Prognostic significance of the cachexia index in patients with stages Ⅰ-Ⅲ colorectal cancer

Abstract

Abstract PurposeThe prognostic significance of cachexia index, a novel biomarker of cancer cachexia remains unclear in colorectal cancer (CRC); we evaluated its prognostic significance in CRC.MethodsThis retrospective cohort study included 306 patients with stage Ⅰ–Ⅲ CRC 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. Overall survival (OS) and disease-free survival (DFS) rates were analyzed using a Cox proportional hazards model. ResultsA low cachexia index was obtained in 94 patients. The low-cachexia index group had significantly lower DFS rates than the high-cachexia index group (5-year survival rates, 86.3% vs. 63.1%, p<0.01). In the multivariate analysis, CA19-9 ≥27.9 ng/mL (hazard ratio [HR]: 1.76; 95% confidence interval [CI]: 1.01–3.05, p=0.045), stage III (HR: 4.06: 95% CI: 2.14–7.68, p<0.01), and low cachexia index (HR: 2.22; 95% CI: 1.29–3.80, p=0.004) were significant independent predictors of DFS. The low-cachexia index group had significantly lower OS rates than the high-cachexia index group (87.9% vs. 67.2%, p<0.01). In the multivariate analysis, CA19-9 level ≥27.9 ng/mL (HR: 2.12; 95% CI: 1.19–3.75, p=0.010), stage III (HR: 2.97; 95% CI: 1.56-–5.67, p=0.001), and low cachexia index (HR: 2.40 95% CI: 1.35–4.29, p=0.003) were significant independent predictors of OS. A similar trend was observed in both stage I+II and stage III CRC patients.ConclusionA low cachexia index might be a long-term prognostic factor in CRC patients, including those with early-stage disease.