Sarcopenia and Inflammation Associated With Increased Risk of Death in Patients with Colorectal Cancer

Prediagnosis inflammation was associated with at-diagnosis sarcopenia (low skeletal muscle mass), and the combination of the 2 nearly doubled the risk of death in patients with nonmetastatic colorectal cancer (CRC), according to a study published in JAMA Oncology.

Sarcopenia and an elevated neutrophil-to-lymphocyte ratio (NLR, a measure of systematic inflammation), have been increasingly recognized as 2 novel prognostic indicators across cancer types, according to the authors. Sarcopenia can be used to predict adverse outcomes such as poor surgical outcomes, treatment toxicity effects, and reduced survival. Similarly, NLR values are utilized to predict treatment response.

“Whereas both sarcopenia and inflammation can be evaluated with existing clinical data and may be modifiable, the relationship between these 2 factors and their independent associations with survival are not well studied,” wrote the authors.

The authors studied 2470 patients from the Colorectal Cancer: Sarcopenia, Cancer, and Near-term Survival (C SCANS) cohort, which included Kaiser Permanente Northern California (KPNC) health plan members who were diagnosed with stage I to III CRC between 2006 and 2001. All participants underwent surgical resection and had abdominal computed tomography (CT) scans at diagnosis.

Using the scans, the authors measured skeletal muscle index. Sarcopenia was defined as less than 52 cm²/m² for normal or overweight men and less than 38 cm²/m² for normal or overweight women, and less than 54 cm²/m² and less than 47 cm²/m² for obese men and women, respectively.

Systematic inflammation was measured by NLR from routine blood tests, and the authors averaged all available NLR measures from the 24 months prior to diagnosis. The mean number of NRL measures was 3, and was characterized using standard cut-offs to define normal inflammation as less than 3, moderate inflammation as 3 to less than 5, and high inflammation as 5 or higher.

The results showed that patients with a higher NLR in the 24 months prior to their diagnoses had less favorable values for all other markers of systemic inflammation: higher platelet-to-lymphocyte ratio, lower lymphocyte-to-monocyte ratio, and lower serum albumin level.

The prevalence of an NLR of 3 or greater and sarcopenia were 46% (n = 1133) and 44% (n = 1078), respectively. Over a median of 6 years of follow-up, there were 656 deaths, 357 of which were from CRC. Increasing NLR was associated with sarcopenia in a dose-response manner: compared with patients with NLR of less than 3, the odds ratios (ORs) for sarcopenia were 1.35 (95% CI, 1.10-1.67) for NLR of 3 to less than 5 and 1.47 (95% CI, 1.16-1.85) for NLR of 5 or greater (P for trend across categories, <.001).

Results also showed that an NLR of 3 or greater and sarcopenia independently predicted overall and CRC-related death. Patients with both sarcopenia and an NLR of 3 or greater had a double the risk of death overall (HR, 2.12; 95% CI, 1.70-2.65) and CRC related death (HR, 2.43; 95% CI, 1.79-3.29).

“Both sarcopenia and high NLR were independent prognostic indicators in nonmetastatic CRC,” concluded the authors. “If our findings are confirmed by additional studies, these 2 biomarkers are already collected in routine care and thus have high potential for use in clinical prognostication.”

References

Cespedes Feliciano E, Kroenke C, Meyerhardt J, et al. Associated of systematic inflammation and sarcopenia with surival in nonmetastatic colorectal cancer. JAMA Oncology. Published online December 14, 2017. doi:10.1001/jamaoncol.2017.2319.