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The role of inflammation in adjuvant chemotherapy-induced sarcopenia (Izmir Oncology Group (IZOG) study)

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Abstract

Introduction

Although the chemotherapy-induced sarcopenia has some explanatory presence in clinical practice, the mechanisms underlying this phenomenon have not been clearly distinguished in patients with cancer. Therefore, we aimed with this study to investigate the role of inflammation by examining the inflammatory markers in the physiopathology of adjuvant chemotherapy-induced sarcopenia in patients with gastrointestinal tract cancer.

Material and method

To detect the presence of sarcopenia, patients’ body composition measurements were assessed using the BIA, and their muscular strength was assessed with a handgrip dynamometer in both pre- and post-adjuvant chemotherapy. At the same time, we examined the baseline and post-adjuvant chemotherapy anthropometric measurements and inflammatory markers in serum (Hs-CRP, IL8, and TNF-α). Patients were divided in three groups. Group 1 consisted of patients who presented post-treatment sarcopenia although they did not have it prior to the treatment, group 2 included the patients who had no pre- or post-treatment sarcopenia, and group 3 was comprised of patients who presented pre-treatment sarcopenia. Each group included 30 patients.

Results

A total of 90 patients were included in the study. Fifty-one of them were female patients. Median age was 60.5 (range 27–83). The patients consisted of cases with colorectal and gastric cancers. In group 1, Wilcoxon signed-rank test revealed a significant difference between scores of IL-8 (pg/mL), TNF-α (pg/mL) and Hs-CRP (mg/dL) given for the post-chemotherapy compared with the pre-chemotherapy ((Z 3.61, p < 0.001), (Z 3.254, p = 0.001), (Z 3.319, p = 0.001)). The post-chemotherapy median scores of IL-8 (pg/mL), TNF-α (pg/mL), and Hs-CRP were 76.31, 7.34, and 1.55, respectively, which remained on the levels of 12.25, 1.6, and 0.51 for the pre-chemotherapy. For group 2, a Wilcoxon signed-rank test indicated no significant difference between scores of the same markers given for the post-chemotherapy compared with the pre-chemotherapy. In all patients (including groups 1, 2, and 3), a comparison of the patients with pre-treatment sarcopenia (n = 30) and non-sarcopenic patients (n = 60) in terms of baseline IL-8, TNF-α, and Hs-CRP mean levels, IL-8 and Hs-CRP were found to be statistically different (146.02 (SD 311.96) vs. 47.24 (SD 66.3) (p = 0.009), 3.91 (SD 4.26) vs. 0.75 (SD 1.08) (p < 0.001), respectively).

Conclusions

The present prospective observational study suggested an association of chemotherapy-induced sarcopenia with inflammatory markers Hs-CRP, IL8, and TNF-α. Inflammation may play a role in chemotherapy-induced sarcopenia in newly diagnosed non-metastatic patients.

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Acknowledgments

The authors gratefully acknowledge the support from friends Yasemin Payam, Betul Akdogan, Oksan Kacmaz, and Songul Uluc Ozaltaş.

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Authors and Affiliations

  1. Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey

    Utku Oflazoglu, Ahmet Alacacioglu, Yuksel Kucukzeybek, Tarik Salman, Yasar Yildiz, Halil Taskaynatan, Seray Saray & Osman Butun

  2. Department of Medical Oncology, Izmir Demokrasi University, Izmir, Turkey

    Umut Varol

  3. Department of Biochemistry, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey

    Hulya Tas Onal & Huriye Erbak Yilmaz

  4. Department of Medical Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey

    M. Oktay Tarhan

Authors
  1. Utku Oflazoglu
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  2. Ahmet Alacacioglu
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  3. Umut Varol
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  4. Yuksel Kucukzeybek
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  5. Tarik Salman
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  6. Hulya Tas Onal
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  7. Huriye Erbak Yilmaz
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  8. Yasar Yildiz
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  9. Halil Taskaynatan
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  10. Seray Saray
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  11. Osman Butun
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  12. M. Oktay Tarhan
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Contributions

Study concept: A. Alacacioglu, U. Oflazoglu. Study design: U. Oflazoglu, A. Alacacioglu. Data acquisition: U. Oflazoglu, S. Saray, Y. Yildiz, H. Taskaynatan. Quality control of data: U. Oflazoglu, A. Alacacioglu, Y Kucukzeybek. Data analysis and interpretation: U. Oflazoglu, A. Alacacioglu, Y. Kucukzeybek. Biochemical analysis of blood: H.T. Onal, H.E. Yilmaz. Statistical analysis: U. Oflazoglu, A. Alacacioglu, Y. Kucukzeybek, O. Butun. Manuscript preparation: U. Oflazoglu, U. Varol. Manuscript editing: U. Varol, A. Alacacioglu. Manuscript review: U. Varol, A. Alacacioglu, Y. Kucukzeybek, T. Salman, M. O. Tarhan.

Corresponding author

Correspondence to Utku Oflazoglu.

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The study was approved by the Institutional Review Board at Izmir Katip Celebi University.

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The authors declare that they have no conflict of interest.

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Oflazoglu, U., Alacacioglu, A., Varol, U. et al. The role of inflammation in adjuvant chemotherapy-induced sarcopenia (Izmir Oncology Group (IZOG) study). Support Care Cancer 28, 3965–3977 (2020). https://doi.org/10.1007/s00520-020-05477-y

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