Host phenotype is associated with reduced survival independent of tumour biology in patients with colorectal liver metastases

Abstract

Background Most prognostic scoring systems for colorectal liver metastases (CRLMs) account for factors related to tumour biology. Little is known about the effects of the host phenotype to the tumour. Our objective was to delineate the relationship of systemic inflammation and body composition features [i.e. low skeletal muscle mass (sarcopenia) and low visceral adipose tissue (VAT)], two well‐described host phenotypes in cancer. Methods Clinical data and pre‐operative blood samples were collected from 99 patients who underwent resection of CRLM. Pre‐operative computed tomography scans were available for 97 patients; body composition was analysed at the L3 level, stratified for sex and age. Clinicopathological variables, serum C‐reactive protein (CRP), and various body composition variables were evaluated. Overall survival was evaluated as a function of these same variables in multivariate Cox regression analysis. Results Skeletal muscle was significantly correlated with VAT ( r = 0.46, P < 0.001). Of patients with sarcopenia, 35 (65%) also had low VAT. C‐reactive protein was elevated (≥5 mg/mL) in 42 patients (43.3%). Elevated CRP was more common in patients with sarcopenia (73.8% vs. 51.1%, P = 0.029). The most significant prognostic factors were the coincidence of elevated CRP and adverse body composition features (sarcopenia and/or low VAT; hazard ratio 4.3, 95% confidence interval 1.5–13.0, P = 0.008), as well as Fong clinical prognostic score (hazard ratio 2.9, 95% confidence interval 1.5–5.5, P = 0.002). Conclusions Body composition in patients with CRLM is not directly linked to the presence of systemic inflammation. However, when systemic inflammation coincides with sarcopenia and/or low VAT, prognosis is adversely affected, independent of the Fong clinical prognostic score.

The Relationship between Imaging-Based Body Composition Analysis and the Systemic Inflammatory Response in Patients with Cancer: A Systematic Review

“…All DEXA studies [14,15,16] included in this review used LUNAR DPX-L & LUNAR PRODIGY software (Discovery ® , Hologic, Bedford, MA USA) for body composition measurements. Of the 20 CT studies, six studies [17,18,19,20,21,22] used Slice-O-Matic software (TomoVision, Montreal, Quebec, Canada), three studies [23,24,25] used Image J software (NIH Image J version 1.47, ), two studies [26,27] used Synapse Vincent software (Fujifilm Medical, Tokyo, Japan), two studies [28,29] used Infinitt PACS software (INFINITT Healthcare Co., Ltd, Seoul, Korea) , one study [30] used OSIRIX software (OSIRIX ®, Version 3.3, downloaded from ), one study [31] used Terrarecon software (Terarecon 3.4.2.11, San Mateo, CA, USA), one study [32] used Somatom Software (Somatom Sensation, Siemens, Fairfield, CT, USA) and manual CT images analyses was performed in four studies [33,34,35,36]. All the 20 CT studies used same thresholds for muscle (−29 to 150 HU) to measure SMA, which were normalized for height 2 to define SMI.…”

Cachexia as a common characteristic in multiple chronic disease

“…The assessment of longitudinal changes of body composition by computed tomography (CT) revealed three phenotypes of body wasting in these patients: patients who lost skeletal muscle and fat tissue, patients who only lost fat tissue, and patients without wasting who had a significantly improved survival. Several other studies investigated patients with different types of gastrointestinal cancer and reported either a loss of muscle tissue or a loss of both skeletal muscle and adipose tissue mass . In addition, loss of cardiac muscle tissue in cancer cachexia (CC) has been shown in clinical and experimental studies …”

Tumor Transcriptome Reveals High Expression of IL-8 in Non-Small Cell Lung Cancer Patients with Low Pectoralis Muscle Area and Reduced Survival

“…The low muscle mass detected by CT images can occur in the absence of systemic inflammation in other malignancies, such as colorectal cancer, but the proportion of patients with low-muscularity is substantially greater in the presence of systemic inflammation [49]. In cases where the inflammation coexists with low muscle mass, the prognosis is especially poor [50]. Taken together, we identified a specific set of upregulated genes coding for secreted proteins that may constitute potential mediators of muscle loss in NSCLC.…”