Systemic inflammation plays a central role in sarcopenia and prognosis of patients with metastatic colorectal cancer: A retrospective study

Abstract

Abstract Background Systemic inflammatory response (SIR) affects the prognosis of metastatic colorectal cancer (mCRC) and is reportedly a crucial triggering factor for sarcopenia. Furthermore, sarcopenia has recently been reported to be associated with shorter overall survival in patients with mCRC; however, the existing evidence is insufficient and inconsistent. Therefore, we aimed to investigate the impact of the body composition of patients on the prognosis of mCRC in relation to the SIR. Methods This retrospective study collected data from 317 patients with mCRC in China between January 2015 and 2020. The data of patients at baseline and after three cycles of first-line treatment were evaluated, primarily including modified Glasgow Prognostic Score (mGPS) [inflammation level calculated using C-reactive protein (CRP) and albumin], body composition parameters [total adipose tissue index, total adipose tissue density, skeletal muscle index (SMI), and skeletal muscle density (SMD)], and overall survival. The Kaplan–Meier survival curve was drawn to verify the predictive effect of mGPS on overall survival. Furthermore, non-parametric tests and the empirical cumulative distribution function were used to evaluate the relationship between mGPS and body composition and univariate and multivariate Cox regression analysis was used to determine the factors related to the prognosis of mCRC. Results In our cohort, the survival curve showed that the baseline mGPS had a strong predictive effect on overall survival. The empirical cumulative distribution function showed that a high mGPS level was associated with a low baseline SMD and SMI and a low SMI after treatment, indicating a significant correlation between sarcopenia and mGPS. Univariate analysis showed that factors affecting prognosis included CRP, albumin, mGPS, and specific body compositions. In multivariate analysis, only mGPS retained independent prognostic value, and a high baseline mGPS level indicated poor prognosis. Conclusions Regarding SIR, we found that body composition and overall survival were affected in patients with mCRC, and sarcopenia and poor prognosis had no direct causal relationship. Furthermore, mGPS was found to be a simple and effective prognostic factor; therefore, it should be monitored during treatment. These findings could help clinicians formulate effective individualised anti-inflammatory strategies and improve the prognosis of mCRC.