Inflammation and Nutritional Risk: A Feature to Consider in Planned Oncologic Surgery

Abstract

IntroductionDeterioration of nutritional status is associated with meta-bolic changes, organ failure,and immunestatus impairment,as confirmed by the recent study by Antoun et al. [1]. Thisstudy highlights the major role of blood albumin levels\30 g/l as a major risk factor for complications in surgicalcancer patients, whereas a preoperative involuntary weightloss as high as 15% is related to the onset of major postop-erative complications [1]. There is now consistent evidencethatthepresenceofsystemicinflammationisassociatedwithincreased weight loss and, in particular, with loss of leanbody mass and functional decline [2]. The basis of the sys-temic inflammatory response in cancer is still stronglydebated. Alterations in neuroendocrine metabolism,humoral changes, including elevated interleukins, interfer-ons,andacutephaseproteinslevels,havebeendescribed[3].Hepatocytes play a major role in the elaboration of the sys-temic inflammatory response, as they are implicated in thesynthesis and release into plasma of several acute phaseproteins, such as C-reactive protein (CRP), which sustainsthe inflammatory response while negatively affecting albu-min synthesis. CRP represents the most commonly usedserum marker to investigate systemic inflammation inpatients with cancer due to its sensitivity, specificity, andhighreproducibility[2,4].AninterestingpointisthatasCRPlevels increase, albumin decreases; this observation isdetectableamongdifferenttumor types[2].Therefore,inthestudy by Antoun et al. the evaluation of CRP levels shouldhave been strongly considered to better assess nutritionalrisk. In fact, cancer patients with albumin levels \30 g/lmight maintain an enhanced systemic inflammatoryresponse as expressed by increased CRP levels.Recent evidences show that genetic predisposition of thehost to local or systemic inflammation may contribute tocancer cachexia [5]. In fact, interleukin-10 genotype of thehost can favor the development of severe protein-energymalnutrition among patients with gastroesophageal malig-nancies. Interestingly, in the same population, increasedweight loss was highly correlated with CRP levels [5].Taken together, these data suggest that clinicians shouldconsider evaluating CRP in planned oncologic surgerypatients in association with the other clinical and biologicalparameters indicated by Antoun et al. [1]. Systemicinflammatory response should be routinely assessed inpatients with cancer, not only to treat but also to preventcancer cachexia-related multiple complications, therebyreducing morbidity, mortality, and improving quality of life.References