Association of Systemic Inflammation and Sarcopenia With Survival in Nonmetastatic Colorectal Cancer

Feliciano, Elizabeth M. Cespedes; Kroenke, Candyce H.; Meyerhardt, Jeffrey A.; Prado, Carla M.; Bradshaw, Patrick T.; Kwan, Marilyn L.; Xiao, Jingjie; Alexeeff, Stacey; Corley, Douglas A.; Weltzien, Erin; Castillo, Adrienne; Caan, Bette J.

doi:10.1001/jamaoncol.2017.2319

Cited by 280 publications

(159 citation statements)

References 43 publications

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“…recommend obtaining and documenting inflammatory status (CRP and albumin) . The N/L ratio has been linked to different degrees of SMM loss . However, in this study, the serum levels of CRP were available for only 24.5% of the patients for whom the CAX stage was evaluable and could not include it as a staging criteria.…”

Section: Discussionmentioning

confidence: 94%

Staging of nutrition disorders in non‐small‐cell lung cancer patients: utility of skeletal muscle mass assessment

Antoun

Morel

Souquet

et al. 2019

J cachexia sarcopenia muscle

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Background An international consensus proposed in 2011 a definition and classification system for cachexia (CAX), mainly based on weight loss, sarcopenia [skeletal muscle mass (SMM) loss], inflammation, and anorexia. The aim of this study was to stage CAX in non‐small‐cell lung cancer (NSCLC) patients by using a classification based on the Fearon criteria and supported by quantifiable parameters. Methods This was a cross‐sectional and non‐interventional multicentre study. SMM was assessed by analysing L3 computed tomography‐scan images. Patients completed the anorexia/CAX subscale of the Functional Assessment of Anorexia/Cachexia Therapy, EORTC QLQ‐C30 quality of life (QoL) and International Physical Activity Questionnaire (IPAQ). Results Patients were recruited in 56 sites. The analysis population comprised 531 patients, and SMM was assessed in 312 patients. Male patients were 66.5%, with a mean (SD) age of 65.2 (10.0) years, 79.9% were PS 0–1, and the tumour stage was mainly IIIB‐IV (87.3%). Overall, 38.7% of patients had CAX, 33.8% pre‐CAX, and 0.9% refractory CAX. Molecular tumour profiles were significantly associated with the presence of CAX: 23.9% in EGFR, ALK, ROS1, BRAF, or HER2+ patients, 41.4% in K‐RAS+, and 43.2% in patients with no molecular abnormality ( P = 0.003). The more advanced the CAX stage, the poorer the scores of functional items of the QoL ( P < 0.001) and International Physical Activity Questionnaire ( P < 0.001). Sarcopenia was present in 66.7% of CAX and 68.5% of pre‐CAX patients. Overall, 43.8% of pre‐CAX patients had only sarcopenia with limited weight loss (≤2%) and no anorexia. Conclusions This is the first study to show the distribution of CAX in a population of NSCLC patients and an association between molecular abnormality in NSCLC and CAX. The original Fearon classification for CAX stages was supported by the associated functional QoL scores and physical activity levels, resulting in a clinically relevant system for detection of early stages of CAX.

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Section: Discussionmentioning

confidence: 94%

Staging of nutrition disorders in non‐small‐cell lung cancer patients: utility of skeletal muscle mass assessment

Antoun

Morel

Souquet

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

show abstract

“…Body circumference was measured at the umbilicus (waist) and greater trochanter (hip). Muscle and fat cross‐sectional areas were normalized by dividing values by the body surface area (BSA) calculated as the height of the patient squared . Body mass index (BMI) and waist‐to‐hip ratio (WHR) was calculated using standard equations, and patients who had a BMI ≥ 30 kg/m 2 were defined as obese according to World Health Organization (WHO) criteria…”

Section: Methodsmentioning

confidence: 99%

“…Sarcopenia was defined by stratifying for sex and obesity status and using optimal stratification methods for psoas muscle area that have been previously described and validated . Specific sarcopenic cutoff values were defined using the maximal predictive value for death (Youden’s index) on receiver operating characteristic (ROC) curves for each group.…”

Section: Methodsmentioning

confidence: 99%

Implementation and early outcomes for a surgeon‐directed hepatic arterial infusion pump program for colorectal liver metastases

Chakedis

Beal

Sun

et al. 2018

Journal of Surgical Oncology

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Introduction Hepatic arterial infusion pump (HAIP) therapy for colorectal liver metastases (CRLM) is beneficial in selected patients yet wide acceptance in the oncology community is lacking. Methods A surgeon‐led team implemented a HAIP program in 2012. Pumps were placed by laparotomy for CRLM and fluorodeoxyuridine was infused via HAIP every 28 days without systemic chemotherapy supervised by the operating surgeon. Results Sixty patients were treated with HAIP, either in the adjuvant setting after liver resection or ablation of CRLM in 26 (43%) patients or with the unresectable disease in 34 (57%). Perioperative complications occurred in 19 (32%) and pump‐specific complications in 14 (23%) that included intrahepatic biliary stricture in one (2%). Time to liver progression was a median 9.2 months (95% CI, 3.1‐15.3 months) in unresectable patients and liver recurrence was a median 24.7 months (2.5‐46.9 months) in the adjuvant group. Estimated 3‐year overall survival from the time of HAIP placement was 64% in the adjuvant group and 37% in the unresectable group. Sarcopenia was prevalent (48%) and was associated with a worse survival (HR 2.4, 95% CI, 1.1‐5.0). Conclusion A surgeon‐led HAIP program may achieve outcomes on par with those of experienced centers and foster strong relationships between surgical and medical oncologists.

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“…7 Several studies suggest that systemic inflammation may lead to ongoing muscle loss in cancer patients and in part drive the associations with cancer survival. 8,9 In vitro studies also highlight the key role of inflammation. For example, exercise-induced myokines released from skeletal muscle, such as interleukin-6, suppress tumor growth.…”

Section: Potential Mechanisms Relating Body Composition and Survivalmentioning

confidence: 99%

Clinical implications of low skeletal muscle mass in early-stage breast and colorectal cancer

Feliciano

Chen

2018

Proc. Nutr. Soc.

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Although obesity has now been widely accepted to be an important risk factor for cancer survival, the associations between body mass index and cancer mortality have not been consistently linear. Although morbid obesity has clearly been associated with worse survival, some studies have suggested a U-shaped association with no adverse association with overweight or lower levels of obesity. This “obesity paradox” may be due to the fact that body mass index likely incompletely captures key measures of body composition, including distribution of skeletal muscle and adipose tissue. Fat and lean body mass can be measured using clinically acquired CT scans. Many of the earlier studies focused on patients with metastatic cancer. However, skeletal muscle loss in the metastatic setting may reflect end stage disease processes. Therefore, this article focuses on the clinical implication of low skeletal muscle mass in early stage non-metastatic breast and colorectal cancer where measures of body composition have been shown to be strong predictors of disease-free survival and overall survival and also chemotherapy toxicity and operative risk.

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Association of Systemic Inflammation and Sarcopenia With Survival in Nonmetastatic Colorectal Cancer

Cited by 280 publications

References 43 publications

Staging of nutrition disorders in non‐small‐cell lung cancer patients: utility of skeletal muscle mass assessment

Staging of nutrition disorders in non‐small‐cell lung cancer patients: utility of skeletal muscle mass assessment

Implementation and early outcomes for a surgeon‐directed hepatic arterial infusion pump program for colorectal liver metastases

Clinical implications of low skeletal muscle mass in early-stage breast and colorectal cancer

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