Significance of Body Composition and Systemic Inflammation in Patients with Operable Colon Cancer Treated with Curative Intent

Abstract

Background: Muscle abnormalities and systemic inflammation have been associated with cancer progression and poor disease outcomes in patients with colon cancer. These factors are easily evaluated and can potentially be modified to improve outcomes. The objective of this study is to investigate the relationship between computed tomography (CT) derived measures of body composition, including low muscle mass (sarcopenia) and low muscle radiodensity (myosteatosis). It will also examine their association with systemic inflammation and determine whether these factors impact hospital length of stay for patients undergoing resection of their primary colorectal cancer. Methods: This study included 133 patients with stage I to III colon cancers diagnosed from 2011 through 2018 who underwent resection with curative intent. CT scans were used to identify sarcopenia and myosteatosis using predefined sex-specific and body mass index (BMI)-specific thresholds. The primary measure for systemic inflammation was the neutrophil-to-lymphocyte ratio. Tumour and patient characteristics were recorded. The primary outcome was hospital length of stay. Associations between body composition and systemic inflammation were examined using linear regression analyses, and their relationship with post-surgical length of stay was determined using logistic regression analyses. Results: A significant proportion of patients were overweight or obese (60.9%). Sarcopenia and myosteatosis were highly prevalent (41.4% and 39.1% respectively). Muscle mass and muscle radiodensity were not significantly correlated with each other. Male sex (p < 0.001) and higher BMI (p < 0.001) were associated with greater muscle mass. Male sex (p = 0.020) was also associated with greater muscle radiodensity but higher BMI (p < 0.001) was associated with lower muscle radiodensity. Inflammation was present in 39.1% of patients. Elevated neutrophil-to-lymphocyte ratio was associated with longer length of stay (OR 1.29, 95% CI 1.04-1.61, p = 0.019). Conclusion: Sarcopenia and myosteatosis were prevalent among colon cancer patients, despite many of them being overweight or obese. Systemic inflammation was associated with prolonged length of stay post-surgery and could potentially be utilised to delineate patients with poorer recovery and who may benefit from additional monitoring or interventions to reduce the length of hospitalisation. These commonly collected markers could enhance prognostication and identify patients with a poorer outcome.