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

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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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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  CAS  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan

    Teppei Kamada, Keigo Nakashima, Junji Takahashi, Yuichi Nakaseko, Norihiko Suzuki, Hironori Ohdaira & Yutaka Suzuki

  2. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Teppei Kamada, Koichiro Haruki, Keigo Nakashima, Junji Takahashi, Yuichi Nakaseko, Ken Eto & Toru Ikegami

Authors
  1. Teppei Kamada
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  2. Koichiro Haruki
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Corresponding author

Correspondence to Koichiro Haruki.

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Conflict of interest

The authors declare that they have no conflicts of interest. The authors have full control of all primary data and agree to allow the journal to review our data if requested.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the International University of Health and Welfare Hospital (approval no: 22-B-7).

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Written informed consent was obtained from each patient.

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Kamada, T., Haruki, K., Nakashima, K. et al. Prognostic significance of the cachexia index in patients with stage I–III colorectal cancer who underwent laparoscopic surgery. Surg Today 53, 1064–1072 (2023). https://doi.org/10.1007/s00595-023-02646-4

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  • DOI: https://doi.org/10.1007/s00595-023-02646-4

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