The relationship between tumour stage, systemic inflammation, body composition and survival in patients with colorectal cancer

Abstract

Background: Disease progression in cancer is often associated with loss of weight and lean tissue and the development of a systemic inflammatory response (SIR) and these have prognostic value. The present study investigated the relationship between these factors in patients with operable colorectal cancer.

Methods: The study included 322 patients with primary operable colorectal cancer. In addition to BMI, pre-operative CT scans were used to define the presence of visceral obesity, sarcopenia and myosteatosis. Tumour and patient characteristics were recorded. Survival was analysed using univariate and multivariate Cox regression.

Results: There was no significant association between TNM stage and any measure of body composition. The modified Glasgow Prognostic Score (mGPS), was associated with greater BMI (p = 0.021), sarcopenia (p < 0.001), and myosteatosis (p = 0.004). On univariate analysis, there was a significant association between age (p = 0.002), ASA grade (p = 0.010), TNM stage (p < 0.001), mGPS (p = 0.001) and myosteatosis (p = 0.017) and disease specific survival. On multivariate analysis, age (HR 1.89, 95% CI 1.27-2.79, p = 0.002), TNM stage (HR 2.27, 95% CI 1.45-3.55, p < 0.001) and mGPS (HR 1.48, 95% CI 1.08-2.03, p = 0.016) remained prognostic.

Conclusions: The SIR is a key hallmark of progressive nutritional and functional decline leading to poorer survival in patients with cancer.

Keywords: Body composition; Colorectal cancer; Computed tomography; Glasgow Prognostic Score; Systemic inflammation; TNM stage.