Underweight status predicts a poor prognosis in elderly patients with colorectal cancer

Abstract

Abstract. The aim of the present study was to evaluate the effect of underweight status on the survival of elderly patients undergoing surgery for colorectal cancer (CRC). A total of 113 patients aged ≥75 years who underwent curative surgery for CRC were included. In addition to standard perioperative variables, body mass index (BMI) was assessed. The patients were categorized as underweight (BMI<18.5 kg/m 2 ) or non-underweight (BMI≥18.5 kg/m 2 ). The 3-year overall survival (OS) and cancer-specific survival (CSS) were analyzed. Of the 113 patients, 24 (21%) were underweight. The two groups were well-balanced regarding all factors evaluated. In the multivariate analysis, underweight status was an independent indicator of lower 3-year OS [hazard ratio (HR)=2.65; 95% confidence interval (CI): 1.08-6.50; P= 0.033] and CSS (HR=3.51, 95% CI: 1.16-10.60; P=0.025) rates. Compared with the non-underweight group, the underweight group had significantly worse 3-year OS (66.7 vs. 86.5%, respectively; P= 0.017) and CSS (74.1 vs. 90.9%, respectively; P= 0.025) rates. Therefore, underweight status was a significant risk factor for poor survival in elderly CRC patients. The development of effective nutritional interventions may improve the prognosis of such patients.

A systematic review and meta-analysis assessing the impact of body mass index on long-term survival outcomes after surgery for colorectal cancer

“…Only adult patients were included in the review. Notably, a few studies evaluated survival after colorectal cancer surgery in patients aged 75 or above [26,51]. Even though patients in these studies are more likely to have comorbidities and lower performance status, their inclusion is imperative due to the increasing burden of colorectal cancer with increasing age [103].…”

Body mass index and weight change during initial period of chemotherapy affect survival outcome in advanced biliary tract cancer patients

“…The poor survival outcome of the underweight group may be related to the loss of muscle and fat mass because of sarcopenia and cachexia. Several studies also demonstrated that sarcopenia has been found to be associated with poor overall prognosis in patients with cancer [ 15 , 22 – 25 ]. Cancer-induced cachexia is known to be not fully reversible by usual nutritional support, leading to progressive functional impairment, reduced tolerance to treatment, and finally decreased survival rates [ 19 , 26 , 27 ].…”

Caution, “normal” BMI: health risks associated with potentially masked individual underweight—EPMA Position Paper 2021

“…Similarly, low BMI was demonstrated as an independent risk factor for increased mortality and co-incidence of cerebrovascular and pulmonary complications in resected lung cancer patients compared to their obese counterparts [ 82 ]. Underweight is suggested to be a predictor of poorer overall survival of colorectal cancer patients being potentially associated with poor performance status and decreased effectiveness of both the surgical and chemotherapeutic treatments [ 83 ]. Both obesity and underweight are related to a decreased survival in non-small-cell lung carcinoma (NSCLC) and small-cell lung carcinoma (SCLC) patients.…”