019;7:1944–57. https://doi.org/10.1158/2326-6066.CIR-18-0766.CrossRefPubMed

26.

Wang S, Xie H, Gong Y, Kuang J, Yan L, Ruan G, et al. The value of L3 skeletal muscle index in evaluating preoperative nutritional risk and long-term prognosis in colorectal cancer patients. Sci Rep. 2020;10:8153. https://doi.org/10.1038/s41598-020-65091-0.CrossRefPubMedPubMedCentral

27.

Abbass T, Tsz Ho YT, Horgan PG, Dolan RD, McMillan DC. The relationship between computed tomography derived skeletal muscle index, psoas muscle index and clinical outcomes in patients with operable colorectal cancer. Clin Nutr ESPEN. 2020;39:104–13. https://doi.org/10.1016/j.clnesp.2020.07.010.CrossRefPubMed

28.

Temel JS, Abernethy AP, Currow DC, Friend J, Duus EM, Yan Y, et al. Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials. Lancet Oncol. 2016;17:519–31. https://doi.org/10.1016/S1470-2045(15)00558-6.CrossRefPubMed

29.

Crawford J. Clinical results in cachexia therapeutics. Curr Opin Clin Nutr Metab Care. 2016;19:199–204. https://doi.org/10.1097/MCO.0000000000000274.CrossRefPubMed

30.

Takiguchi S, Murakami K, Yanagimoto Y, Takata A, Miyazaki Y, Mori M, et al. Clinical application of ghrelin in the field of surgery. Surg Today. 2015;45:801–7. https://doi.org/10.1007/s00595-014-1040-z.CrossRefPubMed

31.

Naito T, Mitsunaga S, Miura S, Tatematsu N, Inano T, Mouri T, et al. Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer. J Cachexia Sarcopenia Muscle. 2019;10:73–83. https://doi.org/10.1002/jcsm.12351.CrossRefPubMed

32.

Hammad A, Kaido T, Uemoto S. Perioperative nutritional therapy in liver transplantation. Surg Today. 2015;45:271–83. https://doi.org/10.1007/s00595-014-0842-3.CrossRefPubMed

Title: Prognostic significance of the cachexia index in patients with stage I–III colorectal cancer who underwent laparoscopic surgery
Authors: Teppei Kamada
Koichiro Haruki
Keigo Nakashima
Junji Takahashi
Yuichi Nakaseko
Norihiko Suzuki
Hironori Ohdaira
Ken Eto
Toru Ikegami
Yutaka Suzuki
Publication date: 01-02-2023
Publisher: Springer Nature Singapore
Keywords: Underweight
Underweight
Colorectal Cancer
Colorectal Cancer
Published in: Surgery Today / Issue 9/2023
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-023-02646-4

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Prognostic significance of the cachexia index in patients with stage I–III colorectal cancer who underwent laparoscopic surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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