Association of Systemic Inflammation and Sarcopenia With Survival in Colorectal Cancer


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Elizabeth M. Cespedes Feliciano, ScD, MSc

Elizabeth M. Cespedes Feliciano, ScD, MSc

Results from the C SCANS (Colorectal Cancer: Sarcopenia, Cancer, and Near-Term Survival) study indicate that prediagnosis systemic inflammation and at-diagnosis sarcopenia are associated with an increased mortality risk in patients with nonmetastatic colorectal cancer. The findings were reported in JAMA Oncologyby -Elizabeth M. Cespedes Feliciano, ScD, MSc, of Kaiser Permanente Northern California, and colleagues.

The study involved a prospective cohort of 2,470 Kaiser Permanente patients with stage I to III colorectal cancer diagnosed from 2006 through 2011. Systemic inflammation was measured as neutrophil-to-lymphocyte ratio and was averaged for the 24 months before diagnosis, with a mean of 3 measurements and a mean time before diagnosis of 7 months. Neutrophil-to-lymphocyte ratio < 3 indicated low or no inflammation. Skeletal muscle index (muscle area at the third lumbar vertebra divided by squared height) was calculated from computed tomography scans at diagnosis, with sarcopenia defined as < 52 cm2/m2and < 38 cm2/m2 for normal or overweight men and women and < 54 cm2/m2 and < 47 cm2/m2 for obese men and women, respectively. In total, 49% of patients were women, and the mean age was 63 years.

Neutrophil-to-lymphocyte ratio ≥ 3 was found in 46% of patients and sarcopenia was found in 44%. Increasing neutrophil-to-lymphocyte ratio was associated with sarcopenia in a dose-related manner; compared with neutrophil-to-lymphocyte ratio < 3, odds ratios for sarcopenia were 1.35 (95% confidence interval [CI] = 1.10–1.67) for NLR 3 to < 5 and 1.47 (95% CI = 1.16–1.85 for neutrophil-to-lymphocyte ratio ≥ 5 (for trend < .001).

During median follow-up of 6 years, 656 patients died, including 357 from colorectal cancer. In analysis adjusting for age, ethnicity, sex, body mass index, stage, and cancer site, neutrophil-to-lymphocyte ratio ≥ 3 and sarcopenia were independent predictors of both overall mortality (hazard ratio [HR] = 1.64, 95% CI = 1.40–1.91; HR = 1.42, 95% CI = 1.13–1.78) and colorectal cancer mortality (HR = 1.71, 95% CI = 1.39–2.12; HR = 1.42, 95% CI = 1.13–1.78). Hazard ratios for overall and colorectal cancer mortality were 2.12 (95% CI = 1.70–2.65) and 2.43 (95% CI = 1.79–3.29) among patients with both neutrophil-to-lymphocyte ratio ≥ 3 and sarcopenia vs those with neither.

The investigators concluded: “Prediagnosis inflammation was associated with at-diagnosis sarcopenia. Sarcopenia combined with inflammation nearly doubled risk of death, suggesting that these commonly collected biomarkers could enhance prognostication. A better understanding of how the host inflammatory/immune response influences changes in skeletal muscle may open new therapeutic avenues to improve cancer outcomes.”

Cespedes Feliciano EM, et al: JAMA Oncol 3:e172319, 2017


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