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Randomized Controlled Trial
. 2012;7(8):e41883.
doi: 10.1371/journal.pone.0041883. Epub 2012 Aug 3.

The relationships between body composition and the systemic inflammatory response in patients with primary operable colorectal cancer

Colin H Richards  1 , Campbell S D Roxburgh, Mark T MacMillan, Sanad Isswiasi, Ewen G Robertson, Graeme K Guthrie, Paul G Horgan, Donald C McMillan
Affiliations
Randomized Controlled Trial

The relationships between body composition and the systemic inflammatory response in patients with primary operable colorectal cancer

Colin H Richards et al. PLoS One. 2012.

Abstract

Background: Weight loss is recognised as a marker of poor prognosis in patients with cancer but the aetiology of cancer cachexia remains unclear. The aim of the present study was to examine the relationships between CT measured parameters of body composition and the systemic inflammatory response in patients with primary operable colorectal cancer.

Patient and methods: 174 patients with primary operable colorectal cancer who underwent resection with curative intent (2003-2010). Image analysis of CT scans was used to measure total fat index (cm(2)/m(2)), subcutaneous fat index (cm(2)/m(2)), visceral fat index (cm(2)/m(2)) and skeletal muscle index (cm(2)/m(2)). Systemic inflammatory response was measured by serum white cell count (WCC), neutrophil:lymphocyte ratio (NLR) and the Glasgow Prognostic Score (mGPS).

Results: There were no relationships between any parameter of body composition and serum WCC or NLR. There was a significant relationship between low skeletal muscle index and an elevated systemic inflammatory response, as measured by the mGPS (p = 0.001). This was confirmed by linear relationships between skeletal muscle index and both C-reactive protein (r = -0.21, p = 0.005) and albumin (r = 0.31, p<0.001). There was no association between skeletal muscle index and tumour stage.

Conclusions: The present study highlights a direct relationship between low levels of skeletal muscle and the presence of a systemic inflammatory response in patients with primary operable colorectal cancer.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. An example of CT image analysis using NIH ImageJ software.
(a) the original CT image in JPEG format, (b) the scale is set using a known distance (10 cm) from the original CT image, (c) skeletal muscle thresholds (−29 to+150 HU) are applied, (d) the abdominal contents and L3 vertebrae are cropped and the skeletal muscle cross sectional area calculated in cm2.
Figure 2
Figure 2. Flow chart representing the study selection process.
* All patients undergoing potentially curative resection of colorectal cancer Janueary 1st 2003 and December 31st 2010. † No CT scan stored in an electronic format suitable for image analysis.
Figure 3
Figure 3. Scatterplots of the associations between C-reactive protein, albumin and skeletal muscle index.
Fit lines are shown for male (____) and female (––-) patients. r = Pearsons correlation coefficient for all patients.
Figure 4
Figure 4. The relationship between B.M.I. classification and skeletal muscle index in male (top panel) and female (bottom panel) patients with primary operable colorectal cancer.
Dashed lines represent cutoff values of the sex-specific tertiles.
See this image and copyright information in PMC

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