Abstract
This study aimed to evaluate the clinical impact of combined sarcopenia and inflammation classification (CSIC) in patients with colorectal cancer (CRC). The skeletal muscle index (SMI) and neutrophil-to-lymphocyte ratio (NLR) were measured in 1270 patients who underwent surgery between January 2005 and April 2014. A Cox proportional hazards model was used to evaluate the correlation of sarcopenia, NLR, and CSIC, with progression-free survival (PFS). The integrated area under the curve (iAUC) was used to compare the discriminatory performance of each model. Using the cut-off values for SMI suggested by Martin et al. and for an NLR of 2.26, the CSIC was defined as follows: nonsarcopenia with low NLR (group 1), nonsarcopenia with high NLR (group 2), sarcopenia with low NLR (group 3), and sarcopenia with high NLR (group 4). Sarcopenia alone was not statistically significant. Multivariate analysis identified that CSIC (group 4 vs. group 1; hazard ratio (HR), 1.726; 95% CI, 1.130–2.634; p = 0.011) and NLR (HR, 1.600; 95% CI, 1.203–2.128; p = 0.001) were independently associated with PFS. The CSIC improved the prediction accuracy of PFS compared with NLR (iAUC mean difference = 0.011; 95% CI, 0.0018–0.028). In conclusion, the combination of sarcopenia and NLR could improve prognostic accuracy, and thus compensate for the limitation of sarcopenia.
Highlights
In 2020, 1.9 million cases of colorectal cancer (CRC) were estimated worldwide [1]
Age, body mass index (BMI), tumor location, tumor size, and status of receiving chemotherapy were independently associated with sarcopenia, whereas Carcinoembryonic antigen (CEA), histologic grade, lymphovascular invasion (LVI), complications, lymph node numbers, and the American Joint Committee on Cancer (AJCC) stage were not
The mean neutrophil-to-lymphocyte ratio (NLR) value was significantly higher in the sarcopenia group than in the nonsarcopenia group
Summary
In 2020, 1.9 million cases of CRC were estimated worldwide [1]. South Korea had the second highest incidence rate of CRC in the world, as of 2018 [2]. Considering this increasing prevalence, accurate prediction of prognosis in patients with CRC after treatment is essential. Tumor-nodes-metastases (TNM) staging has been the most common and simple index for prediction of survival in cancer patients. Despite having its own clinical significance, researchers have reported limitations of staging in estimating patient survival, and recently, a modified staging system has been proposed to provide better prognostic discrimination and stratification in patients with nonmetastatic stage I–III CRC [3]. Many studies have been conducted to overcome such shortcomings in patients with CRC by focusing on host and environmental factors; systemic inflammation and body composition have been studied as indicators that reflect the host response to the tumor [4,5]
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