Association of body composition and nutritional status with survival in stage IV colorectal cancer patients who underwent resection: a retrospective cohort study

Abstract

Purpose: Although host body composition, nutritional and systemic inflammatory status have been suggested to have an impact on prognosis in patients with colorectal cancer (CRC), their impact on patients with stage IV CRC remains unclear. This study investigated the prognostic effects of those parameters in patients initially diagnosed with stage IV CRC who underwent surgery. Methods: Patients with stage IV CRC who underwent surgery were selected. Preoperative computed tomography images were evaluated for skeletal muscle index, skeletal muscle density (SMD), visceral fat area (VFA), and subcutaneous fat area (SFA). For nutritional status and systemic inflammation, prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) were used. The Cox proportional hazard model was used to evaluate the prognostic significance of progression-free survival (PFS) after adjustment for the other covariates in the model. Results: Data of 134 patients with stage IV CRC who underwent surgery between January 2005 and February 2014 were included. SMD, VFA, SFA, PNI, NLR, LMR, and PLR were associated with PFS in the univariable analysis. In the multivariable analysis, SFA (hazard ratio [HR], 0.612; 95% confidence interval [CI], 0.389-0.961; P = 0.033), and PNI (HR, 0.536; 95% CI, 0.345-0.832; P = 0.005) were identified to be independent prognostic factors for PFS. Conclusion: SFA and PNI both demonstrated prognostic significance in patients with stage IV CRC. Accordingly, we believe further studies are warranted to determine whether incorporating these factors can aid in surgical decision-making for stage IV CRC patients.