Evaluation of Nutritional and Inflammatory Status of Advanced Colorectal Cancer Patients and Its Correlation With Survival

Abstract

The purpose of this study was to evaluate novel inflammatory and nutritional prognostic factors in patients with advanced colorectal cancer (ACRC). All ACRC patients attending the clinic for palliative treatment were eligible for study. Demographics, including performance status (PS), C-reactive protein (CRP), albumin (Alb), Glasgow prognostic score (GPS), weight, weight history, body mass index (BMI), and nutritional status using the patient-generated subjective global assessment (PGSGA), were collected and correlated with survival. At a median follow-up of 29.8 mo, with a minimum follow-up of 15.7 mo, the median survival was 9.9 mo (0.8-21.8 mo). Fifteen (29%) patients were newly diagnosed (stage IV colorectal cancer), and 36 (71%) had received prior chemotherapy. Although the median BMI was 27 kg/m2 (range = 17-41 kg/m2), 28 of 50 (56%) were nutritionally at risk. In fact, 19 patients (38%) were critically in need of nutrition intervention (PGSGA score of > or =9). Thirty-three of 48 patients (69%) had an elevated CRP (>10 mg/l with a median of 21.1 mg/L), and 7 patients (15%) had both a CRP of >10 mg/l and hypoalbuminemia (< 35 g/l). A significant positive correlation was found between PGSGA score and CRP (P = 0.003; r = 0.430). Using univariate analysis, significantly worse survival was found for patients with poorer PS (P = 0.001), high GPS (P = 0.04), low Alb (P = 0.017), elevated serum alkaline phosphatase (SAP; P = 0.018), PGSGA score of > 9 (P = 0.001), and PGSGA group B/C (P = 0.02). Using the Cox proportional hazard model for multivariate survival analysis, type of treatment (hazard ratio, HR = 1.48; 95% confidence interval, CI = 1.11-1.79; P = 0.005), PS (HR = 2.37; 95% CI = 1.11-5.09; P = 0.026), GPS (HR = 2.27; 95% CI = 1.09-4.73; P = 0.028), and SAP (HR = 0.44; 95% CI = 0.18-1.07; P =0.069) remained significant predictors of survival. These preliminary data suggest that the type of treatment, PS, GPS, and SAP are important predictors of survival in ACRC.

Inflammatory and nutritional statuses of patients submitted to resection of gastrointestinal tumors

“…Recently, studies have demonstrated an important association between nutritional depletion and inflammation in cancer patients [4][5][6]14,16,17,[19][20][21][22] , including GIT tumors. Since cancer patients are in a constant state of inflammation, and considering the role of this systemic inflammation in progressive weight loss and muscle mass, cancer cachexia can be identified by the presence and alteration of certain inflammatory markers [5][6][7] .…”

C-Reactive Protein Concentration in Dogs with Various Diseases

“…However, as albumin concentration is affected by dehydration and malnutrition in canine patients, it would be difficult to be used it as an inflammatory marker in a clinical setting. Since inflammatory markers, including CRP and albumin concentrations have been used to score general conditions in human medicine recently [17,19], and these might also be used to assess the severity and prognosis of chronic diseases in canine patients.…”

“…Measuring the CRP concentration along with WBC counts is clinically valuable as a screening test for new patients to detect inflammation. In human medicine, CRP has been reported to indicate the severity and prognosis of various diseases [9,10,16,17]. In veterinary medicine, it has been reported to indicate the response to treatment and prognosis in idiopathic polyarthritis [14].…”

Systemic inflammation, nutritional status and survival in patients with cancer

“…Systemic inflammatory response, as evidenced by the GPS, as a prognostic factor in patients with cancer [14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”